Vulnerable Population - Coursework Example

Vulnerable Population Affiliation with more information about affiliation, research grants, conflict of interest and how to contact Table of Contents Introduction ..... 3 Demographics ..... 3 Immigration Status & Occupation of South Asians ….. 3 Growth of South Asian Population ….. 5 Assessment of the South Asian Indian Population ….. 6 Language Proficiency ….. 7 Theoretical Framework ….. 8 Diagnosis of South Asian Women ….. 9 Planning & Development ….. 11 Intervention ….. 12 Outcome ….. 12 Implementation ….. 13 Evaluation ….. 14 Summary ….. 15 Vulnerable Population Introduction:        Good health is a prime factor that determines the well being of an individual as well as nation. The implementation of health programs and policies addressing the minority groups, consisting of all the racial and ethnic sects, “is fundamental to the growth and development of a nation” (No More Denial: Giving Visibility to the Needs of the South Asian LGBTIQ Community in Southern California p. 5).  Demographics: In the US, special concern has been given to the South Asians as this is the third largest Asian community in the United States South Asians in the United States by Group       Group Race Alone Race Alone or in Combination Size Percentage of South Asian Population Size Indian 1,678,765 89% 1,899,599 Pakistani 153,533 8% 204,309 Bangladeshi 41,280 2% 57,412 Sri Lankan 20,145 1% 24,587 Nepali 7,858 < 1% 9,399 Total 1,901,581 100%   (Demographic Characteristics of South Asians in the United States, 2000).    Immigration Status & Occupation of South Asians:    According to the US census in 2000, there were about 1.9 million people living in the US, which was increased by 106% between 1990 and 2000. The majority of South Asian Indians who live in the United States are foreign-born, with a range of immigration statuses that consist of “undocumented immigrants, student and worker visa holders and their dependents, legal permanent residents and naturalized citizens” (9/11 Anniversary: The View of South Asian, 2011). The South Asian community in the US is widely diverse as they come from seven countries with different ethnicities, cultures, languages, education levels, religions, classes, etc.        The ‘first wave’ or ‘first generation’ of South Asian immigrants in the US, who came in between 1890s and the 1920s, focused mainly on occupations such as agriculture, lumber, steamship, and railroad industries. The ‘second wave’ or ‘second generation’ (No More Denial: Giving Visibility to the Needs of the South Asian LGBTIQ Community in Southern California p. 5) of immigrants was either professionals or entrepreneurs, who came from urban and highly educated backgrounds. “The third wave of immigrants, characterized by a demographic shift in immigrants in the 1980s” (Vyas et al. 2010, p. 7) allowed well-established South Asian families to sponsor their emigrating family members, were less educated and more economically disadvantaged than their family members who immigrated to the U.S. in the second wave. Most of them are less proficient in English and were employed in service sector jobs, such as taxi driving, motels, convenience stores and gas stations. The most recent influx of the Indian immigrants to the US was the result of the boom in the IT sector. A wave of well educated immigrants came to US in between 1995 and 2000, to pursue higher education and employment opportunities. It is estimated that about 44% of all H1-B specialty occupation visas are from India, which resulted in a significant growth of Indian community in the US. Foreign-born and Native-born Populations among South Asian Americans   Group Race Alone Race Alone or in Combination Native- born Foreign- born Naturalized Citizens Non- citizens Native- born Foreign- born Naturalized Citizens Non- citizens Bangladeshi 17% 83% 25% 58% 17% 83% 26% 57% Indian 24% 76% 30% 46% 27% 73% 29% 44% Pakistani 24% 77% 31% 46% 26% 74% 30% 44% Sri Lankan 17% 83% 31% 52% 21% 79% 30% 49% Total 25% 75% 30% 45%         (Demographic Characteristics of South Asians in the United States, 2000).     Growth of South Asian Population:        The South Asian community in Los Angeles County has grown over the last several decades. The South Asian community in Los Angeles County consists of immigrants from India Pakistan, Sri Lanka and Bangladesh, 88% of whom are foreign born. As per the census of 2000, there were approximately 300,000 South Asians in Los Angeles County. During “the period 1990 - 2000, there was an increase in the population” (No More Denial: Giving Visibility to the Needs of the South Asian LGBTIQ Community in Southern California p. 5) rate in Los Angeles County, with 63% growth among Indian population, 50% among Pakistani population, 93% among Sri Lankan population and 242% among Bangladeshi population. Growth Rate of South Asians in the United States Since 1990   Group Race Alone Race Alone or in Combination Population in 1990 Population in 2000  Percentage increase from 1990 to 2000 Population in 19905 Population in 2000  Percentage increase from 1990 to 2000 Indian 815,447 1,678,765 106% 815,447 1,899,599 133% Pakistani 81,371 153,533 89% 81,371 204,309 151% Bangladeshi 11,838 41,280 249% 11,838 57,412 385% Sri Lankan 10,970 20,145 84% 10,970 24,587 124% Total 919,626 1,893,723 106%       (Demographic Characteristics of South Asians in the United States, 2000).   Assessment of the South Asian Population:   As there have been a growth in the South Asian population, so too are the cultural and financial inequities and barriers faced by them. It is estimated by the U.S. Census Bureau in the year 1999 that a significant percentage of South Asians live at or below the poverty line. About 13% of Indian lives at the poverty level, which approximately constitutes about 200, 000 individuals.            (Demographic Characteristics of South Asians in the United States, 2000).          For the South Asian community, in general, the concept of family supersedes in importance to that of an individual.  As a norm, men in South Asian family run the home and the women take care of the domestic needs of the family. Among the Asian Indian community in Los Angeles County, about 80% of men and 54% of women have jobs. (Demographic Characteristics of South Asians in the United States, 2000). Language Proficiency:     About one quarter of Asian Indians in the US are limited English proficient (LEP) and/or reside in linguistically isolated households (LIH). Their lack in English language proficiency acts as a major barrier to their access to necessary health services and benefits. LEP and LIH Rates of South Asians by Group   Group Race Alone Race Alone or in Combination LEP Rate LIH Rate LEP Rate LIH Rate Bangladeshi 50% 32% 52% 34% Indian 23% 11% 23% 11% Pakistani 32% 15% 32% 17% Sri Lankan 19% 10% 18% 11%        (Demographic Characteristics of South Asians in the United States, 2000).   Theoretical Framework: For implementing Diabetes Prevention and Health Promotion, the Precede-Proceed model of planning and evaluation is applied. This model helps to explain, design, influence and evaluate the health-related behaviors and environments and their consequences. The precede-proceed model, which is based on the disciplines of health administration, epidemiology and the social, behavioral, and educational sciences, is used in this health initiative and it emphasize that diabetes and its associated risks are caused by multiple factors and efforts to effect behavioral, environmental and social change of the diabetes patients should be multidimensional and participatory. This model requires multi-level planning, as it involves eight phases. Precede, the diagnostic part of the model focuses on the desired goals of the intervention and set the structure and targets for the planning and design of intervention. Proceed is the treatment part of the model and it involves the implementation and evaluation of the intervention. Precede-proceed model also helps to revise the plan as per the results of various evaluations. The Precede- proceed model has been applied to more than 960 published studies in communities, schools and clinical and workplace settings over the last decade. One such research study is the one conducted by Huang & Goran (Prevention of Type 2 Diabetes in young people: a theoretical perspective, 2003) that presents a comprehensive, theoretically diverse model that addresses the socio-cultural, community behavior and potential factors affecting risk behaviors for diabetes. Diagnosis of South Asian Women: Though there has been a significant growth in the South Asian population, not much research was conducted to address the health and well being of the minority sections of South Asian community. The South Asian communities in Los Angeles County have put forward health initiatives to address the health disparities that exist among different sects of the South Asian population. But the health disparities that exist in South Asian women, in particular, needs to be addressed as they are highly susceptible to type 2 Diabetes Mellitus (T2DM) and cardio metabolic diseases. The health promotion and health care implemented by the Government and community organizations are less effective in providing assistance to South Asian women, as these health initiatives tends to be less family oriented. This inability to reach out to the individual family units in Los Angeles County has created a gap between the health needs of South Asian Indian women and the health services offered by the Government, which, in fact, are caused by the cultural, financial and linguistic barriers. Majority of the Asian women belonging to the low income families of Los Angeles County, are homemakers. Their non-proficiency in the English language and economic instability and inequality distances them from the health development programs. But the drastic change in the attitude of the South Asians towards the health issues, in the recent years, has led to initiatives for the health development of the individuals and community health, by reaching out towards each South Asian family. The South Asian organizations in Los Angeles County have, today, bridged the gaps that exist between the health needs of Asian women and the health services offered by the Government of Los Angeles County. (Vyas et al. 2010, p. 6). The majority of South Asian women in Los Angeles County exhibits the risk factors of diabetes and is more vulnerable to this disease. Diabetes mellitus or T2DM, a prominent public health crisis in the U. S. as well in the world, is a chronic condition characterized by high blood sugar level (fasting blood sugar ≥ 126 mg/dL), which occurs when the body becomes resistant to the effects of insulin. (Trends in Diabetes: A Reversible Public Health Crisis, 2010, p. 1). As per the national estimates in the United States conducted by the Department of Health and Human Services on Diabetes in 2007, approximately 17.9 million people had diabetes and about 5.7 million more people had undiagnosed diabetes (Trends in Diabetes: A Reversible Public Health Crisis, 2010, p. 1). The primary risk factor for the Type 2 Diabetes, which is accounted for the 90% of all diabetes cases, is obesity. Poor dietary habits, such as intake of food with high fat and low fiber content, are yet another major risk factor for diabetes.  Other risk factors associated with this condition are age, heredity, race/ethnicity, history of gestational diabetes and physical inactivity. The most common symptoms of diabetes are blurry vision, unexplained weight loss, increased thirst, frequent urination, fatigue, numbness or tingling in the hands or feet and/or skin, urinary tract and/or vaginal infections. Diabetes, in its earlier stages cannot be detected, but when it becomes severe, it causes damage to the nerves and blood vessels leading to heart disease, stroke, kidney disease, blindness, loss of sensation in extremities and amputation, if left untreated. South Asian women exhibit higher rates of cardio-metabolic risk factors such as central adiposity and high insulin resistance when compared to other South Asian communities (Purpose of Investigation and Specific Objectives). It has been found that these conditions are developed in them at an early stage and at lower body mass indices, than the other populations. Further, these conditions are found high in those South Asian women, who have fat around their waist or belly and have higher rates of insulin resistance. The gestational diabetes which occurs during the late stages of pregnancy can also leads to the onset of diabetes in South Asian women. South Asian women with diabetes are found to have worse glycemic control, a higher prevalence of micro-albuminuria, hypertension, retinopathy and cardiovascular disease and renal disease than other ethnic diabetic populations (Purpose of Investigation and Specific Objectives). It is estimated by the health department of LA County that Diabetes Mellitus is one of the costly medical conditions that requires approximately $6.4 billion per year in the region of LA County itself. (Trends in Diabetes: A Reversible Public Health Crisis, 2010, p. 1) Diabetes also affects quality of life as it can lead to disability and premature mortality, if not properly treated. In Los Angeles County, Diabetes has been the sixth leading cause of death since 1997 and it is also accounted for the premature death (death before the age of 75) since 1999. In 2006, Diabetes became the ninth leading cause of death and an estimate shows 25 deaths per 100,000 populations due to this condition. Studies show that the risk of death is twice for a diabetes patient when compared to people without diabetes of similar age. Also, about 35 - 40% of people die from this condition and/or its complications. Planning & Development:     For the planning and development of Diabetes Prevention and Health Promotion program, conceptual bases will be drawn from the projects conducted by Farquhar (The community-based model of life style intervention trials, 1978), Luepker and Råstam (Involving community health professionals and systems, 1990) and Bjärås (Community diagnosis, participation and leadership: Studies of a Swedish injury prevention program, 1992). The intervention phase of this program is directed at the three major risk factors that contribute to the incidence of Diabetes, which are poor dietary habits, physical inactivity and obesity. These risk factors, if effectively controlled, can lead to the reduction of Diabetes Mellitus and IGT in the South Asian Indian population. A Community-based Participatory Research (CBPR) approach will be utilized for Diabetes Prevention & Control that will seek participation of faith-based organizations also. Intervention: In order to promote diabetes prevention and to reduce health disparities, an initiative to reach the South Asian families needs to be taken, which is possible only through the association of South Asian community organizations and local health providers. The two main strategies that will be used in this program are community intervention and intervention within community organizations. The participation of both community organizations and faith-based organizations is highly valued and prioritized in this health care program for the Diabetes Prevention & Health Promotion, as it can ensure that each family member of South Asians, especially women, can have access to the health care services.  Further, participation of local health care providers and Community Health Workers (CHWs) will be encouraged as they can bridge the cultural and linguistic barriers and bring in those individuals who require healthcare services and benefits.  Outcome: Since the incidence of Diabetes itself can be prevented, the primary outcomes, of this healthcare program will be to impart knowledge on the necessity of improving dietary habits, reducing obesity and increasing physical activity. This health care program for the “Diabetes Prevention and Health Promotion will be carried out during a ten year period and its primary outcomes are, (i). Access to health-care provider for regular check-ups. (ii). Ensuring that Diabetes is treated according to current requirements. (iii) Positive Improvements in dietary and physical activities. (iv). Weight Reduction and reduction in BMI and hip-to-waist ratio measurements and, (v). Improved Diabetes knowledge, self motivation and diabetes self-care skills (Trends in Diabetes: A Reversible Public Health Crisis, 2010, p. 4). The secondary outcomes are, (i). To reduce the incidence of T2 Diabetes Mellitus in the South Asian Indian community, especially women, by 25% and, (ii). To reduce the prevalence of Impaired Glucose Tolerance (IGT) correspondingly in the population. Implementation:    The health care program for the Diabetes Prevention and Health Promotion will be executed as per Precede-Proceed theoretical framework that consists of eight phases. In the Precede part, the CHWs in LA County, with the support from South Asian community organizations and faith-based organizations, will conduct health fairs and will carry out Need Assessment Surveys and focus groups with the South Asian population to provide qualitative and quantitative data on topics like general health needs, access to health services, life style behaviors and perceptions of diabetes. CHWs and health care providers will also conduct a health screening to measure fasting blood glucose, cholesterol, body mass index and blood pressure that will yield data to assess the prevalence of diabetes risk factors among South Asian Indian population in Los Angeles County (Project Rice, 2011). The information on the health behavior practices of South Asian Indian population, which can become the risk factors for developing Diabetes, can be available by the focus groups conducted by the CHWs.    In the Proceed part of Diabetes Prevention and Health Promotion, CHWs and local health providers with the support of community and faith organizations, will participate those individuals who were identified as at risk of Diabetes by the health screening tests of Precede part of the project. These participants will be brought in to their nearest community or faith organization sites to meet CHWs, where they will attend group sessions conducted for the education of Diabetes. At the group sessions for the Diabetes Prevention and Health Promotion instruction for the control of the disease will be articulated among the participants and the CHWs will follow them up with weekly telephone calls. The participants will receive access to their local healthcare providers, who are an essential part of this health service program. Evaluation: The efficacy of Diabetes Prevention and Health Promotion program will be analyzed with both summative and formative evaluations, based on its outcome and process. The summative evaluation will provide data of the effects of the program on diabetes mortality, on the primary stages of diabetes and on weight and physical activities measured prior to start of intervention and after each year till the tenth year in the South Asian Indian population, especially women, in Los Angeles County. The formative evaluation will help to evaluate and revise the strategies, tactics and activities used within the intervention. The analysis of data of the interviews and counseling by the CHWs with the participants at the community and faith organization sites, conducted once in six months to assess the predisposing and reinforcing factors for diabetes, health behaviors and primary outcomes, will help to evaluate the effectiveness of Diabetes Prevention and Health Promotion program in the South Asian Indian population in Los Angeles County. Summary: The health disparities in South Asian women can be properly addressed only by community intervention and intervention within community organizations. This way, the cultural, linguistic and financial barriers that exist between the health promotion programs issued by the Government and their health needs can be bridged. Though the process of implementing and sustaining the program within the South Asian population in Los Angeles County is long, tedious and is open to scientific problems in the matter of results, it will provide health awareness and knowledge about the preventive measures of T2DM among the population. Type 2 Diabetes, which occurs due to the insulin resistance of the body and the inability of the pancreas to maintain adequate insulin secretion, is an increasing health concern for South Asian Women as it can adversely impact health, quality of life and life expectancy. Hence, designing a strong prevention intervention is required in order to address the health issues of South Asian Women. Prevention intervention of T2DM will greatly merit from those health programs that are directed towards the lifestyle-related changes in people that includes changes in dietary and physical activities. Moreover, the design of prevention of T2DM is based on precede-proceed model that aims to intervene on variables such as knowledge of diabetes and diabetes self-care skills; self-motivation and outcome expectation of lifestyle and behavioral changes; familial and expert support; overcoming the potential barriers to change. Availability of resources and community involvement are also considered in the proposed model to attain long-term health benefits. For the success of this health program a strong network among the various faith and community organizations, local health providers and CHWs are essential. The long term of the plan though can bring a change in the outcome of the program, the process of evaluation will help to detect whether this health initiative was a success or a failure. Diabetes Prevention and Health Promotion, since is a long term program will also help to increase our existing knowledge of the aetiology of T2DM. Reference List Demographic Characteristics of South Asians in the United States, (2000). U. S. Census 2000. Summary Files 1 Through 4. Retrieved November 26, 2011, from http://www.saalt.org/attachments/1/Demographic%20Characteristics%20of%20SA%20in%20US.pdf No More Denial: Giving Visibility to the Needs of the South Asian LGBTIQ Community in Southern California. (n.d.). Satrang. Retrieved November 26, 2011, from http://www.satrang.org/NeedsAssesmentReport.pdf Project Rice, (2011). NYU Langone Medical Center. Retrieved November 26, 2011, from http://prevention-research.med.nyu.edu/health-research/rice-project Purpose of Investigation and Specific Objectives, (n.d.). Bridges: International Diabetes Federation. Educational Grant from Eli Lilly and Company. Retrieved November 26, 2011, from http://www.idf.org/files/BRIDGES-example-of-a-good-application.pdf Trends in Diabetes: A Reversible Public Health Crisis, (2010). County of Loss Angeles: Public Health. Retrieved November 26, 2011, from http://publichealth.lacounty.gov/ha/reports/habriefs/2007/diabetes/Diabetes_Secure/Diabetes_2010_6pg_Sfinal.pdf Vyas et al. (2010). SAHNA 2010: A South Asian Health Needs Assessment of the Washington, D. C. Region. The George Washington University: School of Public Health and Health Services. Retrieved November 26, 2011, from http://www.gwumc.edu/sphhs/departments/pch/mch/download/Sahna.PDF 9/11 Anniversary: The View of South Asian, (2011). International Business Times. Retrieved November 26, 2011, from http://www.ibtimes.com/articles/211361/20110909/9-11-terrorist-attacks-indians-pakistanis-sikhs-muslims-arabs-osama-bin-laden.htm Read More