T2D and the Social Determinants of Women’s Health

Type 2 diabetes is not just about sugar. It’s about systems—and for women, the stakes are uniquely high.

When we think of type 2 diabetes (T2D), we often picture it as a disease driven by lifestyle: too much fast food, too little exercise, and rising blood sugars. But that picture is dangerously incomplete—especially for women.

The truth is, T2D doesn’t just live in the body. It lives in neighbourhoods, families, paycheques, policies—and in gendered expectations. For women, social determinants of health don’t just influence diabetes risk—they shape every stage of the journey, from prevention to diagnosis to management.

What Are Social Determinants of Health?

The World Health Organization (WHO) defines social determinants of health as the “non-medical factors that influence health outcomes,” such as:

🧩 Income and social status

🧩 Education

🧩 Employment and working conditions

🧩 Access to healthcare

🧩 Housing and food security

🧩 Social supports and community connections

🧩 Racism, sexism, discrimination, and historical trauma

For women, these determinants are often interwoven with gender-based inequities—like lower wages, higher rates of part-time employment, disproportionate caregiving duties, and gaps in reproductive and mental healthcare.

According to the Canadian Women's Foundation

• 💡 10% of women experience low incomes

• 💡 23% of women with disabilities experience low incomes

• 💡 28% of women-led households face housing insecurity

When these elements are unstable or inaccessible — as is often the case for individuals living in poverty — the risk of developing T2D rises dramatically. For those already living with diabetes, social determinants can make it significantly harder to manage the disease and avoid complications. Together, these shape the opportunities to be healthy long before an individual steps into a clinic.

The Gendered Face of T2D

Across Canada and around the world, the burden of diabetes is not evenly shared. Women experience unique barriers and vulnerabilities that make T2D both harder to prevent and harder to live with:

Lower Income = Higher Risk

🔹 In Canada, women are more likely to live in poverty, especially single mothers and senior women. Financial insecurity limits access to healthy food, medications, diabetes supplies, and transportation to appointments. Diabetes prevalence is significantly higher among women in the lowest income quintile and with lower literacy levels.

Unpaid Caregiving Takes a Toll

🔹 Many women juggle caregiving for children, partners, and aging parents—often at the expense of their own health. Stress, disrupted sleep, limited time for exercise or meal planning, and missed appointments all increase diabetes risk and make management more difficult.

Sexual and Reproductive Health

🔹 Women with diabetes face higher risks during pregnancy (gestational diabetes, preeclampsia), menopause (increased insulin resistance), and may experience different symptom patterns, including higher rates of depression and eating disorders—all of which impact glycemic control.

Racism and Intersectionality

🔹 Indigenous women in Canada have among the highest rates of T2D, influenced by colonial history and ongoing inequities. First Nations adults living off-reserve experience T2D at 1.72 times the rate of non-Indigenous adults. Métis and Inuit adults have T2D rates 1.22 and 1.18 times higher, respectively.

Poverty Reduction in British Columbia

In July 2024, Diabetes Canada applauded the Government of British Columbia for renewing its commitment to poverty reduction. This provincial initiative, outlined in B.C.’s updated Poverty Reduction Strategy, highlights a fundamental truth long recognized in public health: poverty is about more than income. It's about the structural and social conditions that shape health outcomes — especially for chronic diseases like T2D.

Women, particularly single mothers, elderly women, and Indigenous women, are disproportionately affected by poverty. Therefore, poverty reduction strategies are crucial for addressing health inequities faced by women with T2D.

"Some British Columbians pay up to $2,800 a year on costs related to diabetes care and management, and for individuals with low-income, such costs are unsustainable." 

B.C. is home to over 596,000 people diagnosed with diabetes, a number projected to rise by 29% in the next decade. Beyond personal and community health impacts, diabetes costs the provincial healthcare system over $583 million annually, with projections climbing to $747 million by 2029.

Women with T2D who are living in poverty may struggle to afford essential medications, supplies, and healthy food, leading to poorer disease management and health outcomes.

BC Poverty Reduction Coalition

While these efforts are commendable, Diabetes Canada urges further action — specifically the adoption of a comprehensive, evidence-informed diabetes strategy as outlined in the Framework for Diabetes in Canada

While B.C. provides drug coverage for some diabetes medications, co-pays and deductibles remain a barrier — particularly for low-income individuals. If a physician-prescribed treatment isn’t listed on the provincial formulary, patients may be forced to pay out-of-pocket or forgo essential care altogether. Some people in B.C. report spending up to $2,800 per year on diabetes-related costs — a figure that is often unsustainable for those with low incomes.

Pharmacare Milestone for T2D

The recent agreement between the Government of British Columbia and the Government of Canada to implement national Pharmacare marks a major milestone in advancing health equity—especially for people living with type 2 diabetes (T2D). Beginning March 1, 2026, eligible residents will receive 100% coverage for diabetes medications, with expanded coverage for diabetes-related devices and supplies starting in April 2026. This policy is especially significant when viewed through the lens of social determinants of health. For individuals and families facing economic hardship, medication costs can be a barrier to optimal diabetes management, leading to poorer health outcomes and increased strain on the healthcare system.

This policy change will particularly benefit women with T2D from lower-income backgrounds by removing financial barriers to accessing these critical resources.

By eliminating out-of-pocket expenses for life-sustaining medications and supplies, national pharmacare has the potential to reduce the disproportionate burden of diabetes among lower-income populations, rural communities, and Indigenous peoples—groups who often face systemic barriers to accessing care. Seamless integration through BC PharmaCare and automatic coverage at the pharmacy counter further ensure that equitable access does not depend on navigating complex administrative processes.

This policy change, combined with BC’s broader poverty reduction efforts, represents a strong commitment to addressing the root causes of health inequities and improving outcomes for people with T2D across the province.

Why This Matters for Healthcare

When healthcare providers understand the broader context in which people live, they can offer care that is more effective and compassionate.

That means:

✅ Asking about food access, housing stability, and income—not just blood sugar.

✅ Providing culturally safe and trauma-informed care.

✅ Advocating for systemic changes—like affordable medication, access to community programs, and anti-poverty initiatives.

✅ Supporting policies that promote health equity and reduce barriers to care.

To improve outcomes for women with T2D, we must treat more than the disease—we must treat the conditions that create and sustain it. That means looking beyond the clinic walls and challenging the systems that undermine women’s health.

What Can We Do?

💡Improving diabetes outcomes means going beyond clinic walls. It means creating a society where the healthy choice is the easy choice, and where no one is denied health because of their zip code, sex, income, language, or skin colour.

👉 Whether you're a healthcare provider, policy maker, researcher, or advocate, tackling diabetes requires seeing the bigger picture.

👉 When we address poverty, inequity, gendered expectations, and systemic barriers, we’re not just managing diabetes—we’re transforming health.

Take a look at these resources:

🌐Canada's Women's Foundation: https://canadianwomen.org/the-facts/womens-poverty/

🌐Women's Health Research Institute at BC Women's: https://whri.org/

Join us for more

Written and clinically validated by Clare Koning, RN, MN, PhD – Supporting evidence-based content at the T2D Network.