Introduction
Type 2 diabetes mellitus (T2DM), while remaining an overwhelming public health challenge for the US population, is a special burden for the minority groups. According to scholarly research, ethnic minorities nationwide, despite a higher predisposition rate, struggle with diabetes management and timely interventions (Joo & Liu, 2021). The purpose of this paper is to examine the ethical and cultural perspectives on the issue of T2DM in minorities. The ethical perspective inquiries are as follows:
- Level 1: What are the ethical obstacles to T2DM management and diagnosis?
- Level 2: What are the ethical obstacles to treating T2DM in ethnic and cultural minorities?
The cultural research questions are:
- Level 1: What cultures and societies are most affected by T2DM?
- Level 2: How is the issue of T2DM management addressed among ethnic minorities in the US?
Ethical Questions
The prevention and management of T2DM is an ethically and economically challenging endeavor because the nationwide prevalence of the disease implies equality in treatment and health care access. As far as primary T2DM intervention is concerned, some researchers suggest that bureaucracy and lack of a functional preventive framework create the ethical challenge of equal access to care (D’Souza, 2017). Moreover, the financial burden for modern T2DM treatment accounts for unequal access to medications. According to D’Souza (2017), the market-driven pharmaceutics for T2DM management promote costly solutions and disqualify cheaper options in order to exploit the business opportunities of one of the most widespread diseases in the US. The scope of the disease, especially in the American context, requires modifications in terms of medication and preliminary screening options for the population.
Another ethical challenge of T2DM management is effectively monitoring the patients’ adherence to treatment. Indeed, according to Godman et al. (2020), many people who live with T2DM do not have proper access to the educational tools that improve their self-management rates and diminish the risk of co-morbidities. Hence, it becomes evident that the population affected by T2DM nowadays faces the challenges of equality and proper public health concern about disease prevention. The issue, however, while depending significantly on the socio-economic status of the patient, disproportionally affects the minority groups.
Among 37 million Americans living with T2DM, the majority of patients have a diverse ethnic background. Thus, people of Hispanic origin and Black and Native American communities constitute nearly 40% of T2DM patients (Centers for Disease Control and Prevention [CDC], 2020). The challenges for minority groups find their roots in biological and socio-cultural factors. The socio-cultural factors include “low income and decreased access to education and health care” (Aguayo-Mazzucato et al., 2018, p. 1). Thus, the ethical challenge of equal access to treatment and screening is explicitly challenging for non-White communities, as the lack of financial opportunities to adhere to the treatment and poor medical supervision stand in the way of T2DM management.
The issue is aggravated by the minoritiesâ biological component to treatment. According to Aguayo-Mazzucato et al. (2018), physiological factors include a higher predisposition to obesity and lower insulin sensitivity. These factors, while common for ethnic minorities, contribute to the family history of diabetes and high genetic susceptibility to the disease. Meanwhile, the public sectorâs efforts for T2DM management remain the same for the population. The existing preventative programs for minority populations do not demonstrate the desired outcomes (Godman et al., 2020).
The most important ethical challenge to T2DM management among ethnic minorities is minority stigmatization and discrimination in the community. According to LeBrĂłn et al. (2019), racial and ethnic discrimination in society leads to higher stress-related mental disorders and diabetes-related distress. As a result, biases, and discrimination tend to have a mediating impact on the patients’ HbA1c levels. Moreover, the racial bias associated with ethnic minorities limits the community’s ability to have a decent socio-economic status and receive a proper education. Thus, the ethical problem of discrimination, while increasing one’s chances of becoming susceptible to T2DM, later creates a challenge for the disease’s proper management and timely access to health care.
Considering the information above, it can be concluded that currently, T2DM management and diagnosis face the challenges of inequality and market-driven treatment strategies. As far as ethnic minorities are concerned, the ethical obstacles are exacerbated by stigma and discrimination in the community. Hence, there is a need to develop a functional framework to address these obstacles and promote efficient diabetes management in the ethnic communities affected.
Cultural Questions
The first question related to the cultural inquiries addresses the ethnic and social groups most affected by T2DM. Thus, according to the latest CDC (2020) report, ethnic communities with the higher T2DM rates include the Native American population (14.7%), people of Hispanic origin (12.5%), African American people (11.7%), and Asian community (9.2%) (p. 4). Such statistics prove the existence of significant care and management barriers for minority groups. Among these populations, the most affected social groups include individuals aged 45 and older with low socio-economic status associated with low pay rates and a lack of higher education (CDC, 2020). Hence, while the White population remains one of the least affected groups in terms of T2DM, the minority populations need specific attention from the public and the clinical community.
One of the reasons for such a disproportional impact on the ethnic minorities is the ambiguous cultural beliefs among different groups. Thus, for example, the Hispanic community of farmworkers from Florida resort to alternative non-clinical methods of treating T2DM (Tyson et al., 2019). They choose these options both because they lack access to health care centers in the community and because the proper medical intervention is costly. At the time of the research, many respondents had high HbA1c rates and were diagnosed with obesity (Tyson et al., 2019). Other social groups at the risk of T2DM development include smokers, physically inactive people, and people with high blood pressure and cholesterol rates, especially the male population (CDC, 2020). According to recent studies, ethnicity is considered one of the risk-enhancing factors for higher low-density lipoprotein (American Heart Association, 2019). Hence, it can be concluded that while almost every ethnic minority is at higher risk of developing T2DM, minority representatives with poor lifestyles and low socio-economic status are affected the most.
Considering the unprecedently high rates of T2DM in the US population, public health initiatives nowadays focus on creating efficient tools for disease management. According to the systematic review by Jang et al. (2018), some of the most recent management interventions include text-based reminders, online educational texts, web-based self-management programs with patient-tailored feedback and recommendations, and personal health records supported by health providers. Although these tools have proved their efficacy in increasing treatment adherence rates and patient motivation, technology-based management techniques are not accessible to most ethnic and social communities at risk.
Many studies oriented at finding ways to improve T2DM self-management are comprised of White participants, which means that the efficiency of these interventions is based on the samples which have the cultural and socio-economic advantage over the populations affected by the condition (Jang et al., 2018). Apart from existing social and cultural barriers to T2DM management, ethnic and social minorities are also at a disadvantage of having poor access to technology-based interventions. Meanwhile, the evidence shows that culturally tailored T2DM interventions such as disease knowledge promotion and access to health care programs have a beneficial impact on the disease outcomes (Joo & Liu, 2021). Hence, the issue of T2DM management among ethnic and social minorities is not addressed to a necessary extent, as the majority of intervention tools are studied on White patients who have an evident advantage over non-White counterparts.
Conclusion
The issue of T2DM prevalence among ethnic and social minorities remains extremely relevant in the American context. Currently, the groups susceptible to the disease include ethnic minorities, people with low socio-economic status, and people with an unhealthy lifestyle. Minority groups living with T2DM, while having inconsistent access to health care and a higher predisposition to the disease, are also faced with the stress of racial and cultural stigma that impedes the process of creating meaningful medical interventions. Both cultural and ethical components of T2DM management have now become crucial in the context of addressing the diabetes pandemic nationwide. Most relevant studies on diabetes today have no regard for the socio-economic and cultural status of the patients, as it promotes costly treatment and technology-based management solutions. Moreover, the management guidelines for T2DM do not account for explanatory tools for people with no access to high education and fundamental knowledge about the disease. Hence, considering the facts above, it can be concluded that T2DM management among ethnic minorities requires more culturally sensitive interventions.
References
AguayoâMazzucato, C., Diaque, P., Hernandez, S., Rosas, S., Kostic, A., & Caballero, A. E. (2019). Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes/Metabolism Research and Reviews, 35(2).
American Heart Association. (2019). Ethnicity a ‘risk-enhancing’ factor under new cholesterol guidelines.
Centers for Disease Control and Prevention. (2020). National diabetes statistics report [PDF document].
DâSouza, R. (2017). Ethical issues associated with diagnosing and managing diabetes. Global Bioethics Enquiry, 5(2), 52-56.
Godman, B., Basu, D., Pillay, Y., Mwita, J. C., Rwegerera, G. M., Anand Paramadhas, B. D.,… & Meyer, J. C. (2020). Review of ongoing activities and challenges to improve the care of patients with type 2 diabetes across Africa and the implications for the future.Frontiers in Pharmacology, 11.
Jang, M., Johnson, C. M., DâEramo-Melkus, G., & Vorderstrasse, A. A. (2018). Participation of racial and ethnic minorities in technology-based interventions to self-manage type 2 diabetes: a scoping review.Journal of Transcultural Nursing, 29(3), 292-307.
Joo, J. Y., & Liu, M. F. (2021). Experience of culturally tailored diabetes interventions for ethnic minorities: A qualitative systematic review. Clinical Nursing Research, 30(3), 253-262.
LeBrĂłn, A. M., Spencer, M., Kieffer, E., Sinco, B., & Palmisano, G. (2019). Racial/ethnic discrimination and diabetes-related outcomes among Latinos with type 2 diabetes. Journal of Immigrant and Minority Health, 21(1), 105-114.
Tyson, D. M., Arriola, N. B., Medina-Ramirez, P., ÄĂ o, L. U., Smith, C. A., & Livingston, T. (2019). âYou have to control it however you canâ: type 2 diabetes management in a Hispanic farmworker community in rural Florida. Human Organization, 78(3), 205-217.