Diabetes among Indigenous People, Changing the Situation - Essay Example

Table of Contents Executive Summary page 2 Introduction page 2 Aims page 4 Methodology page 4 Proposal page 5 Analysing the Task page 5 Conclusion page 8 Recommendations for Future Practice page 9 References page 9 Executive Summary This report considers diabetes, and associated conditions, among aboriginal peoples in Australia, such as kidney failure and heart disease. It looks at why this has developed; reasons why this situation needs positive interventions ; and makes suggestions as to how the situation can be helped with the cooperation of all concerned as well as health care workers. This includes analysing the present situation, making use of available statistics, and the fact that aboriginals react rather differently to a western life style than others may do, because of a genetic susceptibility among other reasons. It includes coming up with ways to overcome any barriers to better health for this group of Australian people including negative attitudes. At all times this must include the co-operation of those affected and interacting with them in positive ways. It also requires use of all available resources, whether local, state or national. A holistic approach is needed, looking at the whole culture, historically and in the present time, so that any changes needed can be arrived at, and procedures set in place, and latter assessed for their effectiveness, so that any necessary changes can then be made. Such an approach requires the co-operation of all involved, whether national and state government, health care workers and the aboriginal people themselves. Introduction Diabetes became a national health priority within Australia in 1997. According to Magliano et al it may be that by 2025 three million Australian citizens will have type2 diabetes, and it is believed that over time this figure will raise. Yet this condition could in many cases have been preventable as the main causes are inactivity and poor diets (Shukla, 2010). The disease is a particular problem among Indigenous Australians and Torres-Strait Islander Australians, who 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 for these people , as well as possible ways in which the situation can be better managed. According to Australian Indigenous Health (2013), the Indigenous Australian people of earlier generations were fit, much leaner and did not have metabolic diseases. It is also noted that among aboriginal people their diabetes is likely to be accompanied by obesity, smoking, lack of exercise and kidney problems, for which they are unlikely to obtain a transplant (Korff, undated). Over time conditions have changed, with many indigenous people living a settled more western life style, but this is accompanied too often by poor diet and far less physical activity than in previous generations. Attempts have been made to redress this negative situation , but there is much more to be achieved in a number of aspects of this problem these being prevention, detection and management for the population as a whole, but in particular for the Indigenous people who are even more susceptible than average. Daniel et al ( 2001) reported that:- Diabetes and impaired glucose tolerance have reached epidemic proportions among Australian Aboriginal people. An urgent need exists for programmes to reduce the prevalence of diabetes risk factors, especially BMI of 22 kg/m2 or more, a limit lower than advocated for Euro-American populations. There have been a number of attempts to improve matters in the past , as outlined by The Australian Human Rights Commission (2014), but , under the heading ‘The challenge - addressing Aboriginal and Torres Strait Islander health inequality’ it says :- Data exists suggests that we have seen only slow improvements in some areas of health status and no progress on others over the past decade. The gains have been hard-fought. But they are too few. And the gains made are generally not of the same magnitude of the gains experienced by the non-Indigenous population Aims To consider the reasons why diabetes is such a problem for this group, and how this is affected both by their physical make up, but also by the changes in culture and lifestyle. Then, using this knowledge, to come up with practical ways in which diabetes can be prevented or ameliorated among this group, and so reduce the rate of death from diabetes, and to reduce cardiovascular disease among those with diabetes, as well as working to prevent the condition developing and taking part in behaviours that are most likely enhance health. The aim of the Australian Human Rights Commission report of 2005 is to reverse the situation within a generation. There was a human rights approach, but this must be worked out to a large extent by health care workers. Methodology Making any real change will involve interaction with members of the group, working with as well as for them, listening as well as teaching. It will require not just education, but changing ideas. It will mean not just treating those who already have diabetes, but also having a viable programme of preventative measures in place. It will mean working with people of all ages, encouraging a more active life style, and also exploring ways in which diets can be improved, even on a relatively low income. As far as possible any staff employed will not just have paper qualifications, but be actively accepting of the idea that the Indigenous people have equal rights as citizens of Australia as the other members of society, including equal opportunities to access good health services . Those involved, both health staff and members of local communities, should identify specific objectives and goals. Then they can come up with ways in which such goals can be achieved. These will be evaluated for practicality and the likelihood that they will be successful, before being put into practice. Later data will be collected and the relative success of particular interventions assessed. Following this, programmes might continue as they are, or be altered or even dropped as is felt to be necessary in order to achieve optimal results. Proposal To engage indigenous Australians in their own health decisions, in particular with reference to type 2 diabetes and its associated problems. Analysing the Task Cameron (2000) cites Aristotle’s definition of a citizen as being someone “who shares both in ruling and being ruled.” She goes on to cite Marshall who believed that citizenship involves having the civil rights necessary for individual freedom, that is freedom of speech, of movement and having the right to own property. He also believed it involved having the political rights needed to take part in political processes, and having the social rights needed to share equally in society. It follows from this that they should have equal access to health care. This is social justice. Yet for many indigenous people within Australia this ideal is not fully part of their daily lives, or even a large part. It is therefore necessary to break down the barriers to good health for this group, these often being imposed by wider society, such as uneven allocation of funding ( Loppie and Dean, 2009). Loppie and Dean also list ( 2009, pages 15 -18) the social determinants of health - the health care and educational systems; the infrastructure , capabilities and resources of their societies; environmental stewardship and cultural continuity. They were writing from a North American prospective, but their words are still relevant. In some instances infrastructures among aboriginal people groups and communities may not be as strong as they once were, and, often because of historical poor educational levels and high levels of unemployment, motivation for change may be poor, because of negative self- images and feelings of hopelessness. Also because of poor relationships in the past with state officials, any government initiatives might be seen as something to be treated very carefully, or even definitely resisted. Grass roots solutions are much more likely to be effective, rather than those imposed by government, because the people involved are more likely to respond to decisions in which they have had a part. At the same time the government may be able to provide funding, skilled staff and data. Such an approach must involve sensitivity to cultural patterns and beliefs, while at the same time seeking to educate and to motivate elders about the problems their people face and how these can be addressed. This is perhaps best done by simply getting to know the members of the community and how their society works. Excellent communication skills will be needed by health care staff, including listening and counselling skills. They will need to be educators, but even more perhaps, facilitators, enabling people to make the most of their innate abilities, as well as learnt skills, and using the best aspects of their culture. This will require knowledge on the part of health workers about these cultures as well as the health issues involved. They need to know also how the physical needs of aboriginal people living a relatively western life style, may be somewhat different from those with a different genetic makeup, especially in the way their bodies cope with a western diet and life style. Although in aboriginal society elders are usually respected and have influence, 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 this 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 active sports could be both beneficial and enjoyable. Low birth weights are an important 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. Aboriginal women are more likely than others to develop gestational diabetes (Australian Indigenous, 2013). Young women want to produce healthy babies and need to know that this is more likely to happen if they themselves have a healthy diet. This could include preparing traditional foods. Such an intervention might well 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 aim is not just to help for those who have already developed the condition, but also to prevent it developing in potential sufferers, which in this case is any Aboriginal person living a Western life style, including its diet. This will require not just education, using resources such as the data available on sites such as Australian Indigenous (2013), but also encouraging and developing the will for change. This doesn’t just involve indigenous people, but also state and national government as they interact with them, produce legislation and provide funding and staff, or in some cases fail to do so. No one is suggesting that indigenous people need to discard the advantages of western living, but these do need to be in balance with older ways and ideas. At the same time they need to be able to take advantage of things which are available to their fellow citizens such as employment and education , as well as health opportunities. Health care workers may possess knowledge about diabetes, its prevalence causes, development, and treatment, but this alone will not be sufficient to deal with this situation. Nor is just being able to treat the established condition. They will need to become able in areas not necessarily not directly involved in health care, including such things as lobbying; writing proposals in order to obtain funding ; and most of all they also need to be able to interact with those whose lifestyle and values may be different from their own, valuing them as equal citizens of Australia. Australia is very much a multi-racial society, but, although equal in law, it is clear that some of its citizens have needs which differ somewhat from those of others, in part because of a genetic susceptibility ( Busfield et al, 2002) . According to Australian Indigenous (2013) although historically diabetes was not present among aboriginal peoples, in recent years they are 1.5 more likely to be obese than their fellow citizens McCarty et al (1996) The rise and rise of diabetes in Australia, 1996: a review of statistics, trends and costs. Canberra: Diabetes Australia. When surveyed (Australian Bureau of Statistics, 2006) 40 % of them stated that they took no exercise at all. A number of studies from the 1960s onwards found a significant correlation between developing a more of a western lifestyle and the rise in levels of type 2 diabetes among indigenous people such as that by Bastian ( 1979). Conclusion Type 2 diabetes is the result of the way people live their lives, so there is a lot that individuals and groups can do to prevent its development, and also to lessen its impact if it does occur. At present however, as with many other areas of life for indigenous people and their health, not enough is being done at present to lessen the damaging effects of this illness among these people. Health workers have an important part to play, but so too do those who hold office in state and in national government, as well, most importantly, as those directly involved. Recommendations Arrange meetings in communities where there are aboriginal people in order to discuss the present situation. These must include elders, but also people from other parts of the communities , including younger people Arrive at definite aims for any intervention . Come up with a list of suggestions as to how these aims could be achieved in conjunction with these communities for possible interventions. Assess these suggestions for suitability and viability, including considering staffing levels, educational and training needs. Choose several possible interventions, considering in particular those with the most likelihood of success and which would make the most positive difference to the health of the community. This would include introducing a time scale for setting up any project, as well as for assessment of its effectiveness. Look into funding issues. Once funding issues are dealt with the chosen intervention is put in place. After a previously agreed period, which would vary according to the action chosen, the results are assessed and any necessary changes made. There should be an ongoing process of assessment and adjustment. References Australian Bureau of Statistics , 2006, National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. , [Online] available at [Accessed 26th October 2014] Australian Human Rights Commission, 2005, Achieving Aboriginal and Torres Strait Islander health equality within a generation, [Online] available at [Accessed 27th October 2014] Australian Indigenous Health, 2013, Review of Diabetes among Indigenous people, [online] available at [Accessed 25th October 2014] Australian Institute of Health and Welfare, Diabetes, 2013 [online] available at [Accessed 1st September 2014] Bastian, P, 1979, Coronary heart disease in tribal Aborigines: the West Kimberley Survey. Australian and New Zealand Journal of Medicine; 9(3): 284-92 Better Health Channel, July 2014 Aboriginal health issues – diabetes. [online] available at . [Accessed 1st September 2014] Busfield, F., Duffy, D., Kesting, J., Walker, S., Lovelock, P., Good, D., Tate, H., Watego, D., Marczak, M., Hayman, N. and Shaw, J., 2002, A Genomewide Search for Type 2 Diabetes–Susceptibility Genes in Indigenous Australians, The American Journal of Human Genetics, Volume 70, Issue 2, p349–357, February, [Online html] [Accessed 25th October 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, Elsevier, [online] available at [Accessed 1st September 2014] Korff, J., undated, Kidney disease among Aboriginal people[Online] available at [Accessed 26th October 2014] Loppie, C. and Wien, F., 2009 , Health Inequalities and Social Determinants of Aboriginal People’s Health, National Collaborative Centre for Aboriginal Health, [Online] available at [ Accessed 24th October 2014] Magliano, D.; Peeters,A.; Vos,T.; Sicree, R.; Shaw ,J.; Sindall,C.; Haby, M.; Beqq.S. 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