Introduction
Diabetes is often referred to as the plague of the 21st century, as it causes massive long-term damage to individuals, communities, and countries. The disease renders a person’s body unable to properly use and store glucose, causing the blood sugar levels to rise too high. High levels of blood sugar can damage organs and blood vessels, causing internal bleeding and cascade organ failures.
There are two types of diabetes: Type 1 (which prevents the body from producing insulin) and Type 2 (which causes a resistance to insulin’s effects) (American Diabetes Association, 2017). Both of these types are the leading causes of kidney failure in the US, with the total number of victims in the country ranging between 1.6 and 2.2 million a year (Centers of Disease Control and Prevention, 2017). The purpose of this paper is to identify diabetes as a health disparity, with the application of health promotion concepts to develop a treatment plan.
Diabetes and the Nine Determinants of Health
Diabetes affects all nine determinants of health as determined by the World Health Organization (WHO) in a negative way. The list of determinants and their relation to the disease is as follows (WHO, n.d.):
- Income and social status: Treatment of diabetes requires time and money to treat properly. Families of low social status and below-average income are more endangered by the disease;
- Education: The development of diabetes is closely associated with the consumption of certain products, obesity, and a low-mobility lifestyle. Individuals not aware of diabetes and the ways of personal maintenance are more likely to contract or develop complications of the disease;
- Physical environment: Research shows that individuals with access to fresh fruits and vegetable markets, gyms, and parks are at 21% less risk of developing diabetes (CDC, 2017);
- Social support: The presence of social support groups, community services, and the general influence of health culture can have a positive or a detrimental effect on diabetic patients;
- Genetics: Diabetes is more likely to develop in families with a history of diabetes;
- Health services: The presence and availability of high-quality health services affect treatment and death rates associated with diabetes;
- Gender: Men and women have a different predisposition towards different types of diabetes;
- Individual characteristics: Personal lifestyles and food choices can affect the likelihood of development of the disease;
- Policymaking: Treating diabetes is expensive, and different countries introduce different policies to help cope with the situation.
As it is possible to see, diabetes influences all 9 determinants of health, making it a major healthcare condition and a matter of concern for individuals, healthcare institutions, and governments alike.
Epidemiology and Incidence of Diabetes at the State and National Levels
According to CDC (2017), almost a third of the entire US population is suffering from diabetes or prediabetes, with the confirmed number of diabetic patients being at 30.3 million since 2015, and steadily rising. Prediabetes, on the other hand, is a condition that, if left untreated, can lead to diabetes. The number of people in the US with that sort of diagnosis is estimated at circa 84 million. The number of new cases in the country is estimated at 1.5 million per year, minus the fatalities (CDC, 2017). A good portion of adults (circa 25%) do not know they have diabetes up until their first visit to the hospital with symptoms pertaining to the condition (CDC, 2017).
Men are found to be more vulnerable to pre-diabetes than women. Additionally, there are racial and ethnic discrepancies in the percentage of diabetic patients based on educational and income levels. Blacks, Latinos, and native Indians are at greater risk of developing diabetes than Asian-Americans and European-Americans.
Although the average for diabetes remains relatively stable across all states, economic discrepancies are associated with the increase in diagnosed and new diabetes cases. Southern states and areas around the Appalachian Mountains have notably higher rates of diabetes than northern and western areas. The average rate of diabetes for adults in states like Oklahoma, Arkansas, Mississippi, and Alabama is between 12% to 15%, whereas in northern states it is between 7% and 10%.
Issues Surrounding Diabetes Healthcare
Cultural Considerations
Black-Americans, Latinos, and Native Indians are all at a higher risk of developing diabetes when compared to the majoritarian white population. Nevertheless, it is important to understand specific cultural considerations coming along with every ethnic, racial, or religious group. Latinos and Black-Americans are historically distrustful of doctors, especially if those doctors happen to be white (Mendenhall, 2016).
They tend to avoid visits to the hospitals, as they are associated with high expenditures. At the same time, black and Latino preferable cuisines tend to contain products high in fat and protein, which increase the chances of developing obesity and diabetes. Ghetto culture, focus on self-reliance, low educational levels, and greater poverty all are associated with the majority of the mentioned minority groups (Mendenhall, 2016).
A nurse must keep these factors in considerations, and seek to win the patient’s trust, and engage in information campaigns when facing individuals from the historically-vulnerable groups. Another aspect of cultural sensitivity when treating diabetes revolves around respecting religious practices. Some groups denounce modern medicine and do not wish to take drugs to prolong their lives (Mendenhall, 2016). In these situations, the nurse must focus on preventive tactics to reduce the chances of developing diabetes, and provide herbal alternatives to the standard drugs.
Healthcare Literacy Challenges
Healthcare literacy in relation to diabetes is comprised out of several subfields of expertise, which include the general knowledge about the disease, the symptoms associated with it, the factors that may increase or decrease the prevalence of disease development, and the commitment to following whatever course of treatment is prescribed. As it was already stated, nearly 1 in 4 Americans with diabetes are not aware of their diagnosis prior to a major healthcare accident. This indicates that healthcare literacy in the US suffers significant challenges, especially in rural and minority locations. Some of these challenges are as follows:
- A lack of personnel dedicated to population education and advocacy. The medical industry in the US is currently suffering from a shortage of primary and secondary healthcare specialists, with nearly 15% of all vacancies being unoccupied (Johnson, Butler, Harootunian, Wilson, & Linan, 2016). This leaves hospitals and major healthcare organizations unable to dedicate enough workforce to working with the communities;
- Financing and material discrepancies. Diabetes education and literacy programs require money and materials to distribute to vulnerable populations, reminding them of the various factors that may lead to the development of the disease and an increase in its severity (Younis, 2017);
- Cultural differences. Due to cultural and economic gaps between different communities, the poor and minority groups of individuals are less likely to receive the necessary education regarding diabetes (Brunk, Taylor, Clark, Williams, & Cox, 2017). Poor communication and understanding of cultural barriers reduce the effectiveness of diabetes information campaigns;
- Language barriers. This challenge is particularly prevalent in illegal migrants and first-generation Americans, who migrated from poorer countries and did not understand the English language well. Nurses fluent in English, Spanish, and other foreign languages are few, reducing the number of potential candidates for educational roles (Brunk et al., 2017);
- Political barriers. Financial cuts to healthcare motivated by political reasons hurt healthcare organizations and non-profitable groups dedicated to promoting the knowledge of diabetes to the masses.
As it is possible to see, there are numerous issues that explain why healthcare literacy regarding diabetes remains at a relatively low level. Should some of these problems be completely or partially resolved, the number of new cases of diabetes is bound to go down, as a result of increased awareness and preventative measures.
Health Promotion Theory and Treatment Plan
In the light of major challenges outlined in the section above, the most appropriate health promotion theory for increasing diabetes awareness would be the social-cognitive theory. This theory promotes self-efficacy, establishes expectations, and promotes reinforcement and self-control through the means of engaging local communities (Ghoreishi, Vahedian-Shahroodi, Jafari, & Tehranid, 2019).
In a situation where nurses are in short supply, expenditures are often cut due to political reasons, and communities are split based on economic and racial boundaries, the social-cognitive theory would encourage community leaders and organizations to undertake the task of educating their members and improving the knowledge of symptoms, predicators, and treatment methods available to the population. The proposed educational intervention plan is as follows (Ghoreishi et al., 2019):
- Implement nurses to get in touch with various non-profit organizations at the community level, such as charities, churches, schools, etc.;
- Provide the organizations with the information, education, and materials to distribute to their intended populations, such as church visitors, students, and beneficiaries;
- Provide information on various healthcare organizations available in the area;
- Give these organizations the authority to promote and distribute diabetes-related information;
- Provide frequent updates and supervision in regards to healthcare agenda, offer reasonable expectations and expectancies as a result of behavioral change.
This strategy is in line with various nursing theories as well, namely Orem’s healthcare theory, which claims that individuals wish to be independent and capable of taking care of themselves (Kant, Khapre, & Singh, 2017). The involvement of community effort would solve the issues regarding a lack of nurses, the lack of cultural consensus, and, to a degree, the problem of insufficient funding while making patients active actors in the process of their own recovery.
Conclusions
Diabetes is a serious healthcare issue that affects all countries around the world. The US has a significant prevalence of diabetic patients due to socio-economic factors, poor knowledge distribution, and a predisposition towards fat-enriched cuisine. Due to the increase in the percentage of elderly individuals, the increased turnover of nurses in hospitals, and the reduction in healthcare budget, the issue of diabetes ought to exacerbate, causing more than 2.2 million deaths a year on average. The proposed solution to the problem involves an educational intervention based on social-cognitive theory as well as Orem’s theory of care.
It would help get the communities involved and increase social awareness of the problem. However, such a solution will not solve the long-term problems plaguing the healthcare system in the US. Only the recruitment of more nurses, expansion of the healthcare budget, and the reduction of inter-racial, social, and economic barriers will enable information campaigns to be effective.
References
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World Health Organization (WHO). (n.d.). The determinants of health. Web.
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