According to the Centers for Disease Control and Prevention (CDC), health disparities refer to the variances in the health status of different groups of people (Gaskin et al. 2014). Individuals can be described by different factors such as geographic location, sexual orientation, disability, education or income, race or ethnicity or gender. Health disparities are inequitable and are directly associated with the current and historical uneven distribution of environmental, economic, political, and social resources. Health disparities result from multiple factors such as educational inequalities, behavioral and individual factors, insufficient access to health care, environmental threats, and poverty. Health disparities are also associated with equalities in education. For instance, dropping out of schools is linked to numerous health and social problems. People with low levels of education are at a higher risk of experiencing some health risks such as intentional and unintentional injury, substance, abuse, and obesity, compared to persons with more education (Gaskin et al. 2014). The purpose of this paper is to explore health disparity on diabetes, determinants of health factors which influence health and how they affect diabetes, epidemiology of diabetes, cultural considerations for diabetes, health care literacy challenges with the population impacted, and application of health promotion theory to the development plan for treatment of the problem.
Health Disparities in Diabetes
Like in many parts of the world, disparities in diabetes care are dominant U.S. Diabetes care is a significant area of national focus with more efforts directed towards improving the health of all Americans and eliminating healthcare disparities. In the United States, the current prevalence of diabetes is starling with about 25 million affected people and another 57 million individuals believed to have pre-diabetes (Gaskin et al. 2014). Ethnic and racial minorities have been identified to convey the inconsistent weight of diabetes with dominance among non-white Hispanics at 11% and that of African American at 12% compared to whites whose overall incidence of diabetes is 7% (Gaskin et al. 2014). Unless the current trajectory is interrupted, the number of diabetic individuals is projected to increase as the population becomes increasingly diverse and continues to age. This is a critical consideration of the annual cost attributed to care for diabetes patients being estimated to be about $185 billion and diabetes being identified as the sixth-leading cause of death countrywide. There are significant disparities in health outcomes and processes of care relevant to diabetes across the world.
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Recent findings from the National Healthcare Disparities Report (NHDR) show that the number of individuals with diabetes who had all three annual services as required by the American Diabetes Association (ADA) in the previous year was lower for those without at least college education, Hispanics, and for poor to middle-income people compared to their counterpart groups (Gaskin et al. 2014). The report also highlighted the rates of lower-extremity amputation being consistently among communities with median incomes <$45,000, Hispanics, and African Americans. The nation is generally doing poor regarding the quality of lipid control, the overall quality of glycemic and blood pressure. For instance, during the years 2000-2005, only 56.4% of diabetes patients reported blood pressures <140/80 mmHg and 47.8% met the expected A1C target of <7% (Gaskin et al. 2014).
Prospective studies have associated low health numeracy and literacy to the poorer knowledge of diabetes and recognition of symptoms, lower confidence or self-efficacy in diabetes management, and poorer glycemic control. Low health literacy has also been identified as an independent indicator of how patients gain from holistic diabetes management program. Whereas other determinants can be easily evaluated even in a time-constrained clinical environment, they are not instinctively evident especially during clinical appointments (Gaskin et al. 2014).
Determinants of Health
Multiple factors combine to affect the health of people and communities. Their environment and circumstances determine People’s health. To a large extent, the state of our environment, our relationship with friends and families, where we live, our income and level of education have considerable influences on health. The more significant factors such as availability and use of health care service usually have less impact on the health of individuals. The determinants of health include a person’s behaviors and characteristics, the physical social, and economic environment. The World Health Organization (WHO) identified nine determinants which make people unhealthy or healthy (Braveman & Gottlieb, 2014). These factors include:
Income and Social Status
Social status and income form one of the most important determinants of health in our society. Life setting and conditions of life are a critical part of well-being, and income determines the live setting and quality of life an individual lives. Higher income and social status are associated with better health. There is substantial evidence that low income and poverty is linked to shorter life expectancies, and increased mortality particularly diabetes mortality. Low income is linked to increased rate of readmissions for acute diabetes as well as the related complications. Low income affects the access to diabetes care services which in turn results in increased complications (Braveman & Gottlieb, 2014).
Low education levels are associated with more stress, poor health, and lower self-confidence. Education is an essential economic and social development which has a profound impact on the health of a population. Health benefits of education are significant at the community level, individual level, and the larger social, cultural context. Unhealthy eating habits are linked to chronic and acute health problems such as diabetes, stroke, hypertension, and higher mortality levels. Lower levels of education attainment limit access to healthy food. Diabetes patients who have low levels of education are unable to manage their condition which in turn increases the complications associated with the condition, and this increases the rates of hospitalization (Braveman & Gottlieb, 2014).
Clean air, safe water, roads, houses, and communities and healthy workplaces all lead to good health. People who have more control over their working environment are healthier than their counterparts. Access to various health-related resources such as medical care, recreational resources, and healthy or unhealthy food affect the health of individuals. A person’s life has a significant impact on developing diabetes. For instance, the risk for type 2 diabetes depends on lifestyle choices and individual factors. Increasing access to physical activity and healthy foods may help to combat the risk of developing diabetes especially in low-income regions. Diabetes is prevalent in minority and low-income populations and therefore making significant changes to the physical environment in low-income areas may lead to improved lifestyle choices (Braveman & Gottlieb, 2014).
Social and Support Networks
When patients have great support from relatives, friends, and communities, they are likely to recover faster. Beliefs, customs, and culture of family and community may affect health. There is a robust relationship in which the emotional and social support from other people can be protective of health. Social support reduces the physiological and psychological consequences of stress and helps to promote immune function. Both formal and informal social network provides a sense of security, belonging, and community. In diabetes patients, social support can predict self-care behavior. Thus having family members involved in self-care behavior can be essential in delivering care to diabetes patients (Braveman & Gottlieb, 2014).
Inheritance plays a significant role in determining the healthiness, lifespan and the risk of developing certain conditions. Personal behavior and coping skills such as smoking, drinking, keeping active, eating a balanced diet, and how to cope with stress and life challenges all affect health. Genes affect the chance of having common illnesses such as diabetes, asthma, and heart disease. Genetics play a significant role in the development of type two diabetes. Scientists have linked several gene mutations to a high risk of diabetes. These mutations can be transferred from parents to children (Braveman & Gottlieb, 2014).
Access and use of health services which prevent and treat illnesses influences health of a community. Availability of healthcare affects a person’s overall mental, social, and physical health status and quality of life. Barriers to health services include the high cost of care and inadequate or lack of insurance coverage. In individuals with diabetes, lack of insurance coverage is linked to poor glycemic control. Besides, poor use of health care services is associated with poor blood pressure and glucose control (Braveman & Gottlieb, 2014).
Men and women suffer from different forms of illnesses at different ages. Many male health risks can be associated with behavior. Generally, men engage in behaviors which lead to high rates of disease and injury. Also, genes, hormones, and anatomy play important roles in men’s increased risks for diseases. Although diabetes strikes men and women almost equal numbers and affects them in the same ways, it raises the risk of cardiovascular disease in women more than in men. Diabetes puts women at a higher risk for developing heart disease compared to men (Braveman & Gottlieb, 2014).
The food which individuals consume gives the body nutrients to function properly. If the body does not get the correct nutrients, the metabolic processes will suffer leading to declining in health. Poor eating habits also impact the health of a person. Poor nutrition impairs the well-being and daily health of an individual and reduces the ability to lead an enjoyable and active life. Poor nutrition can lead to the risk of developing some disorders such as type-2 diabetes, stroke, hypertension, heart disease, obesity, and high cholesterol l(Braveman & Gottlieb, 2014).
Personal behaviors entail what an individual eats if they smoke or drink, and the amount of exercise they do. Lifestyle changes related to physical activity, eating behavior, and obesity play a significant role in the management of type 2 diabetes. Physical activity has been shown to have a protective effect on type 2 diabetes, and lack of physical exercise increases the risk of developing diabetes (Braveman & Gottlieb, 2014).
Epidemiology of Diabetes
Diabetes cases are high and rising in every country. This prevalence is fuelled by the global rise of unhealthy lifestyles and high prevalence of obesity. According to the National Diabetes Statistics Report in 2017, the global prevalence of individuals with diabetes is 384 million, and these statistics are estimated to rise to 592 million in 2035 (Bhupathiraju & Hu, 2016). It is estimated that 30.3 million (9.3%) in the U.S population had diabetes in 2015. These statistics included 29.7 million people of above the age of 18 years (12.3% of all U.S adults. Out of these statistics, 7.2 million people (24.2%) did not report or were not aware of being diagnosed with diabetes. The prevalence of diabetes increased with age accomplishment a high of 24.2% among those aged 65 years or older. The age-adjusted incidence of undiagnosed and diagnosed diabetes was higher among Hispanics, non-Hispanic blacks, and Asians, and Asians compared to non-Hispanic during 2013-2015. According to CDC, the prevalence of diagnosed type 1 diabetes in the U.S in 2016 was 0.55% or 1.3 million adults, while the prevalence of diagnosed type 2 diabetes was 8.6% or 21.0 million adults (Bhupathiraju & Hu, 2016).
Understanding the importance of cultural sensitivity is the initial step towards delivering competent and sensitive diabetes education. It is more than a predetermined knowledge of actions, thoughts, language, customs, beliefs, and cultural values. The importance of gaining relevant insight aids the need to create a certain amount of cultural humility. This helps to create a positive relationship and mutual respect among healthcare providers and patients. People are likely to promote their quality of life and achieve desired outcomes.
Health Literacy Challenges
Poor health literacy is common among diabetic patients and is linked to important health outcomes. In the management of diabetes, health literacy is related to glycemic control, self-care behaviors, self-efficacy, and diabetes knowledge. Also, health literacy provides a better understanding of the racial disparities seen in patients with diabetes. Improved diabetes care can be provided through strategies which address health literacy which is based upon acknowledgment of its role (Bhupathiraju & Hu, 2016).
Health Promotion Theory in a Treatment plan for Diabetes
The Transtheoretical Model (TTM) can be used to offer guidance for the treatment plan for diabetes. Using this model, one can match the intervention for diabetes as well as other aspects of the TTM. The large components all the TMM can healthcare problem providers reinforce behavior change interventions to promote successful outcome of diabetes patients.
Health disparities are inequitable and are directly associated with the current and historical uneven distribution of environmental, economic, political, and social resources. Like in many parts of the world, disparities in diabetes care are dominant U.S. Diabetes care is a significant area of national focus with more efforts directed towards improving the health of all Americans and eliminating healthcare disparities. Multiple factors combine to affect the health of people and communities. Their environment and circumstances determine People’s health. Diabetes cases are high and rising in every country. This prevalence is fuelled by the global rise of unhealthy lifestyles and high prevalence of obesity. Understanding the importance of cultural sensitivity is the initial step towards delivering competent and sensitive diabetes education. The Transtheoretical Model (TTM) can be used to offer guidance for a treatment plan for diabetes (Lee, Park, & Min, 2015).
Bhupathiraju, S. N., & Hu, F. B. (2016). Epidemiology of obesity and diabetes and their cardiovascular complications. Circulation research, 118(11), 1723-1735.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Gaskin, D. J., Thorpe Jr, R. J., McGinty, E. E., Bower, K., Rohde, C., Young, J. H., … & Dubay, L. (2014). Disparities in diabetes: the nexus of race, poverty, and place. American journal of public health, 104(11), 2147-2155.
Lee, J. Y., Park, H. A., & Min, Y. H. (2015). Transtheoretical model-based nursing intervention on lifestyle change: a review focused on intervention delivery methods. Asian nursing research, 9(2), 158-167.
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