Health Promotion Issue: Diabetes As A Government Health Priority
Health Promotion Issue: Diabetes as a Government Health Priority
Diabetes mellitus is a cluster of endocrine diseases characterized by the body's complete or partial inability to absorb glucose, the principal source of energy, from digested foods into cells (Harris, 1995). Unabsorbed glucose accumulates in the bloodstream, eventually exceeding physiologically tolerable levels, damaging blood vessels and capillaries. According to the National Institutes of Health (NIH) (1995), diabetic complications include blindness, renal failure, peripheral neuropathy, and peripheral vascular disease. People with diabetes are also at greater risk of cardiac disease, strokes, amputations, retinopathy, cataracts, glaucoma, and gestational complications compared with people of similar age without diabetes (CDC, 1998; NIH, 1995).
Diabetes is considered to be becoming an epidemic. Diabetes is considered a threat to individuals as well as to societies (Decoster 2001; Decoster & Cummings, 2005). Diabetes is a government health priority in Australia and is considered as one of the country’s most costly diseases. The increasing number of Australians with diabetes and conditions of impaired glucose metabolism is alarming. Diabetes became a health priority in Australia in 1996. Before 1996, the Australian government was not aware of the impacts of Diabetes on Australians and to the whole country as a whole. As a proof of the government’s commitment to deal with Diabetes, it became one of the National Health Priorities and the Australia’s Health Ministry created the “National Diabetes Strategy 2000-2004” (International Diabetes Institute, 2001).
Determinants of Health
There is a strong association between disease and socioeconomic status. Diabetes cannot be eliminated of the fundamental social determinants of health are not addressed. In recent years according to Gorin (2002) researchers from around the world have focused on the social determinants of health. It seems increasingly clear that the health of populations is influenced primarily by social factors (Tarlov, 1996). In addressing Diabetes, health risks, with particular emphasis on the determinants of health must be considered. The determinants of health can be grouped into genetics, social circumstances, environmental conditions, behavioral choices, and medical care (Harrington, et al. 2004).
In studying diabetes, there are risk factors that most researchers are focusing as determinants of health: (1) age, (2) obesity, (3) family history; and (4) ethnicity. The incidence of diabetes increases rapidly with age, so that people over the age of 64 are 3.5 times more likely to be diagnosed (Kenny, et al. 1995). Overweight adults are also at greater risk; men and women 20 percent above their desirable weight, a common indicator of obesity, are twice as likely to be diagnosed with Type 2 diabetes (Harris, 1995). A family history of diabetes (parent, grandparent) also increases the risk.
Although low-income individuals may not have greater risk than other groups for acquiring type 2 diabetes, there is reason to be concerned that their diagnosis may be delayed for a longer time after onset of the disease due to limited access to medical care (Shawver & Cox, 2000). They may not receive sufficient medical care and instruction to manage their disease due to lack of health insurance, little money to pay for services not covered by insurance, and limited ability to understand diabetes self-management instruction that is provided to them. Also, low-income individuals have an increased prevalence of hypertension, cardiovascular disease, obesity, and poor diets that are associated with type 2 diabetes.
It is important to consider these health determinants, particularly those social factors that affect health and well-being of the patients. Diabetes will not be successfully addressed if these health determinants are not attended to.
Secondary and Tertiary Health Promotion
Health promotion aims at prevention. There are three levels of prevention – primary, secondary and tertiary. Primary prevention is geared towards the prevention of new cases of diabetes by eliminating or decreasing contact to risk factors. Secondary prevention is geared towards the reduction of the effects of disease through early detection and management. Tertiary prevention is geared towards the obstruction of the disease from progressing and reduction of complications through treatment and therapy.
Secondary Health Promotion for Diabetes
For diabetes, secondary health promotion will focus on education about and management of the disease. Some of the techniques and resources that will be used are the following:
1. Alcohol and Diabetes (Pamphlet) – this resource will describe strategies for making healthy choices regarding diabetes and alcohol use.
2. Cholesterol and Diabetes (Pamphlet) – this resource will discus ways on assisting and caring for clients in order to help them to meet their targets for LDL-cholesterol by using both medication and lifestyle improvement.
3. Consequences of Diabetes (Video) – this resource will present a medical report regarding the health consequences of diabetes and will educate the patients and their families on the negative effects of diabetes on the body.
4. Diabetes Resource Guide (Booklet) – this basic, yet encompassing guide covers topics such as what is diabetes, healthy eating, physical activity, stress management relaxation, medications, blood glucose monitoring, preventing complications and keeping track.
5. Exercise with Diabetes (Pamphlet) – this resource will provide basic information about being active to help manage diabetes.
Tertiary Health Promotion for Diabetes
Tertiary prevention will involve actual treatment for diabetes and will be conducted by health care practitioners. Through tertiary prevention, it is expected that the progression of the disease will be stopped and the patient will achieve as close to normal physical, emotional and mental functions (Joe & Young, 1994). In this level of health promotion, two stages will be given attention – vascular complications and functional impairment.
1. Vascular Complications – in this stage, complications such as foot ulceration, eye complications and detection of renal insufficiency. In this stage, health promotion strategies will include:
- Aggressive medical treatment to cure complications.
- Teaching and counseling of clients in order to empower them to deal/cope with complications.
2. Functional Impairment – in this stage, client has already experience amputation and blindness or ESRD. Health promotion strategies will include:
- Rehabilitation in order to preserve function and to provide support for terminal care.
- Support group in order to help the client to cope with the disease and its complications.
- Home health care in order to support the client and their families.
Health Promotion Game: Snakes and Ladders
As part of the primary health promotion strategy, I would like to make use of a game that is based on Snakes and Ladders. The game is intended to educate clients about diabetes and to inform them about issues surrounding the disease. The game is also intended to encourage the clients to make healthy choices and have an active, healthy lifestyle in order to prevent diabetes. The health promotion game will be an interactive game that will teach clients (particularly children) how to make healthy decisions and lifestyle choices.
Centers for Disease Control and Prevention 1998, National diabetes fact sheet: national estimates and general information on diabetes in the United States, Washington, DC, U.S. Government Printing Office.
Decoster, VA 2001, “Challenges of type 2 diabetes and role of health care social work: a neglected area of practice”, Health and Social Work, vol. 26, no. 1, pp. 26+.
Decoster, VA & Cummings, SM 2005, “Helping adults with diabetes: a review of evidence-based interventions”, Health and Social Work, vol. 30, no. 3, pp. 259+.
Gorin, SH 2000, “Inequality and health: implications for social work”, National Associations of Social Workers, vol. 25, no.4, pp. 270+.
Harrington, C, Estes, CL & Crawford, C 2007, Health policy: crisis and reform in the U.S. health care delivery system, Jones and Bartlett Publishing.
Harris, MI 1995, Classification, diagnostic criteria and screening for diabetes. In Diabetes in America (NIH Publication No. 95-1468, 2nd ed., pp.15-36), Washington, DC, U.S. Government Printing Office.
Harris, MI 1995b, Summary, In Diabetes in America (NIH Publication No. 95-1468, 2nd ed., pp. 1-13), Washington, DC, U.S. Government Printing Office.
International Diabetes Institute 2001, Diabetes & associated disorders in Australia – 2000: the accelerating epidemic, viewed 18 August, 2009
Joe, JR & Young, RS 1994, Diabetes as a disease of civilization: the impact of culture on indigenous peoples, Walter de Gruyter.
Kenny, SJ, Aubert, R E, & Geiss, LS 1995, Prevalence and incidence of non-insulin dependent diabetes, in Diabetes in America (NIH Publication No. 95-1468, 2nd ed., pp. 47-65), Washington, DC, U.S. Government Printing Office.
National Institutes of Health. 1995, Diabetes in Washington, DC, U.S Government Printing Office.
Shawver, GW & Cox, RH 2000. “Need for physician referral of low-income, chronic disease patients to community nutrition education programs”, Journal of Nutrition for the Elderly, vol. 20, pp. 17-33.
Taylor, AR 1996, Social determinants of health: the sociobiological translation, in D. Blane et al. (eds.), Health and social organization, towards a health policy for the twenty-first century, Routledge, London.