Diabetes is a public health problem that particularly affects Hispanic population especially individuals with multiple risk factors and vulnerabilities. The data collected highlights the need to include structural factors and their intersectionality to understand and improve health policies towards the improvement of populations health.
Intersectionality embodies elements where intersections between determinants of health have a direct influence on wellbeing outcomes and access to health services(7). Despite the progress done on treatments, social influences and variables as age; gender, scholarity, insurance type and marital status need to be recognized and integrated to essential management of chronic diseases as an effort to diminish health inequalities and improve life quality of people with chronic diseases.
Although intersectionality is a socio-legal theory developed to refer to specific situation of black women, factors like gender, race and class were defined as central vector across which inequalities changed(8). These factors regarding intersectionality are not the addition of different factors of inequality but the specific integration of the unique relation that create social inequity, being the methods and social experiences the ones that affect directly social situations generated by the interrelation that includes the dominant powers and induce hierarchical structures with social complexity(9).
The gender roles are social, cultural and economical mediators of the individual experiences in society(10). Inequities in health related to women with diabetes had been focused through accessibility to healthy food, safe environment, work stability, opportunities of personal development and social support that allow an adequate metabolic control and the decrease of difference regarding the morbidity and mortality caused by Diabetes requires the identification of factor related to the population(11)
Prevention and management of diabetes is known because of the need to have multidisciplinary health professionals working to maintain life quality, but the most cost-effective interventions are not related to the health system intervention alone, it is mandatory for governments to notice the determinants of health that impact the most on the natural history of any disease. Especially when those factors causes an intersectionality relation that increases the risk of certain populations and whose needs differ from vertical policies that won’t improve individual health.
Individuals with multiple disadvantages related to intersected social identities intertwine to health opportunities, and theoretically have less metabolic control and equire a different appreciation of multiple social factors and the recognition of social contexts for applicability of public health interventions.
The multilevel intersecting factors increases the disadvantages towards the availability to diminish risk factors related to NCD and for that increasing health inequalities and worst outcomes of chronic diseases like diabetes. The importance of differing between additive or compound intersectional factors can be distinguished and understand where the influence of these factors affects in a specific way the overall health of an individual with multiple inequality factors(12).
The intersectionality highlights missed opportunities related the health interventions approaches towards prevention and management of Diabetes in Ecuador, it`s mandatory to understand how intersectionality can diminish or increase social differences and inequities through the results of natural history of this disease and the consequences on life quality.
The relations in between groups and the existence of a social dominance reproduce social division and the hierarchy related to age, gender and social status. There are different groups coexisting as an integrate unit with assignments of power from one group toward another group and also with specific roles. Hegemonic groups are socially better recognized with higher accessibility to resources; patterns that are reproduced in NCD as diabetes.
Ethnic, social status and gender are axes of subordination that overlap in a person, persons under this axes experiences a unique and qualitative grade of inequality that can not be answered by the addition of the different categories(13). Disadvantages interact with existing vulnerabilities creating a new dimension of empowerment lost in each vulnerable group(14); axes that fall on the metabolic control through personal elections that worsen or improve the health status of women with diabetes These NCD it’s affected by the social role and the power axes that affect directly this specific population. This study integrates the sociodemographic factors like age, scholarity, gender, insurance type and civil status as collaborative or disruptive factors for metabolic control.
Self-care factors in diabetes are resumed in three objectives: diet, exercise and weight control (15–17); factors that respond with a social pattern of accomplishment different between men and women. Social status and gender determine access to different quantity of resources that ameliorate metabolic control and health status(18); being a constitutive part of a person that also defines their decisions, attitudes and experiences regarding selfcare as a decisive way towards metabolic control.
There are behaviors that depend on their closest social support in order to achieve metabolic control objectives. Intersectionality explores the way different social subdivisions are related with the production of social relations and by that, with the life of people; it evolves the relations between social status, gender and other social differences: (1) consequences related to inequalities on individual life, (2) the different representations of how multiple institutions and multiple process built social powers and privileges(19). In other words, the theory builds the interrelation between the generation and multiplication of social inequalities. The role designated as family provider it’s regularly given to men and also the responsibility of food acquisition, that is the basic source of health food in order to modify diet as required in patients with diabetes.
Social elements have different meanings determined by time and space with a specific context regarding the social, culture and historical period(20). The understanding of intersectionality may be used to develop better law and politics that embody other dimensions.
Public health has to face multiple factors regarding health determinants that may become multiple barriers to empower individuals to achieve health, these factors as their age, gender, scholarity, civil status and assurance type can affect the morbidity and mortality burden(12).
Intersectionality theory can analyze inequities that are interdependent, ligated to a historical context, micro and macro social exclusion between one-dimensional reductions(21). Analyze the exclusion through visibility of multiple position and power relations explaining the interconnection between the several forms of subordination(22).
Krause et al. in Argentina found that women had a worst health status compared with men, without homogenic distribution in social groups, which shows that there is a relation between social hierarchy(9), similar results as seen on this research where role designated to specific groups show difference sin between groups for metabolic control.
There is a socialization of gender and the role as health care, women recognize sign and symptoms of disease earlier than men, whom perceive illness as a sign of weakness (9). Differences between social status and age exist more evidence between men and women, factors that increases the differences in women group.