Analysis of a Public or Community Health Problem - Research Paper Example

 Analysis of a Public or Community Health Problem Introduction Diabetes continues to be a rather difficult health problem not only in Washington DC but also in other cities and regions, particularly due to the lifestyles and diets of most of its victims. Diabetes, often referred to as Diabetes Mellitus, is a set of metabolic diseases characterized by high blood sugar since the body fails to produce enough insulin. The other cause of the high blood sugar is victim’s cells inability to respond to the insulin produced. Among the symptoms of diabetes are increased hunger, thirst, and frequent urination. The three common types of diabetes referred to as diabetes mellitus (DM) are Type I, Type 2, and gestational diabetes, which appear in expectant women without prior diabetes diagnosis (Cooke & Plotnick, 2008). While Type I DM is caused by the body’s inability to produce insulin and is managed by insulin injections, the Type 2 DM is caused by the body’s resistance to insulin when cells do not utilize the secreted insulin properly (Gardner, 2011). The other forms of diabetes are cystic fibrosis-related diabetes, steroid diabetes, and monogenic diabetes. That diabetes is a serious health issue in Washington DC is evidenced by the many long-term complications associated with the condition including diabetic retinopathy, chronic renal failure, cardiovascular disease, stroke, high blood pressure, and blindness. This paper explores diabetes as a public health problem in Washington DC with regards to its challenges to the community, barriers to its prevention and treatment, resources used to address the diabetes menace. Finally, the paper will give a few recommendations on the way forward for all stakeholders in the fight against diabetes. Resources for Diabetes Care Non-governmental organizations, government agencies, individual well wishers, and corporate bodies have all come in to fight diabetes by offering labor, monitory, educational, and awareness resources to the Washington DC’s public. Nonetheless, the main resources for diabetes are health care staff and the funding provided by the federal government and the various insurance schemes available for the public not eligible for Medicare or Medicaid. Other resources are health insurance on retirement, normal health care services, hospital care, prescription drugs, and other medical supplies and resources for dialysis and transplantation for diabetes-related conditions such as kidney diseases. Other services are prosthetic care, educational services, food and nutrition and technological assistance. However Medicare has been particularly helpful for diabetics over 65 year-olds and younger patients with certain disabilities, end-stage renal disease, and under/requiring dialysis or a kidney transplant. For these diabetics, Medicare covers diabetes services and supplies such as test strips, needles, syringes lancets, and glucose monitors. Medicare also pays for diabetes screening tests for ‘at-risk’ people and diabetes self-management training. Stakeholders in Diabetes Care To hasten the fruition of the efforts directed at preventing and treating diabetes, quite a number of interested individuals, non-governmental organizations, governmental agencies, and the corporate world have come in to collaborate in fighting the menace. For instance, the Cancer and Chronic Disease Prevention Bureau has established a diabetes control program in Washington, DC and other states in the U.S to help address the condition and its effects on individual patients and the community at large. In Washington DC, these programs are run by the Department of Health, located at 899 North Capitol Street, NE. The main objective of the Diabetes Prevention and Control Program is the promotion, supporting, and sponsoring of well being, health, and quality life among the Washington DC’s residents. Several interventions including preventing and controlling diabetes-related costs, mortality, morbidity in the District are used by the program to manage diabetes. Community partnerships are the other strategies by which diabetes and other related health issues are addressed in the District. In fact, local community groups work in collaboration with the Department of Health to develop, implement, evaluate, and reform health communication interventions and diabetes-related health systems with the objective of positively influencing and changing peoples’ personal and at-risk behaviors that may predispose them to diabetes and other lifestyle diseases such as obesity. Further, these Department of Health/community partnerships have helped improved accessibility and utilization of diabetes health services and support. What is more, the quality and availability of health care has improved for diabetics in the District. In collaboration with non-governmental organizations, individuals, corporate bodies, and community-based groups, the federal government has established other diabetes-related health programs. These programs particularly assess the diabetes risk factors, health status, and preventive health practices already in use, not only for the ‘at-risk’ group but also for the general public that is at risk of contracting diabetes (Wild et al., 2004). In addition to the mentioned stakeholders, professional and academic researchers have also been pretty useful in diabetes care in Washington DC, more so with regards to the translation of research findings into practice and the unification and alignment of diabetes health findings with dissemination of information. The government also plays a critical role in designing and implementing diabetes health policy and decisions and informing the public on the policy and its role in the implementation of the said policy. The contribution of the public is in fact quite welcome for quality community- based programs and clinical preventive services to available, accessible, and utilized by diabetics and other affected people. Thus, the key aspects of diabetes prevention and management taken care of by the collaboration of the mentioned stakeholders are pre-diabetes and prevention, diabetes in youth and other vulnerable groups, diabetes data and statistics, and patient and care-provider information and resources, which is disseminated by different advisory council sub-committees (Wild et al., 2004). Barriers to Diabetes Care In spite of the efforts and resources directed by the federal government in preventing and treating diabetes in Washington DC, a lot needs to be done as several barriers continue to hinder the accessibility and utilization of health services by diabetics and other affected people. These barriers manifest as poor or inaccessible services, communication barriers, regulations, bureaucracy, political interferences, inter-agency coordination, delivery scope, population/human impact, and financial problems. The first barrier to diabetes care is the fact that it is so demanding on patients’ body and spirits that it requires not only biological and social care but also demands that health professionals address its psychological aspects. Taking care of diabetes thus requires many health workers to handle a patient, straining the little available resources (Wild et al., 2004). Second, the need to reorient a diabetic’s life is a challenge to diabetes management as a patient is often required to undertake multiple medications, needle sticks, and adhere to new food restrictions. Further, a diabetic may be forced to increase the level of physical exercises per day and make multiple trips to his/her health care providers. It thus becomes rather hectic to incorporate all these changes in one’s life all over sudden. Worse, still, these recommended changes may contravene a diabetic’s socioeconomic status, belief system, culture, family and individual values, religion, and psychosocial wellbeing (Lawrence et al., 2008). All these aspects of one’s life could thus be barriers to his/her seeking out health care for diabetes. Health professionals consequently require having an understanding of the social and psychological context of each diabetic. Unfortunately, many health workers do not place each diabetic in the right social and psychological context to recognize and understand their unique situations, resulting in frustration, exhaustion, anger, and disorganization in health providers and diabetics. The other barrier to diabetes management in Washington is referred to as the “the barrier of inertia” in which both patient and health provider feel that nothing more could be done. This latter barrier is often associated with failure of a clinician to recognize and understand the social, psychological, and socioeconomic circumstances of a diabetic. Lack of knowledge on diabetes’ pharmacology and pathophysiology, which is the basis of diabetes care, is the other major barrier to diabetes care in Washington, DC. Inadequate financing and poverty are the financial barriers to diabetes care in the District, as the available funds and facilities cannot serve the large population. Consequently, most poor patients decide to seek unprofessional care or opt to stay at home and take care of themselves. Additionally, poor coordination by the stakeholders has rendered diabetes care in the District to perform below standards. For instance, some sections of the District, more so poor neighborhoods, which are socioeconomically disadvantaged, have been somehow neglected in the fight against diabetes. Recommendation There are several methods by which the above barriers to diabetes care could be overcome. First, an office or a management system that recognizes, understands, and addresses all the multiple social, cultural, and economic aspects of diabetes in the District should be established. Second, information technologies such as proper diabetes records/registry and the efficient use of medical assistants and nurses need to be incorporated in the care. Third, diabetics and their caregivers should be empowered to self-manage their diseases without imposing culturally and socially unacceptable or unwelcome interventions on them (Rother, 2007). This suggestion is particularly essential since culture and religious values and beliefs have been cited as among the most difficult barriers to eliminate in diabetes care. Health care staff should be assigned or delegated specific tasks to increase their closeness with patients, thus making them more likely to discover and address each patient’s barriers as patients get more comfortable and feel confident sharing information with them (Rother, 2007). Diabetics and their families should be shown that they are equally important in the management of their care, prompting them to become self-managers. Importantly, the stakeholders in diabetes care should educate, train, and inform the local community on the causes, barriers, and the mechanisms of overcoming the barriers to diabetes care. The communication barriers between diabetics and their loved ones on one hand and health care providers on the other should also be addressed. First, lack of knowledge on diabetes care and its implication should be addressed by the authorities. Health care givers should thus confirm their patients circumstances, understanding, goals, and whether they are illiterate about diabetes (Lawrence et al., 2008). By acquiring such knowledge, health care givers would be in a better position to align their objectives with their patients’. Conclusion From past, present, and forecast statistics, is quite apparent that diabetes is worrying health problem in Washington, DC. Cognizant of this health problem, the federal/District government, non-governmental organizations, community-based groups, the corporate world, and private citizens have joined hands to fight the menace through financing, awareness campaigns, educational strategies, and cultural/social interventions. However, barriers such as lack of knowledge and understanding, poor funding, bad attitudes, religious, cultural, and socioeconomic factors continue to hinder the delivery, accessibility, and utilization of diabetes care in the District. Fortunately, programs such as Medicaid, Medicare, insurance schemes, and improved communication and awareness have been useful managing diabetes care. Appendix I: Diabetes statistics and forecast (National Diabetes Fact Sheet) for Washington DC by the Center for Disease Control and Prevention (CDC) (Washington, DC Metropolitan Statistical Area 2011). Washington, DC Metro Diabetes Statistics 2000 2010 2015 2025 Population 4,821,000 5,489,700 5,822,200 6,514,400 Pre-diabetes 702,400 1,398,200 1,482,900 1,659,200 Diagnosed diabetes 221,400 358,000 477,900 715,900 Undiagnosed diabetes 94,900 211,600 235,400 266,400 Total with diabetes 316,300 569,600 713,300 982,300 Annual deaths due to diabetes 4,420 5,520 6,800 8,580 Total annual cost (2010$) $2.4 B $5.3 B $6.7 B $9.5 B Annual medical costs $1.7 B $3.8 B $4.7 B $6.7 B References Cooke, D. W., and Plotnick, L. (2008). "Type 1 Diabetes Mellitus in Pediatrics". Pediatric Review, 29(11), 384; Gardner, D. G. (2011). Greenspan's basic & clinical endocrinology, ninth edition. New York: McGraw-Hill Medical. Lawrence, J. M., Contreras, .R, Chen, W., and Sacks, D. A. (2008). "Trends in the Prevalence of Preexisting Diabetes and Gestational Diabetes Mellitus among a Racially/Ethnically Diverse Population of Pregnant Women, 1999–2005". Diabetes Care, 31(5), 904. Rother, K. I. (2007). "Diabetes Treatment—Bridging the Divide". The New England Journal of Medicine, 356(15), 1499. Washington, DC Metropolitan Statistical Area (2011). Washington, DC’s Diabetes Crisis: Today and Future Trends. Retrieved on August 12, 2012 from http://www.altfutures.org/pubs/diabetes2025/WASHINGTON_DC_MetroArea_Diabetes2025_BriefingPaper_2011.pdf Wild, S., Roglic, G., Green, A., Sicree, R., and King, H. (2004). "Global Prevalence of Diabetes: Estimates for the Year 2000 and Projections for 2030". Diabetes Care, 27(5), 1047. Read More