Dealing with Diabetes Mellitus among the Aboriginal Australia Community - Assignment Example

Dealing with Diabetes Mellitus among the Aboriginal Australia Community Introduction The prevalence of diabetes mellitus among the indigenous people of Australia is of particular concern. By the year 2000, about 42,000 people were affected by the condition and the figures were expected to rise (Parsons, Wilson & Scardigno 2000). Diabetes mellitus results in an impaired lifestyle as well as severe renal, cardiovascular and eye complications (Parsons, Wilson & Scardigno 2000). Many studies have revealed that in Australia the problem is exacerbated by a combination of factors including a swelling population as well as a surging trend of risk of prevalence of the catastrophe, particularly type 2 diabetes mellitus. Although the condition may be noted to occur heterogeneously, there are concerns that its prevalence is exacerbated by consequences of westernization, urbanization and mechanization (Cockram 2000, p. 42). Along this line, it has been noted that the risk of diabetes mellitus appears to arise from a combination of hereditary predisposition and change of lifestyle (Cockram 2000, p. 42). While in the past the risk of suffering from diabetes mellitus was closely linked to old age, the fact that the condition now appears among young people is worrying. In particular, it has been noted that changes in lifestyle among young people such as reduced physical activity and inappropriate diets have greatly exposed them greatly to the risk. This is because in most young Aboriginal people, the prevalence of diabetes mellitus has been closely associated with the development of obesity, and in particular, central obesity. Many authors such as Cockram 2000 and Manderson and Kokanovic (2009) have noted that there is need for prioritization of diabetes as a major issue affecting governments in affected areas. In addition, interventions to dealing with the condition can be justified on humanitarian and economic grounds. There is need to integrate various strategies to deal with the condition at the prevention level while also eliminating the possibility of occurrence of lifestyle related complications among Australian Aboriginal communities. In view of the points mentioned above, this paper will analyze the strategies that the Australian government has out in place to deal the prevalence of diabetes mellitus. The paper will seek to evaluate whether the strategies have been effective or not. In addition, the paper will review the role of health promotion and community capacity building in relation to dealing with diabetes mellitus, hence a suggestion of mechanisms that could be used to combat the problem. Evidence of the effectiveness of the mechanisms will also is discussed. Review of strategies employed deal with diabetes mellitus among the Australian indigenous people: Have the strategies been effective? Over the recent years, there has been an increase in the prevalence of incidences of diabetes among Australia, and in particular among the Aboriginal communities. Of particular concern is the fact that most of the incidences are closely related with severe health complications such as heart failure (Baliga & Sapford 2009, p.164). In response, several studies been conducted with a view to developing mechanisms through which the prevalence of the condition can be prevented or mitigated. Most intervention programs have entailed people suffering from diabetes mellitus being encouraged to control their blood glucose levels as well as blood pressure. In addition, more emphasis has generally been put on ensuring that people intervene in controlling diabetes mellitus though change of lifestyle. As a result, many indigenous Australians understand that they need to check their diet, do rigorous exercise stop smoking, and control their weights (Parsons, Wilson & Scardigno 2000). However, it is evident that such mechanisms are not reliable since such simple intervention techniques may not be ideal for chronic conditions, or a situation in which a patient is affected by multiple related diseases. In addition, methods such as diet check need to be reinforced by proper nutrition, which unfortunately may not be available to all Aboriginal people. Thus even though Parsons, Wilson and Scardigno (2000) note that consumers need to be informed about the relationship between diet and diabetes, this information may not be relevant to many diabetes patients, who live in abject poverty The results of surveys done by government institutions in the past have been instrumental in studying the condition’s trends over time, hence intervention programmes commensurate with the nature of the trends. Since the 1960s, the Australian Bureau of Statistics (ABS) has been carrying out research through interviews and related methods to obtain reliable data on diabetes mellitus (Thomson & Snow 1994). For a long time, ABS has relied on data from self-reported information to measure the frequency of specific diabetes mellitus conditions (Parsons, Wilson & Scardigno 2000). However, it can be noted that reliance on such information without adequate support from clinical assessments does not reveal the prevalence of the condition precisely. Early studies by government-based institutions in Australia based on interview and clinical assessments have revealed that there are dramatic differences in the occurrence of diabetes mellitus and other diseases related to it such as chronic heart disease, ulcers, hypertension, hernia and arthritis (Thomson & Snow 1994; Australian Bureau of Statistics 1995). The results of various surveys have been contradictory thus making proper intervention quite tricky in spite of the government’s enthusiasm to control the prevalence of the diabetes mellitus menace. To illustrate the above sentiment, the crude results of a survey carried out in 1994 indicated that the prevalence of diabetes mellitus among the aboriginal people was 2.2 percent, which is much lower than the standardized 7.8 percent that has been perceived in the mid-1980s according to results of investigations carried out among the Aboriginal people in Taree area (Thomson & Snow 1994). In a similar dimension, the crude results of the prevalence of diabetes mellitus as reported in the ABS report of 1989/90 indicated a 1.1 percent prevalence, which was a lower value as compared to the 3.4 percent prevalence rate reported from estimates of clinical assessments (Thomson & Snow 1994). From the conflicting results from interviews and clinical studies, it is evident that much more needs to be done to develop methods that will harmonize the findings on the prevalence of diabetes mellitus in order to make various intervention strategies successful. Over the years, it has been widely accepted that non insulin dependent diabetes mellitus (NIDDM) is a key challenge to public health among the minority indigenous communities of Australia (Thompson, Gifford & Thorpe 2000). Nevertheless, the methods used in tackling the phenomenon (interview and clinical surveys) have been ineffective in addressing the condition in totality due to conflicting findings as highlighted above. It is for this reason that Thompson, Gifford and Thorpe (2000) suggested an ethnographic approach that would contextualize the behavioural risk factors for NIDDM and apply it to the development of a more worthwhile and ideal epidemiological risk factor survey tool for the urban indigenous Australian communities. Thompson, Gifford and Thorpe (2000) reported very interesting findings in that their ethnographic study revealed a complex web of meanings that hold people to their families and community members that can and should be considered in any social epidemiology of illness and health. The authors stated that such measures would make the findings more reliable and effective in dealing with the problem of diabetes mellitus. This therefore means that government institutions involved in studies of the prevalence of diabetes mellitus among indigenous Australians should use multi-pronged approaches in order to obtain more reliable findings that can allow proper containment of the condition. As mentioned above, most strategies used by the government institutions (public health institutions) have been based on the initially identified risk factors that have major focus on modifying diets and engaging in physical activity to contain obesity [this point is also mentioned by Thompson, Gifford and Thorpe (2000)]. However, the major problem with such an input is that in many instances epidemiologists and health experts have been unable to identify and comprehend the wider context of social meanings that are attached to risky social behaviours among the Aboriginal communities of Australia (Kokanovic & Manderson 2006). Thus there is need to device methods of research and intervention which take into consideration the everyday realities of the lives of the target group rather than merely making generalized assumptions about the people’ lifestyle. Along this line, Kokanovic and Manderson (2006) and Thompson, Gifford and Thorpe (2000) note that the strategies to be employed in dealing with diabetes should dwell more on understanding the Aboriginal people’s culture in order to facilitate more successful interventions. This is because although survey methods that include studies on knowledge, attitude, practice and behaviour (abbreviated as KAPB) are appropriate for generating data about the ‘discrete’ factors of a population, they lack the power to provide in-depth views of the way in which the factors are related to the people’s daily activities (Thompson, Gifford & Thorpe 2000, p. 726). Specific intervention measures Having recognized the complexity involved in dealing with diabetes mellitus prevalence among the Aboriginal communities, the Australian government through the Diabetes Health Priority Area Advisory Group created the South Australian Diabetes Clearing House to provide information about diabetes, collected through multiplicity of techniques including epidemiology (Parsons, Wilson & Scardigno, 2000). The survey carried out by the South Australian Diabetes Clearing House combined population-based data and clinical information on diabetes mellitus, thus bringing into perspective not only the people suffering from the condition but also how the individuals and the extant health systems are influenced by the condition (Parsons, Wilson & Scardigno, 2000). The South Australian Diabetes Clearing House predicted in 2000 that diabetes mellitus was a current problem (in 2000) and would become even more important in the years to come. According to the projections, ageing of the populations the indigenous Australians was anticipated to increase the number of people in the high-risk age group, contributing to a 25 percent increase in the number of people suffering from diabetes mellitus. This projection however overlooked the fact that even people in their 20s could be at risk of being victims of the condition. The recommendations presented based on the findings therefore were that more interventions should involve preventing the occurrence of diabetes mellitus as well as delaying the onset of risk of the condition among various age groups (Parsons, Wilson & Scardigno, 2000). Preventing and controlling the prevalence of diabetes mellitus among young populations is hampered the difficulties imposed by a number of additional challenges to the young stages of life such as erratic eating patterns, high tendency of contracting viral diseases, and hormonal changed that spur development (Australian Department of Health and Ageing 2009). For this reason the psychological effects of development have made it difficult to constantly monitor the status of the condition. The Australian government has focused on an ambitious scheme to delay the occurrence of type 2 diabetes among people aged between 40 and 49. In 2007, it introduced a novel Medicare package referred to as MBS Item 713 (Australian Department of Health and Ageing 2009) This item encompasses general practitioners who provide advice on risk modification to patients who fall within the target group that is at high risk of suffering from type 2 diabetes. The government also has an ambitious plan to provide subsidies to high risk patients so that they can complete special lifestyle modification programmes. In addition, the State and territory governments have participated through the launch a risk management tool dubbed AUSDRISK, which is expected to contribute significantly to reducing the risk of diabetes mellitus among high risk populations (Australian Department of Health and Ageing 2009). Other interventions In areas such as the Torres Strait and Northern Peninsula Area District, major involvements gave been in place since 1999. For instance, major changes were done to primary services within 21 clinics served by Queensland Health (McDermott et al 2007). These included a visiting diabetes mellitus outreach team of specialists; referral and management protocols as well as evidence-based diabetes screening; and specialised registers and recall systems that were managed by indigenous health workers from the locality. In addition, clear roles were defined for health workers in order to deal with chronic diabetic and other related conditions. Furthermore, audit and feedback systems were enhanced in order to boost reporting and monitoring (McDermott et al 2007). In 2001, Queensland Health endorsed and adapted a computerised health information system (McDermott et al 2007). The system is utilised in all indigenous primary healthcare settings. By 2007, the system had been installed in over 50 community clinics located within Queensland, mostly in the northern region. It encompasses keeping of all information on a central server, and the information can be accessed remotely from all the clinics linked to the system. This allows real-time updating of clinical data related to diabetes mellitus wherever clients can be seen. Since Queensland Health is the only provider of healthcare services to the region, computerised information enables regular monitoring of the entire population of the district (people who can be noted as regular seekers of healthcare services within the connected facilities and those who mostly live in the district) (McDermott et al 2007). Since 2004, the computerised system began reporting customised de-identified reports, which are generated based on clinic, condition of patient, age group, as well as sex. The details are used by the medical management staff to monitor the progress of primary healthcare services for interventions against diabetes mellitus and other related complications (McDermott et al 2007). In spite of the improved intervention mechanisms in Queensland, there appear to be scanty successful corresponding systematic interventions that deal with the causes of diabetes in the populations, as well as other related factors such a poor diet, obesity, and use of tobacco (McDermott et al 2007). Summary of the effectiveness of interventions It is clear that whereas diabetes mellitus been identified and a multiplicity of intervention mechanisms implemented, the interventions have not been effective in addressing all issued pertinent to diagnosis and management of the condition. Most strategies have failed to address population factors as well monitoring of aspects of lifestyle such as diet management and intervention in use of tobacco. Community capacity building and possible strategies to deal with mellitus It has been shown in the discussion that while various government institutions’ interventions in dealing with diabetes mellitus have been helpful, they are not entirely reliable. There is need for more-encompassing strategies that will integrate clinical studies and involvement of entire communities that are affected by the condition. Fisher et al (2007) highlight very important details from the Robert Wood Johnson Foundation that deals with diabetes. The foundation has a broad programme based on “Resources and Supports for Self Management”. The program encompasses individual assessment, collaborative setting of goals, developing skills for self management, providing constant support, spreading community resources and ensuring continuity of quality clinical care (Fisher et al 2007). The “Resources and Supports for Self Management” program also encompasses many lessons such as role of community health workers in self management, importance of self-management follow-up and support (Fisher et al 2007). This is a very important scheme that can be used to support intervention against diabetes mellitus in Australia especially among the Aboriginal people. With self –management programs, more people are likely to participate in diabetes management as opposed to the current situation where there seem to be stigmatization and stereotyping. If the communities become more empowered to deal with the condition, they are likely to be more confident in preventing or mitigating its impact. First, there is need to understand why many indigenous individuals engage in use of tobacco and alcohol, which are risk factors with respect to diabetes. There is also need to provide tangible support to the affected groups in terms of nutritionally balanced foods rather than merely advising them to check diet, which they cannot afford. How effective the strategies could be The strategies mentioned above are likely to be successful because they are multi-pronged. The all-encompassing approach is the best way to deal with a large area that is widely affected by any scourge. As an example, it is easier for diabetes patients to participate in local community programmes (where they feel more at home) than for them to go to hospitals or clinics (where they know they are likely to meet strangers and be asked many questions). There is no doubt that the ambitious strategies implemented by the Australian government the may be constantly hampered by failure of victims of diabetes to be involved in the monitoring and survey programmes. That is why the services need to be brought closer to the people through self-management by facilitating thinking in terms of core dimensions and ensuring continued quality improvement. Conclusion The prevalence of diabetes mellitus among indigenous Australians has widely been recognised and addressed. However, many surveys have shown that the approaches used in interventions have largely not been successful. This paper has addressed the issue and by analysing the various strategies that have been used by government institutions for intervention. It has been noted that a more-encompassing approach is needed in order to enhance capacity building and effective response from the target groups. As it has been discussed, this can be achieved by empowering communities to self-manage diabetes mellitus. Such a move will ensure that more people participate in the programme than they would if they were to go to hospitals and clinics. References Australian Bureau of Statistics 1995, National Health Survey 1995, Available from http://www.ausstats.abs.gov.au/ausstats/free.nsf/0/E6CCCE26FF0DD361CA257225000495E2/$File/43710_1995.pdf (20 October 2009). Australian Department of Health and Ageing 2009 Database, Available from http://www.health.gov.au/internet/main/Publishing.nsf/Content/87F7FAD69E7E67A7CA25714C000032D8/$File/nhpa5.pdf (20 October 2009). Baliga, V & Sapsford, R 2009, Review article: Diabetes mellitus and heart failure - an overview of epidemiology and management, Diab Vasc Dis Res; 6: 164-173. Cockram, CS 2000, The epidemiology of diabetes mellitus in the Asia-Pacific region, HKMJ, 6:43-52. Fisher, EB, Brownson CA, O’Toole, ML, Anwuri, VV and Shetty, G, 2007, Perspectives on self-management from the diabetes initiative of the Robert H\John Wood Johnson Foundation, The Diabetes Educator, 33(6): 216-226 Kokanovic, R & Manderson, L 2006,Social support and self-management of type 2 diabetes among immigrant Chronic Illn; 2: 291 Manderson L & Kokanovic, R 2009, ``Worried all the time'': distress and the circumstances of everyday life among immigrant Australians with type 2 Diabetes, Chronic Illn, 5: 21-34. McDermott, RA, McCulloch, BG, Campbell, SK & Young, DM 2007, Diabetes in the Torres Strait Islands of Australia: better clinical systems but significant increase in weight and other risk conditions among adults, 1999-2005, MJA, 186(10): 504-509. Parsons, J, Wilson, D & Scardigno, A 2000, The impact of diabetes in Australia in 2000, South Australian Department of Services, Available from http://www.publications.health.sa.gov.au/cgi/viewcontent.cgi?article=1018&context=dis (20 October 2009). Thompson, S J, Gifford S M & Thorpe, L 2000 Aboriginal Community ,The Social and Cultural Context of Risk and Prevention: Food and Physical Activity in an Urban, Health Educ Behav; 27:725 Thomson, N & Snow, C 1994, Disability and handicap among Aborigines of the Taree area of New South Wales, Australian Government Publishing Service, Canberra Read More