Diabetes among Indigenous Australians - Literature review Example

Diabetes among indigenous Australians Introduction and background. It has been estimated that every day some 280 Australians will develop diabetes. Since 1997 it has been considered as a national health priority ( Australian Institute of Health and Welfare 2013). A study in 2005 ( Australian AusDiab Follow-up Study/(Australian Diabetes, Obesity and Lifestyle Study) found that 1.7 million Australians had diabetes at that time, but in the cases of type 2 diabetes, the commonest type, it is possible that half the people are still undiagnosed. According to Magliano et al it may be that by 2025 3. million Australian citizens will have type 2 diabetes , and that over time this figure will rise. Yet this condition could in many cases have been preventable as the main causes are inactivity and poor diets ( Shukla, 2010) . In the case of indigenous Australians and Torres Strait Islander Australians they have the fourth highest proportion of people with non -insulin dependent diabetes in the world (Better Health Channel, 2014). Proportionally for every four Australians with type two diabetes three will be aboriginal people ( Australian Institute of Health and Welfare, 2013) This essay will consider both why this is, and it will also look at any barriers to health care, as well as possible ways in which the situation can be better managed. This will include consideration of the fact that prior to 1923 no cases of type 2 diabetes were recorded among aboriginal people. That could in part be due to poor recording for whatewver reason, but, according to Australian Indigenous Health ( 2007) The indigenous Australian people were fit, much leaner and did not have metabolic diseases. Type 2 diabetes is chronic and is marked by having a rise in blood sugar levels because of both a deficiency of insulin as well as an increased resistance to insulin. The liver, which is no longer fully under the control of insulin, then produces more glucose. In response to this pancreatic beta cells produce so much insulin that these cells can die ( Shukla, 2010). Methodology Studies on this topic, as recent as possible, will be researched using search terms such as diabetes, aboriginal health, diabetes statistics, and aboriginal health programmes .Government health department documents and guidelines will also be considered. These will be assessed for their relevance and usefulness. The aim is to consider barriers to better health and access to health care programmes, especially those aimed specifically at the aboriginal population, and to ask questions such as ‘What are the barriers?’ ‘Can these be removed or dealt with?’ and ‘What else needs to be done?’ The literature included will be analysed and evidence accrued. As far as possible the most recent and topical documents will be consulted, but on occasions it may be necessary to look at the historic record. Literature Search Better health ( 2014) lists the possible complications of type two diabetes such as kidney failure, retinopathy and coronary artery disease. The article also considers the reasons why this condition is so much more likely to occur among aboriginal people than in the general population. Possible causes mentioned are genetic susceptibly, such as that shown in the 2002 study by Daniel et al for both impaired glucose tolerance and diabetes when compared to body mass. Diet; obesity; a history of gestational diabetes; having poor living conditions which can lead to low birth weights are also factors. The final item mentioned by Better Health ( 2014) is a lack of access to medical facilities. Some of this items such as being genetically susceptible are fixed, other require massive changes. Such things as poor diet require both education , a change of opinion , but also making good food available at an affordable cost. For modern aborigines the most likely diet tends to be high in fats and sugars and low in fibre and with poor nutritional content. If this malnutrition occurs from childhood then diabetes is more likely to develop. As in modern times the aboriginal people tend to lead a more settled lifestyle than their hunter gatherer ancestors activity levels are lower than in previous generations. A study by Williams et al (1997) showed that aborigines tend to smoke more often than the rest of the population. Obesity is a factor in the development of diabetes, especially if fat is carried around the middle rather than being more generally distributed. Many aboriginal women , some 75 %, carry fat in this way and are more likely to develop type 2 diabetes than the men in their communities. Incidence increases with age as might be expected, but there is a slight decrease among those aged 55 plus ( Shukla 2010). This is different from the pattern in the majority population. The poor living conditions may be linked to poor educational opportunities and again, this could be because some of these people tend to live in isolated communities. Shukla (2010) describes how these various contributory factors can interact. As long ago as 1979 Bastian found a direct correlation between the development of certain conditions and the adoption of a Western life style. It therefore follows that specific measures need to be taken if this problem is to dealt with in a positive way, measures which will help to break down the various barriers to better health. One way in this is being dealt with is by Diabetes Australia ( 2014), established as long ago as 1984, which has lots of advice on its web page and also through diabetes organisations in each state. The web page has links to such facets as what to do when first diagnosed, the differences between Type 1 and Type2 Diabetes. There are suggested recipes, ideas for how the condition can be managed, an area for young people and why medication is sometimes necessary. It is however not aimed directly at aboriginal people and one wonders how many of these would actually access such a site. Diabetes Australia (2014) does have a page specifically for indigenous people, but it can be quite difficult to access, and many going on to the site may assume that what applies to the general population also applies to them. The National Diabetes Service Scheme (undated) describes how prevalence can be as high as 30% in some aboriginal communities and says that mainstream medical services may not be able to deliver culturally appropriate education, management and support services in every instance. There is however at present (2013-2014) an initiative in place to help deal with any barriers. This includes the development and provision of appropriate educational materials and an attempt to develop the best possible profile for health workers in such situations. Discussion. The key issue on this topic is the large gap between what is actually being achieved and what is required, both now and in the future. The presence of diabetes in this population obviously has many causes, not all of which can be addressed, genetic propensity for example. It affects not only those who have the condition , but also those who care for them and perhaps rely on them as providers. The situation is however not just about the presence of diabetes, but has many social implications. Aboriginal people are too often second rate citizens in their own country with fewer opportunities in many areas such as education, employment and housing. These factors exacerbate the problem and it would take a major shift within Australian society for the situation to be righted. Cultural Survival ( 2014) says of the government’s attitude to these people :- The government of Australia has a very poor record when it comes to treatment of its Aboriginal citizens. The article goes on to describes instances of this, such as the rate of imprisonment among these people being so much higher than the average, but does also say that matters have improved in recent years with a number of programmes in place. The authors point out however that though the indigenous people have made some gains they have very little input in these government schemes and plans. Surely there are enough of them with the education and will to do so? This is perhaps the next stage that ought to go ahead – grass roots involvement and planning. No one wants to be victim unnecessarily. Canada and America have similar problems among their indigenous peoples (Canadian Medical Association Journal, 2010). Perhaps each country can learn something more from the others? Recommendations This must consist in not just help for those who have already developed the condition, but for those who are potentially susceptible, that is any Aboriginal person living a Western life style. It must involve breaking down barriers to better health, whether these are constructed by the government when it comes to the allocation of funding, because of a lack of trust, or a lack of knowledge and will . Grass roots solution to this crisis should be sought rather than only using a top down approach, with government agencies descending upon a community and telling them what should be done and where they are going wrong. Such an approach would be sensitive to cultural patterns, seeking to educate elders as to the problems their people face and how these can be addressed. Modern young people of whatever race do not always follow the advice of elders though so these need to be engaged too, preferably by people of their own race, allowing them to come up with suggestions and actions to improve matters. Looking at their people’s history, does not necessarily mean that a return to the hunter gatherer life style is needed, but that a similar dietary balance of fats and carbohydrates would be beneficial as would higher exercise levels. Encouraging such things as football and other sports could be beneficial as well as enjoyable. Low birth weights are a factor and so extra help may be needed for expectant mothers, and those likely to become so, in order to ensure healthier pregnancies and higher birth weights. This could include such things as low budget, but healthy cookery classes. Girls could be encouraged to take part in exercise and sports from an early age so that it becomes part of their life style. The American Disease Control Council ( 2011 ) has a traditional food department. This is certainly an area to be explored. Conclusion Because of the potential seriousness of diabetes of whatever type it has been identified as an area of national health priority. Despite this emphasis however there is still much more to be achieved in areas of prevention, detection and management for the population as a whole, but particularly for the indigenous people who are even more susceptible than average. Such a venture will require funding, training and very careful management, as well as big changes in attitudes among the majority of those concerned either as health workers, patients or potential sufferers Such changes are almost certainly the hardest part of any such programme. They will only come about when all Australian citizens are valued equally whatever their cultural and ethnic background, and when the people involved value themselves and their health above other factors. References AusDiab 2005, The Australian diabetes, obesity and life style study, 2005 [online] available at https://www.bakeridi.edu.au/Assets/Files/AUSDIAB_Report_2005.pdf [Accessed 1st September 2014] Australian Indigenous Health 2007 Review of Diabetes among indigenous people, [online] available at http://www.healthinfonet.ecu.edu.au/chronic-conditions/diabetes/reviews/our-review [Accessed 1st September 2014] Australian Institute of Health and Welfare, Diabetes, 2013 [online] available at http://www.aihw.gov.au/diabetes/ [Accessed 1st September 2014] Bastian , P., 1979, Coronary heart disease in tribal Aborigines: the West Kimberley Survey. [online] available at Australian and New Zealand Journal of Medicine; 9(3): 284-92 [Accessed 1st September 2014] Better Health Channel, July 2014 Aboriginal health issues – diabetes. [online] available at www.diabetesvic.org.au/type...diabetes/aboriginal-and-torres-strait-island. [Accessed 1st September 2014] Canadian Medical Association Journal, 2010., Diabetes hits Canada's native population hardest, Reuters [online] available at http://www.reuters.com/article/2010/01/19/us-diabetes-native-idUSTRE60I5AO20100119 [Accessed 1st September 2014] Cultural Survival, 2014, Aboriginal Australians – the state of play. [online] available at https://www.culturalsurvival.org/australia [Accessed 1st September 2014] Daniel, M., Rowley, K., McDermott, R. and O’Dea, K, 2002, Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk, Diabetes Research and Clinical Practice Volume 57, Issue 1, July 2002, Pages 23–33, Elseivier, [online] available at http://www.sciencedirect.com/science/article/pii/S0168822702000062 [Accessed 1st September 2014] Diabetes Australia, 2014 [online] available at www.diabetesaustralia.com.au [Accessed 1st September 2014] Magliano, D.; Peeters,A.; Vos,T.; Sicree, R.; Shaw ,J.; Sindall,C.; Haby, M.; Beqq.S. and Zimett P. 2009, Projecting the burden of diabetes in Australia--what is the size of the matter? Australia and New Zealand Public Health , December 33: 6 pp. 540 – 3, [online] available at http://www.ncbi.nlm.nih.gov/pubmed/20078571 [Accessed 20th August 2014] Shukla, A., 2010, Type 2 Diabetes in indigenous populations : a multifactorial approach, Cross Sections, Volume VI, [online] available at https://eview.anu.edu.au/cross-sections/vol6/pdf/ch05.pd [Accessed 20th August 2014] The American Disease Control Council, 2011, Diabetes among American Indians and Alaska Natives, 2011, [online] available at www.cdc.gov/media/matte/2011/11_diabetes_Native_American.pdf [Accessed 27th August 2014] The National Diabetes Service Scheme (undated) Aboriginal and Torres Island Peoples Programme[online] available at http://www.ndss.com.au [Accessed 20th August 2014] Williams, E., Tapp, R., Magliano, D., Shaw, J., Zimmet, P. and Oldenburg, B., 2010, Health behaviours, socioeconomic status and diabetes incidence: The Australian Diabetes Obesity and Lifestyle Study (AusDiab) Diabetologia August 26.doi.10/1007/s00125-010-1888-4. 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