In Holyoke MA the rate of diabetes is climbing toward 10%. The income level of the city is about half of the median income for the rest of the state. The obesity rate is 26% and for low-income pre-school children, it is over 12%.
I teach GED classes for parents who are trying to get better jobs for themselves and their families. Some have 2 or 3 jobs and still come to class. For some, their main exercise is walking to work in all kinds of weather. They eat at LOT of McDonald's and chips and sugar snacks and soda. Eating well takes time and money OR education and planning.
Health educators are trying to make a dent, but the obstacles are very high.
One of my math classes each session is "Pringle Math." We analyze the nutrition information on the side on a small tube of Pringles. (Percentage, division, addition, etc.) They are shocked by what they learn.
My grandmother developed Type 2 when she was older, after her children were able to contribute income to the household. "Now I can afford desserts I can't eat them." This was in the old days: NO SUGAR.
A declining economy and rising health insurance prices is the perfect petri dish for diabetes.