NR514-NEED RESPONSES

Diabetes is becoming a health problem in the US and worldwide (Healthy people 2030 framework, n.d.) There is a projection that the cases of diabetes will increase at a significant rate by 2030 in both developing and developed countries. Developing countries could experience up to a 69% increase in diabetes cases, while developed countries will experience a 20 % increase in cases (Stetson et al., 2017). Subsequently, the prevalence of the disease will lead to adverse impacts on individuals and a colossal burden on healthcare systems. There will be a considerable burden in healthcare as the management of the condition requires extensive resources. Besides, diabetes is more prevalent in certain ethnic groups and low-income communities that cannot afford the cost of care, causing high mortality rate. It also leads to comorbidity conditions, which are chronic conditions that further increase the healthcare burden (Healthy people 2030 framework, n.d.). In this regard, the disease is a significant health problem that might lead to a considerable healthcare burden for both developing and developed countries.

Additionally, diabetes is a huge burden as it adversely affects patients' quality of life. It leads to cognitive impairment and other impairments such as low vision, affecting the quality of life of an individual (Stetson et al., 2017). This can further result in increased depression among the affected patients. In most cases, the patients with type 2 diabetes develop blood pressure: high blood pressure damages vital organs, specifically the kidney, as the disease progresses. In the US, a $245 billion cost is incurred directly or indirectly due to diabetes (Stetson et al., 2017). The expenses are related to disabilities, loss of jobs, and immature deaths. Therefore, the disease is a major health problem in the US that needs proper intervention and preventative measures to minimize its effects on the public.  

There have been various measures that have been adopted in mitigating the disease to reduce its burden and comorbidity. Intensive lifestyle interventions have shown promising results in preventing and intervening in the disease. One of the effective programs that have been adopted is the healthy eating campaign program. The program aims at advocating for healthy eating for all people (Healthy people 2030 framework, n.d.). This involves even the school programs to enhance healthy eating among students. People are advised on limiting eating foods with more saturated fats and glucose as they significantly increase the risk of developing diabetes. Consequently, people are encouraged to practice healthy eating habits such as eating whole grains and consuming more fruits and vegetables (Healthy people 2030 framework, n.d.). The intervention has shown promising results in curbing diabetes cases. Educating children about proper diet makes them understand the need for healthy eating from early age and the importance of avoiding foods with fats and added sugars.

Further, there have been physical exercise programs that have been initiated to curb the disease. Physical exercises are effective in preventing the disease progression. Guided exercises have been applied to patients with diabetes, and in most cases, there are positive outcomes within six months (Healthy people 2030 framework, n.d.). Exercises significantly help in reducing blood glucose and preventing blood pressure. Resultantly, this intervention facilitates preventing the progression of the disease and curbing comorbidities such as blood pressure and kidney-related diseases. At the same time, patients could be well guided on weight management, thereby minimizing the risks of comorbidities such as cardiovascular conditions. Lastly, healthcare providers, government, and public collaboration would assist in minimizing the prevalence of the condition and lowering morbidity and mortality rates from diabetes.

References

Healthy people 2030 framework. (n.d.). Healthy people 2030 framework. 

Stetson, B., Minges, K. E., & Richardson, C. R. (2017). New directions for diabetes prevention and management in behavioural medicine. Journal of behavioural medicine, 40(1), 127–144. 

Substance use disorders are linked to many health problems such as infection with HIV, hepatitis C, and sexually transmitted diseases. Deaths from opioid use disorder in particular have increased dramatically in recent years (Healthy People 2030, n.d.). The CDC’s National Center for Health Statistics indicates that there were an estimated 100,306 drug overdose deaths in the United States during the 12-month period ending in April 2021, an increase of 28.5% from the 78,056 deaths during the same period the year before CDC (2021).  

According to data from Healthy People 2030 (n.d.), the current percentage of the population in America who receive treatment for substance use disorder and a co-occurring mental health disorder is 3.4 % (2018). A goal from the Healthy People 2030 initiative is to increase the proportion of persons with co-occurring substance use disorders and mental health disorders who receive treatment for both disorders by over half to 8.2%.  

Best practice guidelines dictate substance use treatment interventions be combined with mental health care, as existing interventions are unlikely to be effective without addressing the underlying psychological issues. Moreover, treatment is likely to be less effective if social and economic determinants, including poverty, unemployment, and declining opportunities for economic growth are not improved in affected areas (Rigg et al. 2018).  

Centers for Disease Control (2021). Press release: drug overdose deaths in the U.S. Top 100,000 annually.  

 Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030,  

Rigg, K. K., Monnat, S. M., & Chavez, M. N. (2018). Opioid-related mortality in rural America: Geographic heterogeneity and intervention strategies. The International journal on drug policy, 57, 119–129.  

Most recent data from the U.S. Department of Health and Human Services states that only 8.0 percent of adults ages 35 years and over received high priority appropriate clinical preventatives services in 2015.  The goal of Healthy People 2030 is to increase that number to 10.9 percent.  Preventative healthcare can prevent the formation of disease, eventually leading to death.  One of the objectives of Healthy People 2030 is to increase comprehensive and high-quality health care services.  Disparities by age, race, and ethnicity continue to exist concerning people getting preventative services. 

The Affordable Care Act focused on reducing healthcare disparities with coverage expansions and funding for community health centers covering groups facing disparities (Artiga et al., 2020).  In addition to, the Department of Health and Human Services and the Affordable Care Act are engaged in eliminating racial and ethnic health disparities. These are just among the key initiatives to eliminate disparities.

While there have been improvements in healthcare coverage and preventative care services, racial and ethnic disparities in the utilization of these services persists (Ma et al., 2020).  Artiga et al. (2020) state that policy changes and decreased federal funding for outreach and enrollment services, CMS’s new eligibility restrictions for Medicaid coverage, and the Department of Homeland Security’s immigration policy changes were some of the reasons healthcare coverage has stalled.  According to the World Health Organization, social and environmental factors governed by the flow of cash, power, and resources at global, national, and local levers are mainly responsible for inequities in health outcomes (WHO, 2020).  Braverman et al. (2014) state that growing evidence points to social and economic factors such as income, wealth, and education as the fundamental causes of the vast range of inequities in healthcare.  In conclusion, addressing current policies and highlighting the effects of social determinants of health should be the focus in eliminating these disparities.  

References

Braveman P., Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes.  Public Health Rep 2014 129(Suppl. 2):19–31. 

Artiga, S., Orgera, K., Pham, O. (2020). Disparities in health and health Care: Five questions and answers. Kaiser Family Foundation: Issue brief. 

Healthy People 2030. Health care access and quality. 

World Health Organization. Social determinants of health. 

Healthy People 2030 (n.d.) stated goals are to “attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all” (p.1). Healthy People 2030 (n.d.) shares data, statistics, and strategies to combat health disparities by state, ethnicity, sex, and age to highlight each communities needs.

This week’s lesson defined intrinsic and extrinsic factors that influence Leading Health Indicators (LHIs). LHIs are listed as high-priority objectives for action. Intrinsic factors such as race and age cannot be altered, and extrinsic factors such as physical environment, access to health care, and diet may be changed (Healthy People 2030, n.d.; ODPHP, n.d.). 

Two high priority Health People 2030 (n.d.) LHI objectives for Native Hawaiian and Other Pacific Islanders (NHOPI) are:

 The Office of Minority Health  (OMH) (2020) reports the following for the NHOPI community:

· In 2018, Native Hawaiians/Pacific Islanders were 2.5 times more likely to be diagnosed with diabetes than the non-Hispanic white population.

· In 2018, Native Hawaiians/Pacific Islanders were 2.5 times more likely than non-Hispanic whites to die from diabetes.

· In 2014, American Samoans had the highest diabetes rate among surveyed Pacific Islander sub-populations, and their rate was 2.8 times higher than the national white population.

· Native Hawaiians/Pacific Islanders were 80% more likely to be obese than non-Hispanic whites in 2016.

· Native Hawaiian/Pacific Islander adolescents were more than twice as likely to be obese compared to non-Hispanic white adolescents in 2017.

· In 2014, Samoans were 5.6 times more likely to be obese than the overall Asian American population.

· Overweight people are more likely to suffer from high blood pressure, high levels of blood fats, diabetes, and LDL cholesterol – all risk factors for heart disease and stroke.

Possible Solutions

McElfish et al. (2019) discovered that community-based organizations were a high priority within the NHOPI community as a way to “leverage, build, and sustain leadership.” (p.8). Additional factors that researchers found to support change within this community should be to include family in diabetes self-management education (DSME) as an ongoing health literacy education tool. Finally, using culturally adapted language, pictures, and culturally appropriate metaphors improve compliance and sustainability.

References

McElfish, P. A., Long, C. R., Kohler, P. O., Yeary, K. H., Bursac, Z., Narcisse, M. R., Felix, H. C., Rowland, B., Hudson, J. S., & Goulden, P. A. (2019). Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Care, 42(5), 849–858. 

Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030 | health.gov. Healthy People 2030. Retrieved April 12, 2022, from 

Office of Disease Prevention and Health Promotion. (n.d.). Reduce the number of diabetes cases diagnosed yearly — D01 – Healthy People 2030 | health.gov. ODPHP. Retrieved April 12, 2022, from 

Office of Minority Health. (2020, March 26). Obesity and Native Hawaiians/Pacific Islanders – The Office of Minority Health. Minority Health. Retrieved April 12, 2022, from