Michael Montoya: ‘Change the Environments That Make People Sick’

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Rates of type 2 diabetes are soaring among Mexican-Americans, but not because there’s a Mexican gene causing diabetes. That’s the argument of Michael Montoya, an anthropologist who teaches at the UC Irvine School of Medicine.

A quest by scientists to discover a diabetes gene or genes among Mexican-Americans has proved both expensive and, so far, unfruitful, Montoya said. Diabetes is more directly linked to generations of hardship, he said, which is the reason it’s epidemic not only among Mexican-Americans but also Native American, Appalachian and Aboriginal peoples, as well as other distressed population groups around the globe.

Montoya has written a book on the subject: “Making the Mexican Diabetic: Race, Science and the Genetics of Inequality.” He recently talked with Voice of OC about the issue in the context of Santa Ana, where the population is largely Mexican-American and diabetes is a serious medical concern.

Q: When it comes to Santa Ana, we hear a lot about the need for people to eat better and exercise more. Shouldn’t they do these things?

A: People eat and exercise to the best of their ability. If you put it [a solution] at the feet of diet and exercise, that presumes everyone has a chance to exercise and equal access to the same foods, parks and free time to exercise. If you work three jobs and are home just in time to cook dinner, when are you supposed to eat right and exercise? What if you’re paying $300 to rent a recliner to sleep on in a crowded apartment? We know sleep is important for weight loss. It’s way more complicated than a simple behavioral change.

Q: What about organized efforts to change behavior?

A: If they are purely behavioral with no support infrastructures, it won’t work. Making it work requires perpetual support to get education and make better food choices available in neighborhoods. You’d have to provide that in perpetuity. If that’s all you’re doing, it’s a treatment protocol but not a prevention protocol.

Q: So what’s the prevention protocol?

A: To prevent more diabetes, you have to do what Latino Health Access [a Santa Ana-based advocacy group] and the California Endowment [a statewide, health-focused foundation and Voice of OC funder] are doing, which is to change the environments that make people sick. It’s not just helping people but managing those environments and helping people change those environments.

Q: Can you give an example of what you might change?

A: Parks. Santa Ana is one of the most dense places in this country. Where are kids supposed to play? Traffic is bad, you’re not safe in every park, and not all playgrounds are open. The city also has a fraction of the park space of Los Angeles.

Q: How do you change that?

A: You mobilize the community to work with powers that be to make more park space available. You use joint-use agreements to open up school playgrounds on the weekend. These changes are largely driven by people working together. … Same thing with safety. You work with police and create safe places to exercise. This has been written about a lot already.

Q: Any more examples of environmental changes that would promote health?

A: Yes, improving occupational safety, livable wages, affordable housing, street safety, infrastructure, lights, park lighting, street lighting, crosswalks and bike trails. All these things are conducive to well-being.

Q: You mentioned stresses on people contributing to diabetes, and of course, everyone faces stress. Can you talk about some of the stresses particular to Santa Ana?

A: I know that residents and the police department are working very hard together to reduce the feelings of insecurity for people who live in Santa Ana. Imagine what it would feel like to have a neighborhood where at night you don’t dare leave your house. Where you are unsure if the police are on your side. Where you are afraid of getting your car impounded or being separated from your family by ICE [U.S. Imigration and Customs Enforcement]. It’s a lot like every parent’s stress but a lot more of it. And it never stops. You are constantly worried about your children’s safety, about gangs, about paying your bills, about being a good worker, a good parent, a good member of your church and community. Year in, year out — things improving little — is like living on constant red alert.

Q: If people don’t have the time to exercise, how will they have time to organize?

A: What’s amazing is that in every church, apartment building, workplace, neighborhood and hometown association, school, and neighborhood, there are people already organizing people to improve their lives. In spite of their time-crunched, resource-scarce, stressful lives, people and organizations have organized walking groups, health fairs, and support networks of all kinds. I am just now reading the research on the health benefits of community organizing, and it looks very promising indeed. Hundreds of people work tirelessly to give new meaning to community-making. These are the unsung, everyday heroes that are around us all the time. We fail them and ourselves when we only look at people and places like Santa Ana for the problems.



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