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Diabetes: A History of Race and Disease
Who gets diabetes and why? An in‑depth examination of diabetes in the context of race, public health, class, and heredity
“[An] unsettling but insightful social history.”— Kirkus Reviews
“The important lessons of A History of Race and Disease may strengthen organized medicine’s commitment to addressing social determinants of health and equity.”—David Goldberg, Health Affairs
Who is considered most at risk for diabetes, and why? In this thorough, engaging book, historian Arleen Tuchman examines and critiques how these questions have been answered by both the public and medical communities for over a century in the United States.
Beginning in the late nineteenth century, Tuchman describes how at different times Jews, middle‑class whites, American Indians, African Americans, and Hispanic Americans have been labeled most at risk for developing diabetes, and that such claims have reflected and perpetuated troubling assumptions about race, ethnicity, and class. She describes how diabetes underwent a mid-century transformation in the public’s eye from being a disease of wealth and “civilization” to one of poverty and “primitive” populations.
In tracing this cultural history, Tuchman argues that shifting understandings of diabetes reveal just as much about scientific and medical beliefs as they do about the cultural, racial, and economic milieus of their time.
“[An] unsettling but insightful social history.”— Kirkus Reviews
“The important lessons of A History of Race and Disease may strengthen organized medicine’s commitment to addressing social determinants of health and equity.”—David Goldberg, Health Affairs
Who is considered most at risk for diabetes, and why? In this thorough, engaging book, historian Arleen Tuchman examines and critiques how these questions have been answered by both the public and medical communities for over a century in the United States.
Beginning in the late nineteenth century, Tuchman describes how at different times Jews, middle‑class whites, American Indians, African Americans, and Hispanic Americans have been labeled most at risk for developing diabetes, and that such claims have reflected and perpetuated troubling assumptions about race, ethnicity, and class. She describes how diabetes underwent a mid-century transformation in the public’s eye from being a disease of wealth and “civilization” to one of poverty and “primitive” populations.
In tracing this cultural history, Tuchman argues that shifting understandings of diabetes reveal just as much about scientific and medical beliefs as they do about the cultural, racial, and economic milieus of their time.
288 pages, Hardcover
First published August 5, 2020
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329 people want to read
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Displaying 1 - 17 of 17 reviews
January 4, 2024
DIABETES: A History of Race & Disease by Arleen Marcia Tuchman, 2020
One of my favorite science books in the last few decades is Siddhartha Mukherjee's The Emperor of All Maladies. It offers a historical and social context for cancer, and its various treatments over many decades.
Tuchman's new "biography" of diabetes now sits right alongside Mukherjee's in my mind. Written in this same spirit - both the medicine but also the historical context of the disease.
Tracing the discovery of diabetes and early treatment methods, the spectrum of the illness - now what is differentiated as Type 1 and 2 - Tuchman also traces the social constructs around the disease.
Little known fact: in the 19th-century, the highest numbers of diabetes diagnoses were among European Jews - and the disease even took the name in German medical literature as "Judenkrankheit" - "Jewish Disease".
As a scientific historian looking at public health data, Tuchman points out that some communities are overrepresented in the records, while others are chronically underrepresented, or altogether nonexistent.
A disease once considered "a civilized disease" (read: white people) began to effect everyone - with Black, Indigenous, Latino, and Pacific Islander communities disproportionately effected even more so in recent decades.
It's about access to any food.
It's about damming rivers, overhunting, and taking away the land where ancestors lived.
It's about poverty.
It's about forced migration.
It's about little to no access to medical care.
It's about erasure.
No records of illness?
Non-existence in medical literature.
Tuchman's central thesis - after chapters focusing on each of the communities effected by this disease - is that socio-economic factors and racism—rather than just race-- explain the disparities.
She also tackles the deep-seated stigma surrounding diabetes - "a disease of fatness", overindulgence, and shows that this is very often not the case, and only perpetuates the idea of blaming the victims, which hinders both research and care.
A phenomenal work of social and medical history.
⭐ Highly recommended.
One of my favorite science books in the last few decades is Siddhartha Mukherjee's The Emperor of All Maladies. It offers a historical and social context for cancer, and its various treatments over many decades.
Tuchman's new "biography" of diabetes now sits right alongside Mukherjee's in my mind. Written in this same spirit - both the medicine but also the historical context of the disease.
Tracing the discovery of diabetes and early treatment methods, the spectrum of the illness - now what is differentiated as Type 1 and 2 - Tuchman also traces the social constructs around the disease.
Little known fact: in the 19th-century, the highest numbers of diabetes diagnoses were among European Jews - and the disease even took the name in German medical literature as "Judenkrankheit" - "Jewish Disease".
As a scientific historian looking at public health data, Tuchman points out that some communities are overrepresented in the records, while others are chronically underrepresented, or altogether nonexistent.
A disease once considered "a civilized disease" (read: white people) began to effect everyone - with Black, Indigenous, Latino, and Pacific Islander communities disproportionately effected even more so in recent decades.
It's about access to any food.
It's about damming rivers, overhunting, and taking away the land where ancestors lived.
It's about poverty.
It's about forced migration.
It's about little to no access to medical care.
It's about erasure.
No records of illness?
Non-existence in medical literature.
Tuchman's central thesis - after chapters focusing on each of the communities effected by this disease - is that socio-economic factors and racism—rather than just race-- explain the disparities.
She also tackles the deep-seated stigma surrounding diabetes - "a disease of fatness", overindulgence, and shows that this is very often not the case, and only perpetuates the idea of blaming the victims, which hinders both research and care.
A phenomenal work of social and medical history.
⭐ Highly recommended.
temp-on-hold
July 30, 2020In her book Diabetes: a History of Race and Disease, author and professor Arleen Marcia Tuchman goes beyond the basic medical history of diabetes to thoroughly examine how racial stereotypes play just as much into what we know about diabetes as the medical facts. Tuchman takes the reader through a modern chronology of the disease, starting at the early 1900s when diabetes was thought of as a Jewish disease before discussing the disease among both Aftican Americans and Native Americans, then looks at race and diabetes post 1985. As a diabetic myself, and someone who has read a lot of books about the disease, I found this book to be both engaging and novel; Tuchman ties both medical history and cultural stereotypes together in a highly readable format. Tuchman writes using medical jargon, but clearly defines and explains everything technical, so no previous knowledge of the intricacies of the disease is necessary in order to follow Tuchman's racial history. Readers interested in diabetes itself, the history of the disease, or how race was perceived to cause the disease throughout the last century would enjoy this book. Great for fans of medical or social history.
May 15, 2023
If you are ever looking for examples of how racism in the practice of science leads researchers and doctors to ask questions not justified by previously-collected data, create data categories that make no sense outside the logics of white supremacy, and come to conclusions that perpetuate racial stereotypes against the evidence of their own research results, this book has several centuries of medical history for you. Also some public health policy analysis to add to the fun.
Some of it didn't really surprise me, some of it had me exclaiming "what?!" for pages at a time.
Some of it didn't really surprise me, some of it had me exclaiming "what?!" for pages at a time.
July 28, 2022
What causes diabetes? Long story short, racism and poverty. This book taught me so much about thinking critically and reading between the lines. The author is a compelling writer who spent over 20 years on this content!
September 7, 2020
A solid four-star book.
The biggest new thing I learned was that diabetes was once considered the "Jewish disease," attendant with both racial and cultural stereotypings that, as the author notes, later passed on to Blacks, Hispanics and Asians.
On those later stereotypes, Tuchman notes that they got worse when diabetes was officially separated into Type I and Type II. Those with Type II, adult onset, were even easier to characterize, or caricature, as lazy.
She then discusses the issues of poverty and class associated with race, and how they feed into diabetes.
The main reason I didn't five-star this was there was no discussion of what epigenetics, that "shadowlands" between genes and environment, might already be shedding on diabetes, along with a couple of lesser issues.
The biggest new thing I learned was that diabetes was once considered the "Jewish disease," attendant with both racial and cultural stereotypings that, as the author notes, later passed on to Blacks, Hispanics and Asians.
On those later stereotypes, Tuchman notes that they got worse when diabetes was officially separated into Type I and Type II. Those with Type II, adult onset, were even easier to characterize, or caricature, as lazy.
She then discusses the issues of poverty and class associated with race, and how they feed into diabetes.
The main reason I didn't five-star this was there was no discussion of what epigenetics, that "shadowlands" between genes and environment, might already be shedding on diabetes, along with a couple of lesser issues.
April 24, 2021
Good information, but very tenuous to read. Would have prefered reading an article about this instead of a book. But provides good detail if that’s your thing.
November 4, 2020
This was a very interesting exploration of the shifting views of diabetes in regards to race over the 20th century in the United States. Tuchman charts the various groups that medical scientists focused their attention and concern most heavily on, starting with Jews at the turn of the century, and ending with African-Americans, Asian-Americans, Native Americans, and Latinx people today. The book is organized by race and largely chronological. The binding thread throughout is Tuchman's argument that race doesn't really have anything to do with diabetes, but rather that class is the deciding factor in determining higher rates, with structural racism making minority groups more likely to experience racism than most whites. Her thesis is well-argued and very compelling. I'd recommend this to anyone interested in medical history and the impacts of racism on medical practice.
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July 14, 2025Bit dissatisfied, but overall this was a thorough historical tracing of how diabetes has been perceived and discussed about in the public sphere, particularly as it pertains to race. She did an excellent job drawing out how different explanations for high diabetes levels were given depending on the racial group which was the "face" of the disease at the time. Like in any field, medicine also has racially coded language or diagnoses, which she made a point to draw out nicely (and in a why which gave me increased insight into the language & social commentary I hear today in the field).
The language used in describing which "sorts of patients" would be successful at managing diabetes certainly echo in today's world. I also really appreciated her laying out how conceptions of "good patient" and "bad patient" came to arise, which is language I also encounter (which has often been confusing to me).
My primary complaint, I think, is just that I didn't quite feel that she drew it all together at the end. I wanted her to lay out more explicitly what her argument was for the high rates of diabetes. She clearly states that it is poverty & socioeconomic factors, yes, but I think I wanted her to pull together her own argument rather than just pointing out what all of the other studies missed. I think that the literature to support her exists, and I was hoping I would find just such a synthesis of that literature within this book, and disappointed that I didn't. This is possibly just a problem of my own expectation, however.
Also, considering this is for a public audience, I was surprised that she never went into the pathophysiology behind diabetes & the various types. I guess you could argue that this wasn't relevant, given that this is primarily a social history, but I think that our understanding behind how diabetes works (and how that understanding has changed) drastically shaped how stigma around the disease has developed. She did talk about the stigma--and the difference in stigma between type 1 and type 2 diabetes--but didn't really talk about WHY. Type 1 & Type 2 diabetes--though having the same presentation, so to speak, have vastly different causes, and this does seem like it would add more insight into how discussion changed and type 2 diabetes specifically came to be so stigmatized. Instead, it seemed like throughout diabetes never changed from a "mystery" disease into one that we understand. There is still mystery around diabetes, yes, but it is by no means a mystery disease. Perhaps she assumed that her readers already knew these sorts of things about diabetes, but that doesn't seem entirely fair, so I'm just confused as to why she chose to not engage with this and how it has undoubtedly impacted discussions and language (particularly within medical circles).
All in all--very glad I read the book, was very educational in terms of how racial bias can shape the research we do (and don't do), how we interpret it, and also what kinds of explanations we offer for "why."
The language used in describing which "sorts of patients" would be successful at managing diabetes certainly echo in today's world. I also really appreciated her laying out how conceptions of "good patient" and "bad patient" came to arise, which is language I also encounter (which has often been confusing to me).
My primary complaint, I think, is just that I didn't quite feel that she drew it all together at the end. I wanted her to lay out more explicitly what her argument was for the high rates of diabetes. She clearly states that it is poverty & socioeconomic factors, yes, but I think I wanted her to pull together her own argument rather than just pointing out what all of the other studies missed. I think that the literature to support her exists, and I was hoping I would find just such a synthesis of that literature within this book, and disappointed that I didn't. This is possibly just a problem of my own expectation, however.
Also, considering this is for a public audience, I was surprised that she never went into the pathophysiology behind diabetes & the various types. I guess you could argue that this wasn't relevant, given that this is primarily a social history, but I think that our understanding behind how diabetes works (and how that understanding has changed) drastically shaped how stigma around the disease has developed. She did talk about the stigma--and the difference in stigma between type 1 and type 2 diabetes--but didn't really talk about WHY. Type 1 & Type 2 diabetes--though having the same presentation, so to speak, have vastly different causes, and this does seem like it would add more insight into how discussion changed and type 2 diabetes specifically came to be so stigmatized. Instead, it seemed like throughout diabetes never changed from a "mystery" disease into one that we understand. There is still mystery around diabetes, yes, but it is by no means a mystery disease. Perhaps she assumed that her readers already knew these sorts of things about diabetes, but that doesn't seem entirely fair, so I'm just confused as to why she chose to not engage with this and how it has undoubtedly impacted discussions and language (particularly within medical circles).
All in all--very glad I read the book, was very educational in terms of how racial bias can shape the research we do (and don't do), how we interpret it, and also what kinds of explanations we offer for "why."
May 7, 2021
If you have any interest in health research, this text is an excellent reminder of the pitfalls related to how people with a disease are characterized and how that impacts whether the root causes are identified and addressed or not addressed. The journey the reader is taken on in Diabetes: A History of Race and Disease begins in the early 20th century when supposedly there was low overall prevalence of diabetes with the highest prevalence assumed to be within the Jewish population, despite data contradicting that assumption. African Americans were believed not to suffer from diabetes – primarily because few ever bothered to diagnose and count disease prevalence among African Americans. Questions arise along the journey: how is diabetes defined and diagnosed? Who is actually examined and counted? Should “primitive” people, i.e., those not of European descent, be lumped altogether (the answer is apparently yes, despite vastly different prevalence in various groups)? Are these “primitive” people sicker because they can’t handle switching to a more modern society in a single generation? Is there a gene responsible? Or are they just making poor lifestyle choices?
What you’re left with is just how ridiculous it is to associate diabetes prevalence with race, rather than with systemic racism, and how racism influences whether those suffering from the condition are "good" (T1DM -not their fault) or "bad" (T2DM - completely their fault due to poor lifestyle choices). From the bogus “thrifty gene” to “personal responsibility,” some policy makers, researchers, and healthcare providers will bend over backwards to avoid addressing the systemic issues that put certain populations at higher risk for chronic disease. What goes unmentioned is that there are policy makers, researchers, and healthcare providers who do examine and address both individuals and the larger issues related to the social determinants of health. Would have loved if this text had ended with a chapter or two examining what has worked/not worked when addressing the larger systemic barriers to good health.
What you’re left with is just how ridiculous it is to associate diabetes prevalence with race, rather than with systemic racism, and how racism influences whether those suffering from the condition are "good" (T1DM -not their fault) or "bad" (T2DM - completely their fault due to poor lifestyle choices). From the bogus “thrifty gene” to “personal responsibility,” some policy makers, researchers, and healthcare providers will bend over backwards to avoid addressing the systemic issues that put certain populations at higher risk for chronic disease. What goes unmentioned is that there are policy makers, researchers, and healthcare providers who do examine and address both individuals and the larger issues related to the social determinants of health. Would have loved if this text had ended with a chapter or two examining what has worked/not worked when addressing the larger systemic barriers to good health.
April 25, 2022
This book charts the changing cultural context surrounding diabetes and who gets it. Each chapter is devoted to one group of people to whom diabetes was at one time thought to be particularly prevelant. Starting with it being seen as a Jewish disease, the author shows us how biased gthis perception was and how the only thing it really showed was that more jews go to the doctor than other groups. The author then goes on to demonstrate how jews were culturally classified as white and transitions into the next chapter to examine diabetes as a white disease. Once attributed as a white disease, diabetes and the personality traits that people with the disease have shift towards a positive one of knowledge, self restraint, control and virtue. The next chapter moves on to how diabetes is not a racial disease, due to the increase in diabetes and a higher deathrate of black populations. It reflects the gradual realisation of the medical establishment that class is more of a predictor than race. The final racial group looked at is native americans and how their immunity to diabetes and then an overt increase in diabetes levels over the century are bdoth used as evidence for their primitiveness. These confusing statements come from the single category of people given to all different tribes into native americans and a lack of understanding of anthropolgists and genetists. It documents how poverty, primitivity and ignorance not wealth, civilisation and education became the traits of people suffering with diabetes.
November 24, 2020
Arleen Marcia Tuchman's father having been diagnosed with Diabetes, inspires her to give us an engaging cultural history of the disease whose meaning has changed over a century with the expression of anxieties about economic, social, and political changes many of which explicitly involved issues of race.
Diabetes was so closely associated with Jews that it was referred to as the Judenkrankheit “Jewish disease” based on stereotypes about Jews as a people around a century ago. Throughout the book that is divided into chapters each focusing on a particular race, Tuchman's argument is that race doesn't really have anything to do with diabetes, but rather that class is the deciding factor in determining higher rates of the disease.
Truly there is a lot to learn from this medical history text, that breaks down medical jargons making it an easy read for anyone interested on the subject, it is well researched and gives the reader step by step historical accounts of the disease both played out in the media and scientific communities. The exact nature of diabetes remained a mystery even with the discovery of insulin in 1921–1922, which radically transformed the management of the disease, it, however, did little to clarify its fundamental cause.
Diabetes was so closely associated with Jews that it was referred to as the Judenkrankheit “Jewish disease” based on stereotypes about Jews as a people around a century ago. Throughout the book that is divided into chapters each focusing on a particular race, Tuchman's argument is that race doesn't really have anything to do with diabetes, but rather that class is the deciding factor in determining higher rates of the disease.
Truly there is a lot to learn from this medical history text, that breaks down medical jargons making it an easy read for anyone interested on the subject, it is well researched and gives the reader step by step historical accounts of the disease both played out in the media and scientific communities. The exact nature of diabetes remained a mystery even with the discovery of insulin in 1921–1922, which radically transformed the management of the disease, it, however, did little to clarify its fundamental cause.
April 7, 2025
What an excellent and thorough work of nonfiction, spanning from the beginning of diabetes and its associations with race to today, with the inherent judgement that comes with it and its actual ties. It reviews every piece of available literature, doing an excellent job at picking them apart and discussing WHY they would have wanted to talk about diabetes in this way. I loved how she also asks important questions about the methods of data collecting the U.S. does — how it methodically collects data on race but less on class, the real factor she says decides whether or not a person gets diabetes. With all her points summoned up, you can clearly see progressions of racial personality narratives, twisted now into the blame for why a person got diabetes.
I also loved that Tuchman made an effort to include voices from those communities that had been decreed vulnerable to diabetes, both including their reasoning and rationale (sometimes how they reclaimed the moniker of diabetes as empowering) and their thoughts on why they'd had so much in their community.
Overall, this was an excellent and fascinating work, and I'm glad my professor assigned it!
I also loved that Tuchman made an effort to include voices from those communities that had been decreed vulnerable to diabetes, both including their reasoning and rationale (sometimes how they reclaimed the moniker of diabetes as empowering) and their thoughts on why they'd had so much in their community.
Overall, this was an excellent and fascinating work, and I'm glad my professor assigned it!
June 20, 2021
The increase in the onset of diabetes is quite alarming particularly in the United States. The author does an excellent job of reviewing the history of disease by race and class. She goes into great detail regarding the circumstances which affected the increase of diabetes in certain populations. There are many factors that contribute to how a population comes to be treated as disposable because they are not valued and this book outlines how that ideas came to be. This should be required reading in high schools and colleges to better educate a populace about race and disease.
February 20, 2022
This should be mandatory reading for anyone who works in the diabetes field. You need to be aware of the historic dimension of racism, fatphobia and structural inequities that play into diabetes if you work with people who live with the condition.
The last chapter also really shows the consequences of the classification of the different types of diabetes and the stereotypes attached to them. A must read.
The last chapter also really shows the consequences of the classification of the different types of diabetes and the stereotypes attached to them. A must read.
June 27, 2023
I was delayed in reading this, but so glad I finally picked it up as a book club pick. The historical context is maddening and fascinating. As a person with diabetes, I knew the deep health disparities that exist in the disease, but it’s wild to hear quotes from doctors/scientists that quite literally laid the groundwork for the inequities we see today. I listened to this on audio and it’s quite dense so I am considering getting a physical copy and re-reading it. Excellent book.
August 27, 2022
Interesting and well-written. I started this because I'm working on digital health platform supporting patients with chronic diseases, including diabetes. There's a lot of health equity work to be done in this space, and I appreciate having a more complete view of the social and societal baggage that come along with the disease.
January 6, 2022
Great achievement.
Displaying 1 - 17 of 17 reviews