Analysis of a Public or Community Health Problem
A community health problem, being a well being issue affecting a large population of the community, has a widespread impact on the community. Diabetes has plagued the population of New York State for over a decade now. Many surveys carried out in the state to assess the prevalence of the condition report increased incidence rates too. Due to the high prevalence rates and the fact that the condition is widespread in the state, this paper will analyze diabetes as a community health problem in New York State and make recommendations on plausible solutions.
Description of the problem
Diabetes is a chronic health condition where the body either produces insufficient insulin, fails to produce insulin or is resistant to insulin. This results in an improper metabolism of glucose in the body resulting in dangerously high levels of blood sugar. If the condition is not properly managed, life threatening complications can arise in one’s body. Diabetes, being a group name that describes diseases that are indicated by high levels of blood sugar as a result of insulin action or defects in its production resulting in both hypo- or hyperglycemia, manifests in two primary types.
- Type I Diabetes
Type I diabetes develops when the beta cells situated in the pancreas are spoiled by the body’s immune system inhibiting the production of insulin. This type of diabetes could be genetically predisposed or as a result of the infection of the beta cells in the pancreas (McDowell, Matthews, & Brown, 2007).
- Type II Diabetes
Type II diabetes occurs as a result of a resistance towards insulin created by the body. The beta cells in the pancreas produce the required insulin, but the body fails to react effectively. This type of diabetes affects adults after a trigger. Obesity is a widespread trigger of this form of diabetes.
There are other lesser forms of diabetes namely gestational diabetes, secondary diabetes and impaired glucose tolerance. Gestational diabetes just like the name suggests is a type of glucose intolerance diagnosed when a woman is pregnant due to inability to increase the secretion of insulin. Management is required in order to normalize the maternal blood sugar levels lest the fetus is affected. The major predisposing factors are obesity and genetics.
Although the condition is asymptomatic and not essentially life threatening to the mother, it is linked with an increase in jaundice, neonatal morbidity and neonatal hypoglycemia. Secondary diabetes refers to the occurrence of glucose intolerance after particular conditions like hormonal disturbances, pancreatic disease, malnutrition and drug overuse. Impaired glucose tolerance refers to a condition characterized by intermediate blood glucose levels between normal and abnormal (Matthews, 2008).
Epidemiological and demographic data on diabetes in New York State
The three year moving average reports a steady increase in the prevalence of self-reported diabetes in the adult population. The average has almost doubled from 4.6% reported in 1996-1998 to 8.5% reported in 2007-2009. Diabetes is most widespread in adults aged between 65-74 years at 20.3%. Non-Hispanic blacks report a higher prevalence of self-reported diabetes at 12.1% compared to Non-Hispanic whites who report at 7.7%. The majority of adults diagnosed with diabetes living in New York State are Non-Hispanic whites.
However, minorities defined by race and ethnicities constitute a larger proportion of individuals with diabetes reported at 44% than the total population of New York State at 32%. The household income is one of the parameters explored in the propensity for diabetes. Adults earning less than 15000 dollars annually are at 15.2% three times more likely to report with diabetes compared to adults in households earning more than 15000 dollars annually at 5.2%. In the very least, two thirds, representing 66% of adults diagnosed with diabetes live outside of New York City.
National estimates from the 2005-2006 survey reported a 5.1% prevalence of undiagnosed diabetes in adults more than 20 years. These estimates can be used to show a general picture of the prevalence of undiagnosed in the population of New York State. Using these estimates, it is inferred that over 760000 adults over the age of 20 years are projected to have undiagnosed diabetes. There is a 42% prevalence rate for high blood sugar testing in adults without health insurance. There is a 62% prevalence rate for high blood sugar testing among the population in New York State with a health insurance (Ekoé, 2008).
Adults without a regular health care provider also report a lesser prevalence rate for testing for high blood sugar compared to a 64% prevalence rate for those with a regular healthcare provider. Epidemiological data reports a higher prevalence of prediabetes among obese adults at 10.7%, and overweight adults at 5.3% compared to prevalence of 2.9% among adults who are neither obese nor overweight. The occurrence of gestational diabetes in New York State has gradually increased from 1995 where prevalence of 35.5 per 1000 live births to 2006 where a prevalence rate of 47.3 per 1000 live births. The state surveys report Asian women to have the highest prevalence rate of gestational diabetes at 7.9%.
In a report dabbed The Hidden Health Care Costs of Diabetes, there was a 30% increase in the percentage of inpatients admitted for diabetes in New York State between the year 2000 and 2008. This accounts for a whopping 84%of the entire growth in admissions over the same period of time. In addition, patients diagnosed with diabetes have a 60% more likelihood t be readmitted to hospital inside 30 days of treatment `when compared to patients without diabetes.
Available resources and initiatives
Owing to the high prevalence rates of both diagnosed and undiagnosed diabetes in New York State, there are a myriad of initiatives, programs and collaborations combating diabetes. While most of these programs and initiatives are state run, a good number of them are organized and overseen by the private sector. Most of these are awareness programs running messages on prevention through public education. There are also a number of programs and initiatives helping in the management of diabetes for the large population already diagnosed with diabetes. The following is an analysis of some of the programs and initiatives available to the population of New York State diagnosed with diabetes: -
- The New York State Diabetes Campaign
This entails a 35 million dollar five year program dabbed the New York State Diabetes Campaign aimed at reversing the epidemic that is diabetes in the New York State. The campaign initiated by the New York State Health Foundation works with partner clinics to achieve its mandate. The campaign is governed by three focus areas namely improving clinical care, promoting policy and mobilizing communities. The clinic chosen to partner with the New York State Health Foundation uses federally qualified health centers as recommended by the National Committee for Quality Assurance Diabetes Recognition Program and Bridges to Excellence Diabetes Care Recognition Program.
The voluntary programs are to help communicate the program to the beneficiaries and in return receive recognition for the delivery of quality diabetes care. The recognized health facilities used in the campaign benefit from being distinguished as community leaders in the practice of data abstraction efforts. The incentives are received through recognition by the Patient Centered Medical Home.
The success of an effective program is dependent in its communication to the targeted beneficiaries. The communication of this program is done alongside four levels of engagement meant to encourage health centers and beneficiaries to participate in the program. The ultimate of the four levels of engagement is to create ultimate centers of excellence in the management of diabetes by channeling support and resources to the health centers. The chosen health centers are mandated to recruit individuals with diagnosed diabetes into the program. They are also mandated to communicate the theme of the program through public awareness drives. These awareness drives are organized in collaboration with the two volunteer programs aforesaid.
The awareness campaigns are to run messages encouraged screening for diabetes I order to target the undiagnosed cases, which according to the epidemiological data provided earlier, are very prevalent in New York State. This approach shows promise because apart from targeting those individuals who are diagnosed with diabetes, it also reaches out to the undiagnosed cases. The existence of this program is communicated to the beneficiaries by the federally accredited health centers.
- Diabetes Campaign Collaborative 2012-2013
This campaign collaborative is funded by the New York State Health Foundation and run by the Healthcare Association of New York State’s Diabetes Campaign Collaborative. This campaign is spearheading the fight against diabetes by partnering with providers to offer new and coordinated systems aimed at providing care and prevention. During the initial year of the program, more than 250 clinics and 112 hospitals participated in the diabetes campaign. The campaign resulted in over 260 practitioners being recognized with the National Committee for Quality Assurance. 800 more practitioners are projected to participate in the second year f the program.
The Diabetes Campaign Collaborative 2012-2013 was designed with a unique set of provisions intended to aid hospital based primary care centers and clinics to prevent complications and improve outcomes for patients with diabetes. This is to be done through the adoption of forward looking, aptly coordinated practice models that will not be rendered ineffective after the post healthcare reform era.
Communication of the program was done through the use of federally accredited primary health care centers. The Heads of Medicine in these centers were mandated to inform the beneficiaries of the programs. Those that were diagnosed with diabetes are immediately inducted into the program. Outreaches were also conducted to reach out to those that might not have access to the primary care centers either due to physical or economic reasons. This increased the penetration of the program (LeRoith, Taylor & Olefsky, 2004).
- Diabetes Prevention Program by New York City’s YMCA
The New York City’s YMCA group has increased the classes in five of its boroughs from eighteen to twenty one. The program was launched in New York City towards the end of 2010. In the very beginning, the program was piloted in Bedford-Stuyvesan and Vanderbilt branches. However, the program expanded citywide in the following year with the classes being held in many more branches. The program has been credited across the board for the innovativeness of its health promoting activities focusing on healthy living, wellness and prevention. The program uses group-based lifestyle interventions intended especially for people at a higher risk of developing type II diabetes.
Over the 16 sessions, the YMCA lifestyle coach trains the participants to increase their physical activity, embrace healthier diets and also learn of other behavioral modifications necessary in the management of diabetes. The participants meet centrally once a month for more support towards helping them maintain their progress. The program communicates its activities through its network of youth centers across the city. This is an effective means of communication because it has a wide outreach and penetration. Communication is also done through the group’s website.
- Diabetes Prevention and Management Toolkit
This initiative is geared towards providing information to the patients and care givers towards proper management and prevention of diabetes. The Diabetes Prevention and Management Toolkit provides information for those at risk in order to help them prevent the development of type II diabetes. It also offers information on effective ways to help manage diabetes for those already diagnosed with diabetes. The Diabetes Prevention and Management Toolkit contains two kits namely the Personal Diabetes Care Card and Manage your Diabetes Brochure. The Personal Diabetes Care Card is a card designed to fit in a typical wallet to help a persona with diabetes keep track of all the basic tests they require, how often they require them and the test results.
The Manage your Diabetes Brochure entails a tri-fold brochure that aids diabetics keep track of their results and assists them to set their own management goals under the supervision of their health care providers. The initiative is communicated online through its website where the toolkit can also be downloaded. Referrals are made to deserving patients to the website for downloading and access to the information. This method of communication is not very effective as it requires the use of technology that may not be readily available to the larger population.
Barriers to solving the community health problem
- Services needed
Diabetes is a health condition that requires management in order to prevent the life threatening complications that might arise as a result. Solutions towards diabetes are geared towards preventive and management initiatives. A cocktail of services are needed in the formulation of sustainable solutions towards the menace that diabetes is. Public awareness campaigns and public education services need to be initiated. These provide the much needed information to augment preventive strategies. Screening services are also requisite in order to establish the incidence and prevalence rates. These help track the progress achieved by the programs. Screening also helps diagnose the undiagnosed cases of diabetes. Nutritional counseling services are also required since a big part of managing diabetes in dependent on nutritional therapy.
- Access
Programs towards prevention and management of diabetes are best rolled out in a primary health care facility. This presents a challenge in that the primary health care facilities may be far from the reach of the beneficiaries resulting to physical inaccessibility. Economic inaccessibility may prevail in low social economic set ups especially where they are required to meet the cost of some of the services. Mobile camps and e-health are viable solutions to physical inaccessibility but the inadequacy of resources might be a bottle neck.
- Communication challenges
New York State is quite expansive; a factor that is challenging to the communication of the programs since the beneficiaries are widely dispersed. Penetration is key to the accomplishment of a program. It is important for the targeted population to be made aware of the existence of the programs. Finding a medium through which the communication is to be passed through is very challenging. This is because the beneficiaries are dispersed between various age categories, social and economic status. Owing to this, finding a communication medium that cuts through is very challenging. This is especially so in the midst of inadequate resources.
- Regulatory/Political issues
Very many states require insurance coverage in the treatment and management of diabetes. This goes a long way in reducing the economic gap that might impede the delivery of services. Some states require that the policies cover equipment and services done at home that aid in the management of diabetes.
- Interagency scope of delivery and care
The agencies involved in the running of programs and initiatives towards the prevention and management of diabetes have their efforts harnessed and synchronized. The agencies scope towards the delivery of services is wide. It encompasses efforts like patient education, public awareness and nutritional counseling. Surveys are also carried out to ascertain and evaluate progress.
- Financing/Economic and Budgetary Issues
Writing proposals with brilliant ideas towards the management and prevention of diabetes is the first step. Trends in the running of these programs show that serious financial implications are involved. With the limited resources provided by the state, budgeting for the numerous activities involved is quite challenging. The input by the corporate world has been influential in the conclusion of the programs. However, there are deficits that hamper the service delivery and by extension the success of the program.
- Population/Human Impact
The epidemiological information adduced above reports high prevalence rates of diabetes in New York State. There are also enormous numbers of undiagnosed diabetes. The large number could impact the success of any solutions towards diabetes. This is because the large numbers strain the resources.
Major stakeholders
The following are the major stakeholders that would be involved in solving the community health problem: -
- New York State Health Foundation
The input of the New York State Health Foundation is very important to the success of any initiatives. As espoused above, funding for the programs and initiatives is very vital. New York State Health Foundation has over the years funded various programs.
- National Committee for Quality Assurance Diabetes Recognition Program
The quality of programs aimed at preventing preventive solutions and ways of managing diabetes cannot have compromised quality. In order to ensure quality of services delivered, timely evaluation and monitoring is required. The National Committee for Quality Assurance Diabetes Recognition Program is experienced in monitoring the course of these programs and would offer their expertise in ensuring quality in service delivery is not compromised (Crowe, & Stachowiak, 2010).
- Primary Healthcare Facilities
The efficiency of the programs is increased when they are carried out from the premises of a primary healthcare facility. The primary healthcare facilities have medics who can offer consultancy in order to augment the services given. All the agencies listed above have their mandate cut out for them and there is no cross over in their responsibilities.
Recommendations/Conclusion
Based on the analysis of diabetes, I make the following recommendations towards solving problem.
- Very many Americans, not just in New York State are living with prediabetes. This is a condition in which some of the diagnostic criteria for diabetes are met. Statistics show that the individuals with prediabetes can reduce their chances of developing diabetes by change of lifestyle and a little weight loss (Bernstein, R2011). I recommend that prevention programs encompass lifestyle changes and weight loss programs.
- The fight against diabetes has been fought on the pillars of management and prevention. This is because of the stoppage of the pancreas to manufacture enough insulin in type II diabetes. Research is ongoing as spearheaded by the National Institute of Diabetes, Digestive and Kidney Diseases for a cure for diabetes. Clinical trials are ongoing for an artificial pancreas. To augment these efforts, I recommend for increased funding by the congress to the principal researching agency for the cure for diabetes.
- The 5.1% prevalence rate of undiagnosed diabetes in New York State is high. Owing to the nature of the complications resulting from diabetes, such a high prevalence is a rubble strip in the fight against diabetes. In order to lower the prevalence of undiagnosed diabetes in the state, I recommend increased nutritional assessment throughout the primary health care facilities in the state (Ekoé, 2008).
References
Bernstein, R. K. (2011). Dr. Bernstein's diabetes solution: The complete guide to achieving normal blood sugars. New York: Little, Brown and Co.
Crowe, L., & Stachowiak, J. (2010). The diabetes manifesto: Take charge of your life. New York: DemosHealth.
Ekoé, J.-M. (2008). The epidemiology of diabetes mellitus. Chichester, UK: Wiley-Blackwell.
LeRoith, D., Taylor, S. I., & Olefsky, J. M. (2004). Diabetes mellitus: A fundamental and clinical text. Philadelphia: Lippincott Williams & Wilkins.
Matthews, D. (2008). Diabetes. Oxford: Oxford University Press.
McDowell, J. R. S., Matthews, D. M., & Brown, F. J. (2007). Diabetes: A handbook for the primary healthcare team. Edinburgh: Churchill Livingstone.
