Hsh701 Public Health | The Assessment Answers

Answer:

Statement of Problem

There are around 1.2 million diabetes cases in Australia with diabetes 2 accounting for 85% of the total diabetes cases. An average of 280 people develops diabetes that translates to 1 person in every 5 minutes (Ding et al., 2015). There also exist up to 500000 undiagnosed type 2 diabetes who fall to risk of late diagnosis that can lead to health complications. The Department of Health need to take action to enhance early diagnosis and management of diabetes 2 to reduce the annual disease cost burden and improve patients’ quality of life.

Background

Diabetes 2 has increased over the past decade affecting 4.1% of the Australian population (Ding et al 2015). It recorded that 1002000 million Australian have been diagnosed and are living with diabetes 2. The statistics show that diabetes type 2 has high incidence as compared to type 1 diabetics’ cases that form 10% of diabetes cases in Australia. The diabetes prevalence in the country has doubled from 1989/1990 to 2004/2015. The rate stabilized between 2007/2008 and 2011/2012. . From this period, the prevalence rate has increased from 4.4percent to 5.1 percent (Zimmet et al., 2014). The records show that there are about 980000 hospitalized Australians with diabetes 2 in 2015/2016. The increased number of diabetes 2 has led to increase total annual diabetes cost impact of estimated $14.6 billion.

The diabetes 2 prevalence for specific population indicates who are most affected by the disease. The rate of men with diabetes 2 is 1.4 times higher as compared to females. This shows that out of total 980000 diabetes 2 cases reported in Australia, there were 2991 females and 4217 male patients in every 100000 people in the country. The diabetes 2 hospitalization rate increased with age and majority (87%) of patients were 55 years and above. The hospitalization rate was highest for men aged 85 years and above recorded at 30055 per every 100000 people as compared to females aged 75 to 84 recorded at 19261 per 100000 (Zoungas et al, 2014).

The second notable statistics show that diabetes 2 hospitalization rate increases with socioeconomic disadvantage and remoteness. The population living in remote areas had twice high hospitalization rate as compared to populations residing in major cities. The rate is even larger for women as compared to men who were estimated to be 7854 compared to females in major cities at 2870 per 100000 populations in Australia. The rate for male is 1.3 times higher compared to males in major cities. The population in the lowest socioeconomic group recorded twice high rate of hospitalization as compared to population group in the highest socioeconomic group. The hospitalization rate was higher at 2.1 times for females and 1.6times higher for male in low socioeconomic population groups as compared to high socioeconomic group (Ding et al 2015). These statistics indicate that females in disadvantaged areas or low socioeconomic group were vulnerable to diabetes 2 as compared to males in the same situations.

Another notable statistics that shape the diabetes 2 prevalence is indigenous community hospitalization rates. The Aboriginal and Torres Strait Islander people had approximately 54000 hospitalization cases out of the total cases recorded. This rate can be equated to 13350 diabetic cases per 100000 populations. The hospitalisaation rate among Aboriginals and Torres Islander Australians is 4 times high compared to non-indigenous people of Australia who have 3,266 cases per 10000. This prevalence disparity was even higher between indigenous females at 5 times higher than non-indigenous female Australians and 3 times higher for indigenous male Australians compared to non-indigenous male Australians. These statistics show that diabetes 2 is high among indigenous communities as compared to non-indigenous Australians.

Pre-existing Policies and Activities

The Department of Health has several programs that have been running to support treatment an management of diabetes condition in Australia. First, the government has Medicare Benefits Schedule that provides subsidies for patients that have terminal conditions. The Medicare allow eligible patients  to be refereed by GP up to 5 subsidies for allied health services that involve planning and managing of a chronic condition. The second support management program is the Pharmaceutical Benefit Scheme. This scheme aims to provide medicine subsidies for treating diabetes. The third government program to support diabetes management and treatment is the National Diabetes Services scheme. The scheme is managed Diabetes Australia and provides subsidized products for diabetes patients that include blood glucose test strips, syringes and needles, insulin pump and urine ketone test strips. The fourth government activity to support diabetes is the significant investment in diabetes research. The diabetes research is undertaken by the National Health and Medicare Research Council (NHMRC). The research is aimed at improving patients’ care that has complex terminal conditions. The government also funds the Australian Institute of Health and Welfare (AIHW) that conducts national monitoring and surveillance of vascular diseases. The AIHW provides important insight on how diabetes affects different populations in Australia. The government also has developed Australian National Diabetes Strategy 2016-2020. The strategy is an important framework that is intended to inform the government and Department of Health on how to use the existing resources to treat and manage diabetes. The strategy outlines how to better coordinate, target, and prioritize national response to diabetes. The strategy therefore emphasizes on diabetes prevention, management and treatment, early intervention and role of primary care in addressing the issues of diabeties in Australia.

Considerations

Several actions can be taken to change the current prevalence an improve people living with diabetes 2 quality of life. These actions can be health promotion for lifestyle intervention mechanisms, empowering people of low socioeconomic group and enhancing accessibility of health care services in remote areas. These actions will enhance early diagnosis hence early intervention, enable management, and treatment to minimize risk of threatening complications, and ultimately improve quality of life for people living with diabetes 2 condition.

Health promotion action will involve promotion of healthy lifestyle. Researchers attribute development of diabetes 2 to a population lifestyle that increases the disease risk. These healthy lifestyles that can reduce diabetes 2 developing or be manageable are physical activities, body weight control, and diet. Obese people have a high risk of developing diabetes 2 (Nolan, Damm, and Prentki, 2011). Obesity has shown to increase the BMI that is associated with high diabetes risk. According to Nyenwe et al. (2011) study, diabetes 2 prevalence increases from 3.9% for individuals not overweight to 16% obese individuals. Obesity is also a major risk factor for other life threatening conditions such as hyperlipidaemia, cardiovascular disease, and hypertension. Promoting weigh control lifestyle will therefore reduce diabetes 2 incidences by around 3.6% and reduce development of life threatening complications such as cardiovascular disease (Spallone et al., 2011). The second healthy lifestyle promotion will be diet that has a major role in development of diabetes 2. There are significant effects that dietary manipulation has on insulin sensitivity and glucose tolerance especially proportions of carbohydrates and fats consumed (Grace, Clayton, and Mcdonald, 2012). Special diet can therefore reduce risk of diabetes 2 and can also be used to manage the disease by people living with the condition (Hirakawa et al., 2014). The other important healthy lifestyle promotion is physical exercise. The insulin resistance reduces when an individual is involved in physical activities and cells are able to use the glucose much effectively. Increasing physical activities makes an individual insulin more effective hence reducing insulin resistance (Hordern et al., 2012).Physical exercises can also enable people living with diabetes 2 avoid other life threatening complications such as heart problems. Health promotion activities by the Department of Health will reduce new cases of diabetes 2 developing through preventive programs and modifiable risk factors. This will therefore reduce prevalence and enable people with diabetes manage their conditions at low cost and avoid development of other complications.

The second action is empowering people of low socioeconomic group to middle or high socioeconomic status. Diabetes 2 though caused by genes, 75% of contributing factors to it development are socioeconomic factors (Abouzeid et al., 2013). People of low socioeconomic group lack adequate income to meet their health needs, have low education levels, majority are unemployed and live in poverty. Socioeconomic factors determine an individual ability to reduce or avoid development and management of diabetes 2 (Barendse, Singh, Frier, and Speight, 2012). First, low socioeconomic group are unable to afford balance or special diet. They have little or no meal choice and are likely to eat what is available. This is risky to people susceptible to diabetes 2 and if not taken into account can lead to development of other complications. Low socioeconomic groups in Australia lack affordability to health care. The activities for low socioeconomic group is creating employments (Jobs), enhancing access to credit to start small businesses, and implementing physical activities programs in remote (Campbell et al., 2011). Jobs and business will increase the people’s income increasing their purchasing power and they will be able to make healthy choices and buy. This will enhance their consumption of balance and special diet that reduces risk of diabetes. Improving socioeconomic factors from remote populations will improve their quality of life and control risky contributing factors of diabetes 2 (Campbell et al., 2011).      

Another action that can reduce diabetes 2 prevalence is building of hospitals in rural and remote area and health education to member of the community. Minges et al. (2011) found that people living in rural and remote areas have to travel for about an hour to see a GP as compared to people living in cities. Building hospitals will enhance remote communities’ access to health care for diagnosis and management of the disease. Health education can involve community participation on the best practices to prevent and minimize the disease development. Community participation will enhance implementation of healthy practices that are culturally accepted by the population (Hibbard and Greene, 2013). Community participation to health education about diabetes 2 can be done by training selected community member who then reach out to all members in the society. This activity will enhance support of best healthy practices that will be used to prevent and manage diabetes 2. The community health worker will disseminate health information, diagnose early signs, and refer patients to the health centers for treatment (Azzopardi et al., 2012). These activities therefore will enable disadvantaged groups in Australia to access GP and health information on diabetes 2 hence reducing development and improving management of the disease.

Recommendation

The Department of health will need to apply the following recommendations to prevent, reduce and manage diabetes 2 prevalence in Australia;

1. Build hospitals in remote areas: The ministry should build hospitals in rural and remote areas to enhance accessibility and encourage people living in remote areas to seek treatment. This will reduce the rate of diabetes 2 development.
2. Training community health worker: This will enhance community participation on developing best practices to manage diabetes 2. Community health workers will disseminate health education, enable early diagnosis, and make referrals to health care centers for further diagnosis and treatment. This will increase early diagnosis for early interventions hence reducing risk factors for diabetes 2 development.
3. Empowering communities economically: This will involve offering job opportunities and access to credit to finance their projects. Applying this multi-sectoral approach will reduce risky socioeconomic determinants of diabetes 2.
4. Launching health promotion programs: These programs will encourage healthy lifestyle in terms of physical activities, weight management, and diet to reduce susceptibility of diabetes 2 among Australians.        

Sources Consulted

Abouzeid, M., Philpot, B., Janus, E.D., Coates, M.J. and Dunbar, J.A., 2013. Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia. BMC public health, 13(1), p.252.

The authors review the Australian National Census and diabetes data that are from National Diabetes Serves Scheme to establish the relationship between ethnicity and socioeconomic status and type 2 diabetes incidences. The study concluded that type 2 diabetes vary with socio economic status and ethnicity. The study has been used because it provides evidence on prevalence within specific populations of different social status.

References

Azzopardi, P., Brown, A.D., Zimmet, P., Fahy, R.E., Dent, G.A., Kelly, M.J., Kranzusch, K., Maple-Brown, L.J., Nossar, V., Silink, M. and Sinha, A.K., 2012. Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention. Med J Aust, 197(1), pp.32-6.

The study purpose was to establish cases of diabetes 2 among young indigenous Australians in remote areas. The study is used to show the problem that exist in remote and rural areas in Australia that are a big challenge to managing diabetes 2 risk factors.

Barendse, S., Singh, H., Frier, B.M. and Speight, J., 2012. The impact of hypoglycaemia on quality of life and related patient?reported outcomes in Type 2 diabetes: a narrative review. Diabetic medicine, 29(3), pp.293-302.

The study reviews literature to find out the impact hypoglycemia has on quality of life together with reported outcomes of type 2 diabetes. The study is used as evidence of what happens to patients with diabetes disorder and doesn’t manage their condition.

Campbell, D., Burgess, C.P., Garnett, S.T. and Wakerman, J., 2011. Potential primary health care savings for chronic disease care associated with Australian Aboriginal involvement in land management. Health Policy, 99(1), pp.83-89.

The study rationale was to identify possible methods of saving cost on primary care of chronic diseases by empowering indigenous people to work on land. The study found that the participants were in better health that showed substantial saving of cost. The study has been used as evidence to multi-sectoral approach in reducing diabetes cost burden in the Australian public health.

Ding, D., Chong, S., Jalaludin, B., Comino, E. and Bauman, A.E., 2015. Risk factors of incident type 2-diabetes mellitus over a 3-year follow-up: Results from a large Australian sample. Diabetes research and clinical practice, 108(2), pp.306-315.

The study aimed to describe diabetes 2 incidence among Australians. The study categoriesd populations into health status, socio-demographic, lifestyle, and family history to understand the risk factors that impact the disorder. The tuy has been used to show incidence statistics in Australia.

Grace, B.S., Clayton, P. and Mcdonald, S.P., 2012. Increases in renal replacement therapy in Australia and New Zealand: understanding trends in diabetic nephropathy. Nephrology, 17(1), pp.76-84.

The purpose of this study was to understand the cause of renal replacement therapy(RRT) among people with diabetic. The study found that RRT increased by 321% from the year 1990 to 2009 as a result of increased diabetic patients. This study was used to show that if diabetes 2 is not managed, it can develop to other complications.

Hibbard, J.H. and Greene, J., 2013. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health affairs, 32(2), pp.207-214.

The study aimed to outline important strategies to reform a health care system by engaging all stakeholders. The study has been used to show the importance of community participation in making own health decisions toward management of a certain health issue.

Hirakawa, Y., Arima, H., Zoungas, S., Ninomiya, T., Cooper, M., Hamet, P., Mancia, G., Poulter, N., Harrap, S., Woodward, M. and Chalmers, J., 2014. Impact of visit-to-visit glycemic variability on the risks of macrovascular and microvascular events and all-cause mortality in type 2 diabetes: the ADVANCE trial. Diabetes care, p.DC_140199.

The study purpose was to record how microvascural and macrovascular event cause mortality in diabetes 2. The study is used to show the important of early diagnosis and management of the disorder using special diet to avoid development of complex life threatening conditions.

Hordern, M.D., Dunstan, D.W., Prins, J.B., Baker, M.K., Singh, M.A.F. and Coombes, J.S., 2012. Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia. Journal of Science and Medicine in Sport, 15(1), pp.25-31.

The authors’ purpose was to explain the role of exercises to improving glycaemic control for diabetic patients. The study has been used to show evidence on the importance of physical activities in preventing and managing diabetes 2.

Minges, K.E., Zimmet, P., Magliano, D.J., Dunstan, D.W., Brown, A. and Shaw, J.E., 2011. Diabetes prevalence and determinants in Indigenous Australian populations: a systematic review. Diabetes research and clinical practice, 93(2), pp.139-149.

The study systematically reviewed prevalence of diabetes 2 among indigenous Australians. The study has been used to show evidence that prevalence of diabetes 2 is higher among indigenous Australians as compared to non indigenous people of Australia.

Nolan, C.J., Damm, P. and Prentki, M., 2011. Type 2 diabetes across generations: from pathophysiology to prevention and management. The Lancet, 378(9786), pp.169-181.

This study reviewed diabetes 2 Pathophysiology with attention to epigenetic, genetics, epidemiology, and cell biology to establish the susceptibility of the disorder. The study found that diabetes 2 susceptibility is acquired early in life. The review is used to show need for diabetes management.

Nyenwe, E.A., Jerkins, T.W., Umpierrez, G.E. and Kitabchi, A.E., 2011. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Metabolism, 60(1), pp.1-23.

The study aimed to outline different diabetes 2 management strategies and how they have evolved over time. The study has been used as evidence to how management of diabetes can reduce it development by controlling body weight.

Spallone, V., Ziegler, D., Freeman, R., Bernardi, L., Frontoni, S., Pop?Busui, R., Stevens, M., Kempler, P., Hilsted, J., Tesfaye, S. and Low, P., 2011. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes/metabolism research and reviews, 27(7), pp.639-653.

This research aimed to investigate the Cardiovascular Automic Neuropathy (CAN) and how it impacted by diabetes. The research is used to show the relationship between CAN and diabetes diagnosis and management.

Zimmet, P.Z., Magliano, D.J., Herman, W.H. and Shaw, J.E., 2014. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology, 2(1), pp.56-64.

The study records diabetes 2 prevalence for the past 20years to outline the big change that the disorder has in the 21^st Century. The study also focuses on identifying contributing factors to increasing prevalence of diabetes 2. The study has been used to show the challenge that diabetes 2 has become over the years.

Zoungas, S., Woodward, M., Li, Q., Cooper, M.E., Hamet, P., Harrap, S., Heller, S., Marre, M., Patel, A., Poulter, N. and Williams, B., 2014. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia, 57(12), pp.2465-2474.

The study aimed to analyze diabetes 2 impacts on age, duration, diagnosis, and subsequent complications. The study has been used as evidence of the increasing prevalence of diabetes 2 by age.