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

sang “

”  on his 1999 album “Going Back to Crawford” (his Mississippi hometown), he was singing about

as well as the nation. As of 2011, according to the latest report from the Centers for Disease Control and Prevention, 20.9 million Americans had diabetes. That marked an almost

four-fold

increase since 1980, when 5.6 million people had been diagnosed. Worldwide,

That really makes us want to sing the blues.

The long history of diabetes—its management with insulin since 1922 and a variety of oral drugs since the 1950s, its current prevalence, and the lack of a cure—means there are plenty of movies, novels, guides, websites, and organizations offering insights and information.

It has also long been linked 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. Such race and class overtones have come with judgments about those who have the disease. Although no one ever welcomed the diagnosis, diabetes was once considered a "clean" disease, more common among those wealthy enough to survive the "dirty" infectious diseases still killing off the poor and unwashed. A "disease of civilization," diabetes had the added benefit, according to some, of requiring daily management skills and a life of discipline and moderation that turned diabetics into "better than average citizens."

Stevie Ray Vaughn's lyrics are catchy, even humorous, but Big Joe Williams' words create a mood that might better capture the daily challenges of living in impoverished regions like the Delta. In "Sugar Diabetes Blues," Big Joe describes a visit to his doctor, who advises him to "Go back Joe, don't eat nothin' sweet, cause you know you got the sugar diabetes." Sage advice, but Big Joe Williams' lyrics evoke feelings of being trapped, watching the "sugar diabetes man headin' for me," begging "please somebody do something for me." One might choose to read these lyrics as evidence of someone shirking responsibility, unwilling to help himself by avoiding the consumption of sugar. But it may be more accurate to hear in them the futility of trying to stop a disease that is ravaging communities like Crawford without any help from outside.

   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.


Arleen Marcia Tuchman, Ph.D., is writing a cultural history of diabetes.

The Public's Health blog has developed a sort of mini-series about public health and entertainment, particularly the blues.

If you have suggestions along these lines, email them to us.