Socioeconomic Position and Weight Change Among Blacks Research Paper

Abstract

The relation between diabetes and obesity has now been long established in the recent years. The strong genetic component and environmental factors both contribute to high prevalence rates of diabetes. The changes in the lifestyle, sedentary mode of living, poor eating habits and socioeconomic status are very important contributors to the development of diabetes type II. Currently, the US population is showing a very high rate of obesity that is increasing among all age groups, sexes, socioeconomic status, and ethnic populations. This points towards need for important steps to be taken in reducing obesity prevalence.

Introduction to the Thesis Statement

Diabetes is a condition that means an increase in sugar levels in the body above normal levels. This may be either due to inherent loss of insulin function, or may be due to insulin insufficiency. The prior is known as the diabetes type I and the later is known as diabetes type II. Diabetes type II is more of a developed health condition, which takes place due to changes in lifestyle. Increase in weight, changes in eating pattern and eating of poor quality and junk food are more likely to lead to diabetes type II.

Diabetes is among the most common prevalent diseases found in the world. Its prevalence has been found to be very high in the United States, which is due to increase exponentially. However, the United States also shows some of the most prominent discrepancies in the prevalence of disease in various populations. The risk of development of condition as well as the related complications that can develop as a direct result of diabetes is also high in such cases. There are many factors that have been identified as the primary cause of its varying prevalence in different populations (Bennett et al, 2005). Among these are included socioeconomic status, diet, lack of physical exercise and obesity. Obesity has been considered a very important factor in the etiology of diabetes (Mokdad et al, 2003). In the United States there has been an exponential increase in obesity among all age groups and races. There has also been a concurrent increase in the diabetes incidences. This increase has been especially prominent in the African American population, where a large percentage of cases of diabetes and complications develop due to lack of access or provision of care. This disparity is also evident in other races, but African Americans also possess the genetic tendency to develop the disease in a very high percentage. Obesity patterns have also increased in this population in the past years (Department of Health and Human Services, North Carolina, 2003). Therefore, obesity, a prime factor in the development of diabetes, has resulted in a very high percentage of diabetes cases in the African American population. Along side, socioeconomic status of the African American population, and lack of adequate health care provision by the authorities has resulted in manifold increase in this number.

The current review is aimed at studying the correlation between obesity, diabetes, and the socioeconomic status and how diabetes impacts these three as well as other economic and social factors. Studies have shown very high risk of diabetes where obesity is found, and that too has been reported the most in the ethnic minorities. The black population, especially the African American women show the highest numbers of obesity and concurring diabetes (Bennett et al, 2005). The life expectancy of these women due to this disease considerably decreases, making it one of the most significant killers of patients belonging to this community.

Disparity can be defined as “the differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States” (Department of Health and Human Services, North Carolina, 2003). Areas of disparity range from race or ethnicity, income, gender to geographical location, age, disability status, and sexual orientation (Department of Health and Human Services, North Carolina, 2003).

The current statistics points to a very grim picture of diabetes among the African American populations. The risk of developing diabetes among them is as high as 50 to 100 percent with more evidence showing that this population has higher genetic vulnerability to this disease as well. This along with poor care provision, low economic status, poor access to care, and inability to afford care has increased the numbers of diabetics among the African Americans significantly (Signorello et al, 2007). Men as well as women show same trends, and with higher genetic predisposition, this problem is likely to increase the number of people suffering from this disease.

This disparity is even prevalent among the pregnant African American women where gestational diabetes occurs in very high numbers. This risk is significantly increased should the woman be obese, older in age, has family history of diabetes, or belongs to an ethnic minority with high epidemiological results for diabetes (Thorpe et al, 2005). Gestational diabetes rates is African American are very high, second only to Asian women, who report to have the highest incidences of gestational diabetes. Other ethnic populations also display such trends. These trends are very suggestive of the overall poor health of the women, who are most vulnerable to developing diabetes (Thorpe et al, 2005). These rates are also very different from the rates among white females, who show a much lesser number of developing gestational diabetes. As to why this takes place is a point to be researched extensively, but genetic factors are also being considered as a possible explanation to it.

Diabetes is essentially the inability of the body to utilize glucose sources in the body The global prevalence of this condition is as high as 6%, which is continuously increasing. This means a very heavy burden on the health structures around the globe. The effect of this abnormal metabolism leads to problems in the metabolism of carbohydrates along with proteins, fats, water and electrolytes (Adeghate, Schattner and Dunn, 2006). Diabetes also leads to decrease in the level of performance in the individual. With the co-presence of obesity, such patients are more likely to fall victim to cardiovascular complications as well as diabetic emergencies. The employers may have to take care of very large insurance claims due to repeated hospital admissions as well as providing support for medications. The patient in turn may not be able to provide a complete service to the employer, and repeated absences and leaves of varying durations may take place frequently. Improper pay scales may increase the risk of diabetes, as the patient may not be able to get the necessary health care required for his or her condition. Therefore, as far as work is concerned, the effect is very negative on the productivity of the company the patient works for.

The cause of diabetes has been found to be multigenic in nature, and the role of environmental as well as genetic factors is now established (Adeghate, Schattner and Dunn, 2006). Factors such as ethnicity, location, seasonal variation, nutritional factors, toxic agents, viruses and infection and immunological changes have all been implicated in the etiology of diabetes (Adeghate, Schattner and Dunn, 2006). This shows the intense complexity of the disease on treatment levels, and how each individual factor can further complicate the outcome of the disease.

Williams and Collins (2001) point out the effect of residential areas as a thread in the disparity in health care delivery. Most of the African Americans are affected by this residential discrepancy, which increases racial differences as well as socioeconomic divide in the various communities in the American population. The high death rates of the African Americans compared to white population is the proof of the fact that racial disparities are very prevalent in the current USA health care system (Williams and Collins, 2001).

A similar more recent study by Virnig et al in 2007 also explores the role of residential and geographical distribution in the cause of disparity (Virnig et al, 2007). This study looked into 5.1 million Medicare+choice enrollees, which showed racial as well as geographic disparity. Again this disparity was noted in geographical areas populated most by the African American populations. The role of residential segregation and socioeconomic status strongly points towards increased or decreased tendency to develop diabetes or other health care problems. Virnig et al, therefore, conclude that in order to best achieve a reduction in disparity, there needs to be more geographical equality as well (Virnig et al, 2007).

Diabetes is mainly diagnosed via blood sugar tests of the patient. High levels of blood glucose above normal recommended levels are usually indicative of the pathology. However, the clinical presentations of these patients are variable according to the type of the diabetes (Adeghate, Schattner and Dunn, 2006). The genetic correlation of diabetes has been significantly established now, and many genome wide studies and researches support it. Likewise treatment plans will differ according to age of patient and the type of diabetes he or she presents with. While type I may be easier to handle, the type II diabetes is more likely to lead into complications alone and with other chronic diseases.

The type I diabetes is also known as the insulin dependant diabetes mellitus, which takes place during earlier years of life. This condition takes place as a direct result of loss of insulin function, which leads to glucose intolerance. In most of the cases, diabetic ketoacidosis is the first encounter with the disease, with which the patient presents with in the emergency department (Olefsky, 2001). This condition is relatively rare and strong genetic component is involved in the pathology.

Type I diabetes has a very high rate of genetic transfer among offspring and siblings. Many genes have been identified in the pathology of diabetes type I. Some of these include HLA-DR3 and HLA-DR4, which increase the risk of this disease by more than 7 times (Adeghate, Schattner and Dunn, 2006). The chromosome 6 has been linked to HLA complex (Adeghate, Schattner and Dunn, 2006). Type I diabetes has been found in higher prevalence in males than in females.

The method of controlling diabetes type I is through the proper and timely use of insulin. Only this method allows for successful resolution of high blood sugar levels, and the patient may live to have a very healthy and long life (Olefsky, 2001).

Type II diabetes is the most prevalent form of diabetes among all diabetic syndrome. the syndrome is also known as non insulin dependant diabetes mellitus, since the main problem is either insulin resistance or inadequate production of insulin that caters to the needs of the body (Olefsky, 2001). This type of diabetes is largely prevalent in due accordance of the changes in the lifestyles (Olefsky, 2001). Complications related to NIDDM are both macro as well as microvascular in nature (Bazzano, Serdula and Liu, 2005). This prevalence has been found to be high in almost all populations. Among the genes found to be responsible for type II diabetes include Gc genotype gene on chromosome 4, lipoprotein antigen gene on chromosome 6, insulin gene polymorphism on chromosome 11, apolipoprotein genes on chromosome 2 and 11 etc. (Adeghate, Schattner and Dunn, 2006). In contrast to type I, the type II diabetes is more common in the females, although Mexican populations may show this prevalence otherwise (Adeghate, Schattner and Dunn, 2006).

Ethnicity is among the most prevalent causes of prevalence of diabetes in any region. For example high prevalence rates have been reported in the populations of South African Indians, Pima Indians and Pacific Islanders of Nauru and Fiji. The asian populations show a lesser incidence of diabetes, however, the lack of proper demographic data may be misleading into thinking that this prevalence is less (Adeghate, Schattner and Dunn, 2006).

The living conditions and location of the population can also play an important role in the prevalence of diabetes. Urban populations are twice as likely to report higher incidences of diabetes in both genders than those living in the rural areas.

Intake of fatty foods with reduced intake of fibrous foods is considered a major cause for the development of insulin resistance. Related factors to this are body weight, hip to waist ratio, fasting blood insulin concentrations, type of carbohydrate intake, and post meal concentrations of glucose intake etc. (Bazzano, Serdula and Liu, 2005).

When compared, the rates of diabetes prevalence of diabetes in various races and ethnicities were similar to each other if the socioeconomic status was similar. This suggests that it is a complicated issue in understanding the role of socioeconomic status in the pathology of diabetes. Social factors such as “fetal or infant malnutrition, chronic stress, depression or psychosocial complications, obesity, inactivity and lack of access” are also very important contributors to the whole picture. Therefore, only claiming that socioeconomic status alone or obesity alone is the cause of diabetes is erroneous (Signorello et al, 2007).

The reported costs for diabetes treatment and medical expenditures have been estimated at $92 billion in 2002 (Value of Effective Diabetes Management and Prevention, 2008). Among these 44% for inpatient hospital care, 15% for nursing home care, and 11% for physician office visits. The medical expenditures for each diabetic individual per year amount to $13,243 compared to no diabetic patients at $2,560 (Value of Effective Diabetes Management and Prevention, 2008). The functional loss of diabetes has been high in economic impact as well. There have been estimated 88 days lost to disability and 176,000 cases of permanent disability, at a cost of 7.5 billion (Value of Effective Diabetes Management and Prevention, 2008). Most of the health care costs for diabetes complications are spent on cardiovascular diseases, followed by nephropathy, neuropathy and retinopathy (Value of Effective Diabetes Management and Prevention, 2008).

Diabetes is now a globally prevalent disease that is affecting the morbidity and mortality rates extensively. Depending on the ethnicity, the rates of diabetes are variable. While high rates have been recorded in the Hispanic population, the European population shows relatively less frequency of the condition (Adeghate, Schattner and Dunn, 2006). The northern Americans display some of the highest prevalent rates for diabetes. African regions in the past did not display large prevalence in diabetes type II. However, with the emergence of new living styles and standards, the disease is starting to grow rapidly in this region as well (Adeghate, Schattner and Dunn, 2006). Diabetes has now become the 6^th largest cause of death in the United States (Olefsky, 2001).

It is now estimated that USA males run a 32.8% and females run a 38.5% chance of developing diabetes when all aspects are considered (Bazzano, Serdula and Liu, 2005). This inclusion of one third population is a major concern to the health authorities, for already, the current health care setups are unable to take up the load of chronic illness patients due to lack of resources and infrastructure. The ultimate costs are very likely to lead to an altogether collapse of the health care system, which researchers say is not so far away now (Bazzano, Serdula and Liu, 2005).

Diabetes in the USA

The USA statistics reveal that about 7 percent of the population suffers from type II diabetes, with the raise of 800000 new cases per year expected. It has been diagnosed among all ethnic populations, and now it is found in all age groups as well. This points to the severity of the endemic of diabetes in the US and outside of the US, which is also displaying similar trends with regards to prevalence and pathology (Olefsky, 2001 and Peek et al, 2007). Approximately 1 in 3 men and 2 in 5 women are at risk of developing diabetes during their life times in the USA.

The study carried out by Narayan in 2007 has shown for the first time the lifetime risk of developing diabetes in the American population. Interestingly, it has also shown the disparity that takes place in this incidence in a comprehensive manner. Diabetes risk of diagnosis has been found to be as high as 40 percent for Black population and 45 percent for Hispanic population. The white population in contrast runs the risk of only 26 percent; where as other ethnic populations show 36.9 percent of risk for developing diabetes.

In women, the Hispanic women show the highest risk rates of 52 percent of developing diabetes. The black population runs a 49 percent lifetime risk of developing diabetes. Other ethnic populations have a 43 percent risk, where as the white population runs the risk of 31 percent (Narayan et al, 2007). This extreme difference in the lifetime risk shows the discrepancy in the various races in the development of diabetes type II. Similarly, the numbers of years lost due to morbidity have been calculated to be highest in the black population, which are about 22 years. Other ethnic minorities have life years lost equal to 21 years. Black females in this regard lose more years than males and other ethnic minorities (Narayan et al, 2007).

The major trend that has been of concern in the health care system of the USA is the presence of disparities. These disparities have been present for a very long time, and continue to show their presence in various forms. These disparities vary from decreased enrollment of jobs of various ethnic minorities in the health care sector to lack of proper care provision in the health care departments (Peek et al, 2007).

In north Carolina, the statistics show that African Americans are second highest in number second to only American Indians in the prevalence of diabetes. This is as high as 1.5 times more than whites. The socioeconomic status has revealed that families with incomes less than $15,000 are more likely to suffer from such ties. Death rates are also twice as high in this particular community when compared to whites. Heart rates are also among the highest in the African American community (Department of Health and Human Services, North Carolina, 2003). Study carried out via telephonic survey by Mokdad et al in 2001 have found a very high prevalence of diabetes in almost all ethnic groups of the American population (Mokdad et al, 2003). Obesity reported in this study was as high as 20 percent, although the more recent studies this percentage to be higher. The men were slightly more likely to develop obesity, however, the females were more likely to develop diabetes as a direct result of weight gain. The primary group of highest prevalence was from age 50 to 59 (Mokdad et al, 2003). The report was also able to display a high disparity in the incidence of diabetes among African Americans, which was as high as 31 percent, an 8 percent higher rate than the next most affected, group of Hispanics. The prevalence was some what linked to the educational status of the patient, as around 27.4 percent of the total diabetics had education less than high school. Ex smokers were more likely to develop the condition (Mokdad et al, 2003). The study proposed that since obesity was among the prime factors that led to development of diabetes, reversal of this prevalence would result in reduction in consequent numbers of diabetic patients (Mokdad et al, 2003).

Factors Created Due to Diabetes

The economic burden of diabetes is a very heavy one for all aspects of society. Whether it is an individual challenge or an inpatient case in a hospital, diabetes has raised the cost of health as well as various aspects of life considerably. Concurrent decrease in the quality of life is another serious concern, which raises chances of co-morbidity excessively (Olefsky, 2001). The costs estimated of direct medical costs and lost productivity in the USA amount to approximately 132 billion dollars per annum (Bazzano, Serdula and Liu, 2005).

The increase in the numbers of diabetes patients is highly expected as the number of elderly population increases. Along side, early development of this disease a longer than average care system required for each patient. This means that with time the resources and manner of treatment is likely to become inadequate to meet the demands of the ever-increasing diabetic population (Peek et al, 2007).

Health problems are mainly due to the lack of blood sugar control that the patients may display, or may have inadequate means to take care of. One of the most damaging effects is blindness of the eyes as a result of diabetes, which can take place at any age in the diabetes pathology. Kidney complications can lead to fatal loss of kidney function, and heart complications as well as strokes have a very high risk of taking place in a patient suffering from diabetes. Even in pregnancy, the diabetes leads to many complications, which may cause complications in the proper development of the fetus, and may pose serious threat to the mother and the offspring. Most of the diabetics have to live with poor body defense system, which means that they are constantly under threat of infections, and surgical complications. Therefore, the health complications of the patient suffering from diabetes are likely to take place at any point in time, and only careful planning and treatment can ensure that these complications are minimized (Olefsky, 2001).

Obesity has now been established as the leading cause and factor involved in the pathosis of diabetes, which is involved in 60 to 90 percent of the cases. The BMI, weight changes and increases, and waist to hip ratios etc. is very strong determinants of diabetes. Weight control and proper dietary intake has been found to be of immense help in the prevention of diabetes development (Bazzano, Serdula and Liu, 2005). As in diabetes, obesity is also a preventable condition, which could mean preservation and optimization of function of all components and functions of the body. Obesity directly affects and stresses the various organs of the body, including the liver, heart and the kidneys etc. (Mokdad et al, 2003). Changes in lifestyle, which are mostly negative in nature, are not tolerated well by the body, and therefore, any increase in weight directly results in the increased risk and prevalence of diabetes (Mokdad et al, 2003).

The role of physical activity has been a prime link found in the etiology of diabetes. The sedentary living style of the urban population and lack of exercise together with eating of junk food has been contributory to the increased prevalence of diabetes. In this regard, the role of BMI has also been found as a major determinant of the condition (Adeghate, Schattner and Dunn, 2006). The more active persons are less likely to show any glucose intolerances or type II diabetes as compared to active persons. Therefore, a primary target for community approach should be to encourage physical activity among the people (Bazzano, Serdula and Liu, 2005).

Other factors that promote diabetes include alcohol intake and cigarette use. Although still controversial, these two habits are also very detrimental to health in other aspects as well, and therefore, must be considered in the history of the patient who presents with diabetic symptoms. Studies on women have shown a 42% higher risk of diabetes development that smoke than in those who do not.

How Is Diabetes and Obesity Linked

The current trends in the living society have led to various health problems including obesity. These rates have been reported to be highest in the developed countries where the living standards and norms have led to obesity in a dominant percentage of the American population (Baskin et al, 2005). What is interesting to note is that this trend is slowly penetrating in to the young generation, and many youth are now beginning to show high obesity rates than in the past. Since the 1980s, the trend of obesity has nearly doubled, and now more people are getting obese with time (Baskin et al, 2005).

Obesity is defined as the BMI of more than 30, where as overweight is defined as BMI of less than 25 in kilogram per meter square. Obesity occurs as a result of consumption of fats and sugars, the use of refined sugars and the lack of exercise and physical fitness regimes (Drewnowski and Spector, 2004).

It is interesting to note that diabetes type II patients show high obesity findings. The role of refined sugars has been an exceptionally important factor in this regard. Along side use of fried food and lack of exercise are also essential tools in the diabetes epidemiology. The percentage of obesity now ranges from 65% to almost 76% in ethnic populations in America. These rates are due to increase exponentially as the rates of children showing obese patterns are also increasing significantly. This pattern of increased weight is now evident among all ethnic populations (Bazzano, Serdula and Liu, 2005).

Research has now shown that socioeconomic status is also a very strong determinant of the diet a person takes and the consequent effect it can have on a person’s weight. A person may gain weight when he or she eats foods that are rich in artificial sweeteners, and have a higher calorie number. Therefore, poor persons are very likely to gain weight more quickly than rich people, who may be able to choose more expensive health conscious foods (Baskin et al, 2005). Geographical variation has also been found where by the south Atlantic states have shown higher obesity rates than in other American regions (Baskin et al, 2005).

Even obesity has shown the presence of disparities within the American population. It has been seen that some races and ethnicities demonstrate more obesity than others, as well as the related complications that go along with it. The African American population has shown one of the highest rates of obesity and obesity related complications in the United States. The second highest rates have been found to be among Mexican American women (Baskin et al, 2005). Along side, the nature of work can also be an important clue to the development of obesity in an individual (Schulte et al, 2007). While it is not considered so, obesity must also be considered a workplace hazard, as it can lead to myriad of health complications such as diabetes, heart disease and stroke. Heavy work demanding environments affect eating patterns as well, and the person may compromise with eating bad or junk food. Missed meals, overwork, stress, lack of rest and constant activity may distract the person from his or health, which can lead to many complications in health (Schulte et al, 2007).

Another complication that may result in higher diabetes incidences among the obese is the faulty methods of weight loss. Many obese people try to lose too much weight too quickly, which leads to sudden stress inflicted upon the body. Similarly, when any reduction in weight is achieved, the person may stop exercising at all, which leads to reversal of the condition to previous. This extreme fluctuation also affects the outcome and results in very high risk of diabetes or glucose intolerance (Mokdad et al, 2003).

The study of Bennett et al in 2005 has shown very high incidences of obesity and diabetes occurrence in the black women of the USA. The BMI indexes are very high for such women with higher chances of its increase (Bennett et al, 2007). Low socioeconomic status in childhood was seen as a common factor in such subjects, and still was suffering from poor quality and standard of living. However, the study concluded “childhood SEP was generally not associated with increases in BMI among men. Adult SEP was not associated with BMI change among men, nor was life course SEP. Education and occupation, rather than employment status and home ownership, appeared most responsible for this association.” (Bennett et al, 2007).

The study of Bennett actually points to the complex social pattern that plays role in the increase of BMI among populations, and the significant role of SEP in this regard. Increase in obesity has been associated with high absenteeism rates. Also, the distribution of body fat has been associated with the number of leaves from work, which can be 1.6 times more than for those with lesser weights. This along with the morbidity of diabetes is more likely to result in more absences and leaves from work, leading to loss of working hours for any enterprise (Schulte et al, 2007).

Disparities in obesity are a very significant trend that has emerged in the preceding years in the American health care history. Since obesity is a condition that is easily preventable, the lack of any efforts taken by the health care sector in reducing this prevalence, especially in most at risk populations, is a serious question posed. One of the most important contributors is the lack of access to health to many of the Americans. This is because many of them may not be able to afford medical insurance. This automatically cuts down a major proportion of the American population, regardless of race from getting proper medical help for their condition. However, even in this aspect, disparities are evident. Obesity is as high as 76 percent in the African American and Mexican Americans reported. Disparities are also higher in this group, and are continuing to increase at a very rapid rate (Ammerman et al, 2006).

Physicians are also likely to show disparity in providing health care to the various populations. The minority physicians are very likely to show some important features in their care provision. Most of the minority physicians are likely to “choose primary care specialties, serve patients of their own ethnic group, serve Medicaid recipients and work in health manpower shortage areas.”

The patients receiving health care from minority physicians are more likely to “be ethnic minorities, be of low income status, have Medicaid or no insurance, and report worse health status and more acute service use” (Cooper and Powe, 2004).

The African American community is currently suffering immensely from these disparities in the healthcare provision, which is evident in their overall health status. African Americans have a 2 to 4 times higher rate of developing diabetes related complications. These include renal diseases, blindness, amputations, and amputation related mortality respectively (Peek et al, 2007). These findings are some what duplicated in other ethnic minorities as well. Among these are included are Latinos, who show higher rates renal disease and retinopathy (Peek et al, 2007). Even the diabetes related mortality rates are very high for ethnic populations. These have been reported to be more than twice among the African Americans than in the white populations (Peek et al, 2007).

Ammerman (2006) claims that these disparities are found in many other aspects of life as well. Ammerman claims that lack of access to basic necessities such as food, inability to afford better food, lack of physical recreation activity and locations, psychosocial factors in obesity etc. are all important contributors to disease and obesity (Ammerman, 2006).

The physical effects of these disparities are directly resulting in the increase in the prevalence of diabetes in the African Americans (Ludwig et al, 2002). Combined with other chronic illnesses such as heart diseases and high blood pressures, the mortality risk and rates both are very high. Conditions such as insulin resistance, compensatory hyperinsulinemia, chronic stress conditions, chronic inflammation and hypercoaguability, under and over nutrition at various stages of life, neuroendocrine or metabolic dysfunction etc. are also important adjuvant to diabetes related complications. Genetic predisposition is a factor that is inherent and very important in the pathology of the condition (Ludwig et al, 2002).

Proposed Solutions to Combat Disparities

As a result of efforts carried out by the local government and the health ministry, many key areas have been identified that are in need of reform. These perspectives have been identified as follows:

1. There is an overall lack of grass roots involvement in the decision making process in the development, implementation, and evaluation of programs, policies and funding to address disparities.
2. Lack of inclusion of communities affected most by disparities at state and local ‘tables’ where discussions on policies, interventions, programs or research and evaluation decisions are made.
3. Limited ownership and lack of accountability for the elimination of health disparities.
4. Failure to have a diverse workforce that is representative of the communities served in the state.
5. sociocultural differences such as lack of trust, language differences, and differences in attitudes, values, beliefs and myths.’ (Department of Health and Human Services, North Carolina, 2003).

The only primary solution for diabetes is the prevention of it in the first place. In this regard, the health community and the government have an important role in the provision of adequate knowledge to the community about the various aspects of diabetes and how to prevent it. Therefore, the current preventive strategy should focus not only on the individuals suffering from diabetes, but also on the community at all levels. The more the community is informed about the various aspects and complications of diabetes, the more motivated they will be to take up measures to prevent it (Bazzano, Serdula and Liu, 2005).

Low socioeconomic status is a very important contributor to the decrease in the care acquisition. Insurance and private practice fee is very high in the USA and may not be affordable to many Americans. The African American community is among those communities that do not enjoy high status. Therefore, in many of the cases, despite having understanding about the complications of the disease, the patients may forego care due to lack of financial resources (Peek et al, 2007). This is perhaps one of the most significant factors that contribute to diabetes related complications. Low-income status also means that the people may be unable to carry out many of the recreational activities that are of physical nature. This means that low socioeconomic status may be a very significant barrier in the acquisition of high quality of life for the people, which in turn may increase chances of developing diabetes.

A very important challenge is the proper provision of services for health care. It has been recognized that “access and coordination of health services, cost containment, reimbursement for services, health education and training for community” are the key challenges in the provision of quality care. Many of the key reforms in the past have failed to be implemented as a direct result of lack of resources and finances in the health care sector (Department of Health and Human Services, North Carolina, 2003).

Virnig et al, along with others points out to the residential and the geographical divide in the prevalence of diabetes. This residential divide in many ways determines the disparities and the population that will be affected (Virnig et al, 2007). Thereofore, areas, where there is less investment or facilities of healthcare present are more likely to suffer from health care disparities. Any efforts in the past have been more oriented towards creating betterment in the facilities that are already present. New facilities created are very less in number, and therefore, the areas, which suffered from lack of these facilities, still suffer the same. Without the introduction of quality healthcare facilities in these areas, the disparities are more likely to continue. Most of the economically deprived areas may suffer from poor or inadequate healthcare setups. Since residential segregation has resulted in a very high numbers of ethnic minorities in these regions, they are very likely to suffer from poor health care in the future as well. Here the socioeconomic, geographical divide becomes more evident than ever, and the need to do something about it becomes more pressing (Virnig et al, 2007).

Current Programs Done to Reduce Diabetes

Current plans in the removal of disparities are an essential need to remove the stigma attached to the current American health care system. In this regard, programs such as Healthy People 2010 are an important step in the promotion of equality and ideals that are the image of US nation. These programs are basically quality improvement programs that aim for the provision of quality health care to all patients at all levels regardless of their socioeconomic status. These quality improvement programs have been made exclusively to target various populations of diabetic patients, and have been at least able to improve the follow-up responses among the patients. Still, the level of quality care that could be provided to the patients is missing and more programs and initiatives are necessary to ensure optimal diabetic care provision.

This program has been largely successful in its outcomes compared to the other efforts that have been carried out in the past. This may be due to the direct approach rather than round about and short term approaches by the health leaders that were taken in the past (Williams and Collins, 2001).

The lack of quality care provision has been identified as a very important contributor in the disparities related to diabetes health care provision. Various testing services and benefits related to health insurance are usually not carried out in the ethnic minorities or are not provided.

This does not however, mean that the whites are receiving the best healthcare for diabetes. One of the main problems that have been reported is related to the poor adherence demonstrated by the patients regarding care and medical updates. This may also cause complications to remain undetected and may lead to poor health outcomes (Peek et al, 2007).

Sociocultural challenges remain a very important emerging theme in health care disparities. The lack of professionals of various ethnic minorities leads to lack of people who are able to understand the language of the ethnic minorities (Cooper and Powe, 2004). Other challenges found are “conflict in communication and attitudes, the values system of client and providers” (Department of Health and Human Services, North Carolina, 2003).

The OMHHD and the DHHS Steering Committees have been formed in the state of California that looks exclusively into elimination of health disparities. The program introduced in this regard has been termed as the “Eliminating Health Disparities Call to Action”. This may be perhaps one of the first most comprehensive programs carried out to remove disparities (Department of Health and Human Services, North Carolina, 2003).

Since disparities are present at almost all levels of health care, the removal of these is more complicated. Therefore, the programs or policies proposed to eliminate these disparities focus at one part or segment of the health care sector at a time. In this paper, the prime focus is the removal of disparities in the provision of health care and access to healthcare (Peek et al, 2007).

Regular follow-up programs have been able to provide the physicians with the ability to monitor the patient’s health more frequently, and he or she may be able to detect the various complications of diabetes at very early stages. This can prevent morbidity and morbidity related mortality by a significant percent. The patients although not entirely compliant, also have the assurance that they have a record maintained about their condition, and should any complication arise, the physician will not be in the dark. Interventions by the providers helps in achieving better controls of the diabetes condition, and helps in creating motivation among the public as well as the patient.

Introduction to Literacy Programs

The literacy and general awareness programs are the first step to reducing the prevalence of diabetes. This is because these interventions will be able to guide and inform the general masses about how not to get diabetes in the first place. Preventive programs are therefore the first most efficient step in ensuring future reduction in the numbers of newly diagnosed cases. There are many mediums that can be used to provide the necessary information to the public. The media in all its forms, and communication by the regular physician are an essential component of this methodology. Newspapers, magazines, radio, television, Internet and brochures are a very effective manner of communication. Alongside, the general physicians should ensure that should a patient in the family develop diabetes, the entire family should be educated about its various aspects and how a proper lifestyle change can lead to better outcomes. Prevention is better than cure is the most important aspect of diabetes care, which will be economical with respect to time, life expectancy and quality of life, costs, mental and physical burden, absence from work and reduction in the participation of daily life activities. Since obesity is the current most pressing theme in the development of diabetes, the public should be guided about how obesity occurs, what factors promote it, and how it can be reduced effectively.

Almost all physicians agree that proper exercise is the first step towards achieving better health. Therefore, the diabetic as well as non-diabetic people are all advised to do regular exercises. In this regard, the promotion of various physical activities is an essential requirement of the total plan for diabetes reduction.

The current medical assistance programs are another successful intervention that has been introduced in the recent years to combat diabetes and other chronic illnesses. Its multiple approach programs are able to address the needs of the people with good results and are able to achieve better patient compliance than other methods. More research and methods to develop this program is underway, to improve the yield of results (Peek et al, 2007).

Creating Cost Effective Methods for Diabetes Management Programs

Perhaps the most significant method of reducing the prevalence of diabetes will be to remove the primary causes that lead to it. A good and healthy lifestyle and the intake of a proper diet are the most effective methods for prevention of diabetes. In this regard, any community health care programs that focus of such issues only are likely to help create awareness among the public, and therefore, may lead to a conscious effort in them to improve their lifestyle. Along side, such educational programs may also help patients identify key symptoms of diabetes, and may help in timely diagnosis without the development of complications (Bazzano, Serdula and Liu, 2005).

Hu et al, (2001) state that “a combination of several lifestyle factors, including maintaining a body mass index of 25 or lower, eating a diet high in cereal fiber and polyunsaturated fat, and low in saturated and trans fats and glycemic load, exercising regularly, abstaining from smoking, and consuming alcohol moderately, was associated with an incidence of type 2 diabetes that was approximately 90 percent lower than that found among women without these factors. The results suggest that in this population, the majority of cases of type II diabetes could be avoided by behavior modification” (Hu et al, 2001).

A very important factor in the reduction of diabetes is the reduction of the main causes of it. Of this obesity is the primary cause that needs to be handled. Whether this is a matter that needs to be addressed on an individual or a societal level remains to be addressed. The psychological changes that may develop as a direct response to obesity also need to be catered to. In order to reduce the incidence of diabetes especially in children, it is important that parents and community workers create awareness and information within the youth about the negative consequences of living styles that are detrimental to health. Since lack of physical activity is one of the most common cited reasons for obesity, community programs should start activities that promote physical activity in all age groups. Most of the obese patients or people or children may avoid taking part in such activities due to poor acceptance by peers. Marginalization due to weight gain is a very important contributor to anti social behavior, which can also result in lack of interest for personal health. Therefore, community programs that address these issues and help people gain more tolerance and acceptance of obese people will be the first step in creating healthier societies (Bazzano, Serdula and Liu, 2005).

Any increases in the BMI that are above 25 are a very strong indication for the development or existence of diabetes. Therefore, should the patients display such as high BMI, they must be placed on active life regime, where weight loss and proper exercise must be followed. Since ethnicity is a very strong determinant of the clinical features of the disease and how the disease will progress in a person, it is important to know these factors before hand, and create awareness among people about how they can prevent or delay such an event to take place (Bazzano, Serdula and Liu, 2005). The replacement of refined sugars and high fat intake should be with fruit, cereal, vegetable and dietary fiber sources (Bazzano, Serdula and Liu, 2005).

Education programs carried out in China and Finland regarding education of the people and masses about healthy lifestyle and proper exercising resulted in significant reduction in the BMI of the participants, and the incidence of diabetes consequently. This can even reduce the numbers of diabetes by half (Hu et al, 2007).

Keeping in mind the cultural issues involved with the provision of care, Metghalchi et al, 2008 undertook study of the effects of culturally sensitive diabetes education program in the Spanish Hispanic population (Metghalchi et al, 2008). The program was aimed at maintaining check on the various indicators of diabetes including blood levels, and the introduction of patients to various methods and lifestyle modifications that help reduce the prevalence of diabetes related complications. Along side, the study and the program kept record of insulin levels, hemoglobin A1c, total cholesterol, triglycerides, low-density lipoproteins, and high-density lipoproteins respectively. The follow up of three months with proper education led to marked improvement in overall levels, and displayed better health of the patients post study. The program has been a very successful attempt at methods to improve clinical outcomes of diabetes, and indicates that such programs can contribute extensively towards catering to the needs of diabetic ethnic minorities (Metghalchi et al, 2008).

Creation of Satellites for the Provision of Diabetes Care

Satellite setup creation is another important method that can ensure the provision of quality diabetic care to the patients. This method is especially useful for patients who are unable to access care due to distance or immobility. With the help of community health care setups, the patients have an easier, more affordable and nearer access to care, and can gain guidance and information from these sources at all times.

The satellite programs are more likely to succeed with the support from various allied health care services such as professional nursing staff; community health care workers, non-physician clinicians and staff led prescription programs (Peek et al, 2007). This strong healthcare force is able to maintain care of the patients at a distant pace from the hospitals, and helps in reducing the numbers of hospital admissions taking place solely as a result of lack of care. These health workers however, should be well trained to properly understand any ethnical or cultural changes that may take place within their area of service. Without proper communication, the health care workers are unlikely to gain any support from the patient (Peek et al, 2007).

Distance care provision through computer-aided technology is another method where by care provision for diabetic patients can be carried out. IT and other methods such as telehealth are some of the most effective modes of future medicine, which will be able to provide up to date and quality health care to the patients at all times (Jackson et al, 2006). Since self-management is an important aspect of total diabetes care, the provision of quality timely professional guidance will help patients identify their own health status, and to seek medical help if they feel any thing is out of norm. The constant communication between the health professional and the patient also will allow no missing of events pertinent to the health of the patient. In this manner, health care provision can be carried out with more efficacy than ever before (Jackson et al, 2006).

Conclusions and Recommendations

For the most part, there is now a very deep understanding about the various issues that pertain to health disparities in the united states and how various factors are influencing this disparity. Therefore, the current needs and recommendations are easily identifiable, keeping in mind the requirement of the project. Firstly, is the proper recognition of the disparities where ever and whenever they take place by whomever member of the health care structure. This is the key that will help in creating accountability, and therefore, will result in lesser incidences of intentional disparities carried out in this regard. Second is the inclusion of the elimination of disparity as part of the competency levels to be exhibited by every health care individual (Department of Health and Human Services, North Carolina, 2003).

Diabetes is a condition that is rapidly becoming one of the most prevalent diseases in the globe. The management of such cases is a very difficult process, and prevention is the primary cure for this. Obesity and sedentary living styles along with low socioeconomic status is a very strong predictor of the possibility of getting diabetes. As more evidence is gaining regarding disparities in the health care sector of the US, the health providers and policy makers are targeting newer programs towards providing good preventive care and follow-up programs to ensure reduction in complications. Obesity however, remains a very tough challenge in the health care sector, for a very large proportion of the US population suffers from obesity. Methods to reduce obesity, and to increase physical activity among the people are an essential step to improve outcomes.

Any health programs that are developed must introduce and promote the sense of healthy living among the public, and educate the public in identifying how and where disparity is taking place. In this regard, the public as well as the health care sector holds responsibility for constant evaluation of monitoring health progress. The health teams and personnel therefore, must be of a cooperative disposition, which are able to ensure that care is provided with utmost competency levels. They must also be able to have said in devising policies that exclusively eliminate disparities in the public (Department of Health and Human Services, North Carolina, 2003).

The African American community is among the hardest hit populations due to diabetes. The high morbidity and mortality rates along with high-risk rates make diabetes a potentially lethal weapon for this population. The lack of proper resources and access is the second most important factor in the propagation of this disease, which increases diabetic complications significantly.

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