‘It's a full time job being poor’: understanding barriers to diabetes prevention in immigrant communities in the USA

This study explores the social determinants of diabetes in a low-income, Latino, and immigrant neighborhood in a Californian city, emphasizing food environments. We conducted focus groups and semi-structured interviews of a convenience sample of staff and clients at a local non-governmental organization. Eight themes emerged as key barriers to healthy eating: (1) cost of food vis-à-vis income; (2) transportation; (3) language; (4) stigma; (5) immigration status; (6) insufficient formal/informal food assistance; (7) work conditions; and (8) competing basic needs/constraints of poverty. We conclude that the public health and health education rhetoric of ‘individual choice’ is a barrier in itself to understanding the diabetes epidemic, and that without the recognition and understanding of, and intervention upon, socioeconomic, policy, and political barriers to healthy lifestyles, the prevention of diabetes will remain out of reach.