Diabetes Mellitus among the Aboriginal Australian Community - Essay Example

Diabetes Mellitus among the Aboriginal Australia Community Literature review Introduction The prevalence of diabetes mellitus among Australian indigenous populations has been recognized as a major health issue. When people in other areas of Australia talk of managing diabetes, this implies not only the problem of dealing with the blood sugar level of indigenous Australians but also dealing with their life which is characterized by massive poverty, drug abuse and many other negative aspects of living (Thompson & Gifford 2000). From the above perspective, achieving any form of balance in the life of indigenous Australians requires maintenance of momentous connection to family life, the people’s land and as well as analysis of their past and potential future, all of which are significant for improvement of their health and general well being (Thompson & Gifford 2000). Yet indigenous Australians, like many other indigenous people around the world, live a type of life in which identity with culture is closely related to their health. In essence, it is difficult to separate health issues from the cultural aspects of indigenous Australians (Thompson & Gifford 2000). This review will focus on diabetes mellitus among indigenous Australian communities with respect to its prevalence, what has been to study it as well as manage it, and the success or failure of various intervention programmes. In the end, the review leads to the areas that need more intervention and what needs to be done for more success. Nature of prevalence of diabetes mellitus among indigenous populations Indigenous Australians are one of the people living in the worst conditions in the world. The poor conditions are attributed to the fact that the indigenous people’s original lifestyle was badly distorted socially and economically as a result of displacement caused by settlers (Thompson & Gifford 2000). Indigenous Australians have been forced to cope with instances that expose them to risk. Such include infectious diseases, alcohol and drug abuse as well as western diets featured in most cases by foods rich in sugar and fat (Thompson & Gifford 2000; Bambrick 2003 Cassano 1992). Occurrence of renal diseases among indigenous communities has been an issue of particular concern over a period of about twenty years ago (Shephard et al 2003; Bambrick 2003; Shephard et al 2003). All the aforementioned factors have collectively contributed to the occurrence of chronic renal diseases at a level much higher than that occurring among other Australian communities (Shephard et al 2003, Bambrick 2003). One of the major social and health problems that have seriously affected the indigenous populations of Australia is the occurrence of diabetes mellitus. Shephard et al (2003) note that cases of morbidity and mortality are continually on the rise due to the heavy impact of diabetes mellitus on the populations. Daniel and others (1999) have also shown that Type 2 diabetes is among the leading causes of premature mortality among the indigenous communities of Australia. The figures of patients suffering from Type 2 diabetes are much higher among the indigenous populations (between 15 to 25 percent) as compared to values ranging between 2 and 5 percent among the non-indigenous Australians (Daniel et al 1999; Thompson & Gifford 2000). The prevalence of diabetes mellitus among Australian indigenous populations has been recognized as a major health issue. Studies of cohorts have shown that obesity and tobacco smoking a well as the other features of the metabolic syndrome are independent indicators of the prevalence of the condition (Daniel et al 1999). Obesity is one of the factors that have contributed to the high prevalence of diabetes mellitus among indigenous Australian communities. This is because of the rather sedentary life that the communities have been forced to adapt to, in addition to having diets of high sugar content (Daniel et al 1999). Generally, obesity is considered to be one of the greatest contributors of diabetes mellitus. In many studies carried out among indigenous populations, it has been found out that the prevalence of obesity among individuals correlates with the level of westernization that individuals have undergone (Daniel et al 1999). Among the indigenous communities, it has been noted that poor diet and sedentary lifestyle contribute to obesity. The same conclusion made about the rising level of obesity among women in most parts of Australia (Daniel et al 1999). By the late 1990s, it was found out that indigenous people of Australia were at a nine-fold level of risk of developing renal related complications compared to non-indigenous people. The figures presented by Shephard and others (2003) show that in the Northern Australia Territory where more than 20 percent of the inhabitants are indigenous communities, the rate of occurrence of renal diseases was considered a pandemic in the 1990s. In Tiwi Islands there were reported cases of 2700 patients in every 1 million people (Shephard et al 2003).This led to calls for the introduction of screening programs at the community level in order to tame the prevalence of renal diseases such as diabetes mellitus (Shephard et al 2003). In 1997, the Renal Unit located at Flinders Medical Centre responded to a request from the Umoona Tjutagku Health Centre and collaborated with the health service in conducting a renal disease screening program for adults within the Umoona Community, about 850 kilometres to the north of Adelaide (Shephard et al 2003). The program was later expanded to include screening services for children as it was understood that they were equally at risk of suffering from diabetes mellitus (Shephard et al 2003; Bambrick 2003). The Umoona community is one of the indigenous populations that have greatly been affected by the renal diseases, particularly diabetes mellitus (Shephard et al 2003, Bambrick 2003). Many of its members suffered from advanced renal complications during the 1990s and were dislocated from their families in order to undergo specialised dialysis services in a number of health facilities in Southern Australia as well as the Northern Territory (Shephard et al 2003). Members of the screening project found out that members of the Umoona community were not only suffering from renal complications but were also severely traumatised by the condition (Shephard et al 2003). Therefore, they made a recommendation that in addition to treatment; there was need for education and awareness about renal diseases among indigenous communities. Additionally, they proposed that the then existing programs needed to be strengthened in order to have a wider and better coverage of indigenous communities (Shephard et al 2003). Although the indigenous Australians are well aware of the health problems afflicting them, there is a common perspective that intervention and management programs have not been effective in addressing their plight (Bambrick 2003; Shephard et al 2003; Daniel et al 1999). In spite of the ever increasing research into the risk factors that amplify the prevalence of diabetes mellitus among indigenous Australians, morbidity and mortality rates seem to be still at very high rates (Shephard et al 2003). Several published articles have shown that there is a relationship between way of life, family aggregation, genetic makers, genetic admixture and the risk of prevalence of diabetes among indigenous populations (Cockram 2000, Thompson & Gifford 2000; McDermott et al 2000; Bloomgarden 2004). The pattern of prevalence of diabetes mellitus among indigenous populations is perturbing. Before 1991, studies showed that men under the age of 25 years were not at risk of being affected by diabetes, and the condition was as well uncommon among women about the same age (McDermott et al 2000; Bloomgarden 2004). However, by the year 1995 the prevalence of diabetes mellitus was realized even among very young populations. The declining onset age of diabetes among indigenous communities bears a variety of implications regarding other complications related to diabetes mellitus such as hyperglycaemia during pregnancy as well as the ensuing intergenerational intensification of the diabetes risk (McDermott et al 2000; Thompson & Gifford 2000; Bloomgarden 2004). Some researchers such as Bambrick (2003) and Thompson and Gifford (2000) have reported that smoking of tobacco is a major contributor of severe complications of diabetes. Along this line, Daniel et al (1999) reports that the various complications related to diabetes such as nephropathy, neuropathy, retinopathy, ischemia and erectile dysfunction are increased by tobacco smoking. It is for this reason that avoidance of tobacco smoking has been suggested as one of the ways to mitigate the impact and occurrence of diabetes (Daniel et al 1999; McCulloch et al 2003; Cockram 2000; Bloomgarden 2004). According to McCulloch et al (2003), it is well understood that recruitment of individuals into smoking and addiction to nicotine are very high among indigenous Australians, but the rates of cessation are much lower. This phenomenon is particularly much pronounced among individuals who are much challenged and in a status of socioeconomic disadvantage (McCulloch et al 2003; Daniel et al 1999). Along this line, indigenous people in areas such as Queensland are the most disadvantaged people in Australia. Although smoking is considered a major problem with respect to management of diabetes, little is known about the helpfulness of cessation intervention in patients suffering from diabetes (McCulloch et al 2003). Even then, many assumptions have been made that the intervention programs already in place are helpful in dealing with the diabetes menace among indigenous Australians as they have been in non-diabetic patients (McCulloch et al 2003). Evidence from past practice among Australian physicians indicates that most of them are unlikely to apply well-characterised management interventions in diabetes control programmes apart from the conventional practice of advising people to quit smoking (McCulloch et al 2003). Nevertheless, it is not known whether smoking intervention programmes are being implemented and/or if they are effective in the context of helping indigenous Australians (McCulloch et al 2003). Therefore, there is need to carry out studies to examine the differences in health characteristics between the indigenous people who are already aware of their diabetic condition and those who have not been diagnosed. Bio-statistical and epidemiological methodologies in study of diabetes mellitus among indigenous communities Many researchers have noted that the epidemiology of any disease occurring among diverse groups of people is difficult to understand. In particular, Thompson and Gifford (2000) have termed such a condition as “a research discipline that is itself out of balance” (p.1458). This is because in contemporary epidemiology, the scales of research are tipping towards the attributes at individual level and separate from variables that operate at group level as well as population levels (McCulloch et al 2003; Thompson & Gifford 2000). In view of the above points, epidemiology has practically ceased to operate as part of a multidisciplinary technique in understanding the causal agents of diseases among populations. Instead, it has become a set of non-specific methods for determining levels of associations of exposure and disease among various individuals (Thompson & Gifford 2000; McCulloch et al 2003; Cockram 2000). The above standpoints about epidemiology do not mean that research on risk factors at various individual or molecular levels are not important (Thompson & Gifford 2000). In essence, they mean that such researches do not suffice the needs of various intervention programmes. Hence, there is need to focus on what is happening at family community and society level. This is the reason why a number of epidemiologists have called for more emphasis on the study of social, cultural, historical, political and environmental impacts that touch human life (Thompson & Gifford 2000; McCulloch et al 2003; Daniel et al 1999; Jupp 2001; Brown 2007). In their paper titled Trying to keep a balance: The meaning of health and diabetes in an urban Aboriginal community, Thompson and Gifford (2000) discuss the importance of comprehensive epidemiological approaches for defining, understanding and acting appropriately with respect to risks that concern non-insulin dependent diabetes mellitus (NIDDM). Such approaches begin by analysis of the perspectives and vivid experiences of the diabetes menace amongst indigenous Australian communities (McCulloch et al 2003; Daniel et al 1999). Thompson and Gifford (2000) also note that understanding and experiencing of the risk of diabetes and the disease itself cannot be isolated from the people’s experiences in life that are characterised by unpredictable, unstable and disempowered realities of day to day life. This is because it occurs through the experiences lived through a recollection of the past as well as what is felt today and what the communities anticipate in future (Thompson & Gifford 2000; McCulloch et al 2003). According to Thompson and Gifford (2000), there are several tensions between the reality of the indigenous people being severely affected by diabetes mellitus and its effects on individual lives, on various communities as well as at society level. It is clear that the tensions that arise give rise to further dilemmas among the indigenous communities, especially when epidemiological models that focus on individuals are applied by health practitioners and researchers (McCulloch et al 2003; Bambrick 2003; Daniel et al 1999; Brown 2007). This is because most of the current epidemiological models not only fail to a take into deliberation the wider political and social contexts of well being and risk, but also fail to demystify the prevalent risks and how they are connected to general well being (Thompson & Gifford 2000). In fact, some of the factors identified by researchers and health practices as “risks” are in themselves the factors of protection and connection when viewed from the indigenous people’s perspective (Thompson & Gifford 2000). A major problem in dealing with the problem of diabetes mellitus is that most health intervention programs that are based on individual risk factor alteration can be viewed from the indigenous people’s standpoint as being risky (Thompson & Gifford 2000). This applies not only to their diabetes status but also to their more general well being and health conditions (McCulloch et al 2003). There is need for studies in which epidemiology systems incorporate various interacting mechanisms within a multiplicity of levels ranging from the molecular as well as individual level to the societal level investigations in order to come up with probable outcomes and determinants (Thompson & Gifford 2000; McCulloch et al 2003). Such an approach is what many researchers term as ecological epidemiology or eco-epidemiological interventions (Jupp 2001; Brown 2007). Ecological epidemiology or eco-epidemiological intervention involves a shift from the conventional individual to society mechanisms to dealing with chronic diabetes conditions and instead focusing on a renewed emphasis on host and environment- thus implying an approach that has meaning and context (Jupp 2001). This approach is what Thompson and Gifford (2000) term “a systematic and holistic model” as opposed to the conventional linear model. According to Daniel and others (1999), time trends for the prevalence of diabetes mellitus among indigenous Australian communities have largely not been published, and for this reason, the exact level of prevalence of the menace cannot be quantified. In addition, the relationship between body mass index and the risk of developing diabetes mellitus as well as the potentially modifying effects of sex and age have not been assessed for the indigenous populations (Magliano et al 2008; Cockram 2000; McCulloch et al 2003). Yet such information is very vital for the process of identifying optimal beneficial body mass index ranges for the indigenous people as well as for public health intervention programmes to curtail the catastrophe of non-communicable diseases among the indigenous communities of Australia (Daniel et al 1999; Magliano et al 2008; Cockram 2000). Daniel et al (1999) report that a strong linear relationship exists between the body mass index of indigenous Australians and the risk of diabetes. Nevertheless, the exact relationship between obesity and the risk of diabetes among indigenous populations is still unknown (Thompson & Gifford 2000; McCulloch et al 2003). Hence there is need for further study on how obesity modifies the risk of developing diabetes among Australian indigenous populations. Preliminary investigations such as that done by Cassano et al (1992) show that there is a greater risk of indigenous Australian men with a relatively high body mass index (≥ 26.9 kg/m2) being affected by diabetes mellitus. In line with this, there is need for a thorough study into community based initiatives that aim at preventing and reducing body weight among indigenous Australians (McCulloch et al 2003; Daniel et al 1999). A study by Thompson and Gifford (2000) revealed that aborigines suffering from diabetes mellitus are uncertain about their future and rarely talk about their diabetic condition. In order to avoid traumatising thoughts over diabetes, they would rather dwell on the future than talk about what would arise as a result of their condition (Thompson & Gifford 2000). The indigenous people’s perception of diabetes mellitus is directly related to what they know they need to take out of their bodies in order to regain balance. Thus, the diabetes illness is rarely measured in the context of how actually the indigenous people feel (McCulloch et al 2003; Thompson & Gifford 2000). As an example to illustrate misconceptions about diabetes, the indigenous people of Melbourne understand the treatment of diabetes mellitus in three contexts: diet control, use of tablets, and needles. To them, the severity of a diabetic condition is related directly to the type of treatment being used on any patient (McCulloch et al 2003). They consider patients on diet advice to be the least affected, and those under needle treatment to be the worst affected. Hence, every individual fears reaching the needle “stage” (Thompson & Gifford 2000). Efforts to curb the prevalence of diabetes among indigenous people are curtailed by the approaches used in dealing with the menace (Thompson & Gifford 2000). For instance, due to time limits and acute episodes of diabetes mellitus, most peopled tend to deal with the condition using methods that deal with measured and therefore perceivable blood sugar levels rather than employing long term measures to prevent the long term and less perceivable complications related to the condition (Thompson & Gifford 2000). Most people suffering from diabetes mellitus use unspecialised methods of treatment such as diluting their blood with water and using substances such as vinegar and tree extracts to flush sugar out of their bodies (Thompson & Gifford 2000). Although it is possible for some diabetes mellitus patients to manage their condition, most of them often give up due to the fluctuating level of their blood sugar content. In some cases, the blood sugar levels fluctuate to unmanageable levels and the patients “don’t know where they are going with it” (Thompson & Gifford 2000). Hence, many people often talk about the difficulties they encounter dealing with diabetes in part because they are also faced with other unpredictable problems in life. Most importantly, the indigenous people have other problems at family and community level which they prefer to talk about rather than the unpredictable nature of diabetes mellitus (Thompson & Gifford 2000). Thompson and Gifford (2000) have noted that the various problems encountered by indigenous communities seem to amplify the problem of diabetes mellitus to higher levels. Intervention programs therefore need to be multidimensional in order to address the wide array of problems so far discussed. Conclusion The prevalence of diabetes mellitus among indigenous Australian communities is related to the change of lifestyle that occurred when the communities were forced by circumstances to adopt western-like lifestyles. The change of lifestyle has exposed the communities to strange ways of life characterised by diets having high sugar content, alcohol and drug abuse, and adoption of an almost sedentary life that promotes obesity. Drug abuse, particularly tobacco abuse has been closely linked to high prevalence of diabetes mellitus and this needs further research. Most of the research and intervention programmes currently in place to support diabetes mellitus patients have failed to demystify the condition, hence making indigenous communities to live under constant fear of diabetes. Therefore, there is need for more research on people’s perceptions about diabetes and implementation of programmes that will involve systematic and holistic models that uncover the mysteries surrounding diabetes mellitus. With respect to conditions that can easily be arrested such as obesity, there is need for programmes that encourage body mass reduction among indigenous Australians. 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