Singing the diabetes blues

Lord, I'm sick an' down

Can't tell my head from my feet

Lord, I'm sick an' down

Can't hardly tell my head from my feet

Well, I got the sugar diabetes

Somebody please. Lord have mercy on me.

When Delta Blues guitarist and singer Big Joe Williams sang "Sugar Diabetes Blues" on his posthumous 1999 album, Going Back to Crawford, he was singing about a problem haunting his Mississippi hometown, the Delta, and the nation.

As of 2011, the Centers for Disease Control and Prevention reported, 20.9 million Americans had diabetes, a nearly fourfold increase since 1980. Worldwide, 347 million people have diabetes. That really makes us want to sing the blues.

Diabetes means high blood sugar due to a lack of the hormone insulin - because the pancreas isn't making it (type 1 diabetes) or because the body's cells aren't responding to it sufficiently (type 2). The latter is often linked to obesity.

"Weird Al" Yankovic even has a song about the pancreas. And Weird Al's weird lyrics include the accurate lines "Secreting those enzymes (bap bap bap) / Secreting those hormones too / Metabolizing carbohydrates / just for me."

The long history of diabetes - its management with insulin since 1922 and a variety of drugs since the 1950s, its current prevalence, and lack of a cure - means plenty of information is available.

But that history is more than a story about medical breakthroughs, statistics, and efforts at prevention. It is a history of beliefs about race, ethnicity, and class.

From the early 20th century, when Jews were believed to suffer disproportionately from diabetes, to today, when government websites draw attention to its higher prevalence among American Indians, African Americans, and Latinos than among non-Hispanic whites, the disease has always had a "racial face."

It also has long been related to class. During the first half of the 20th century, middle-class whites were considered most likely to develop the disease; today it is more often linked to poverty.

Race and class overtones have come with judgments. Although no one ever welcomed the diagnosis, diabetes once was considered a "clean" disease, more common among those wealthy enough to survive the "dirty" infections still killing the poor and unwashed. Some believed the "disease of civilization" had the added benefit of requiring daily management skills and a life of discipline.

Today, diabetics are told they are sick because of poor lifestyle choices. For some who know the difference, type 2 diabetes, which is more affected by lifestyle, is the target. Type 1 diabetics are seen as victims of their biology.

In the end, we may want to think hard about what we mean by lifestyle "choice." Big Joe Williams' hometown of Crawford, with a median income of $15,223, is poor even for Mississippi, which has the nation's highest poverty rate. More than half of Crawford's 1,262 residents live in poverty; fewer than half have finished high school, and the nearest hospital is 14 miles away. Small wonder that the prevalence of diabetes in Crawford was 13 percent in 2012 vs. 9.3 percent nationwide.

Well, I'm down in Crawford, Mississippi

Down on my knees

Sad what they say.

This is how Big Joe Williams ends "Sugar Diabetes Blues." Sad, I would say, that instead of working to eliminate the crushing structural inequalities that keep communities like Crawford among the poorest in the nation, we blame the high rates of any disease on those who are sick.