The Impact of Diabetes: a Health Disparity among the Latino Community in California - Essay Example

Diabetes: A Perennial Healthcare Disparity among Latinos in California Diabetes is a debilitating disease in which the body does not produce or aptlyutilize insulin, a hormone manufactured by the pancreas that translates all foods into sugar and energy by maintaining sugar levels in the blood. In juvenile onset or insulin dependent diabetes, more popularly tagged as Type I diabetes, the body does not produce any insulin. On the other hand, in adult onset or non-insulin dependent diabetes, also known as Type II diabetes, the body does not manufacture adequate levels of insulin or is incapable of appropriately utilizing it. 1 Diabetes is depicted as a health disparity between Latinos and Whites. In the United States in 2000, there were 2 million Latinos (10.2%) who were afflicted with diabetes.2 Latinos are said to be 1.9 times more likely to have diabetes than non-Latino whites. Moreover, Mexican-Americans are two times more likely to acquire diabetes than non-Latino whites of similar age ranges. 3 Country-wide, for every two diagnosed cases of diabetes, another undiagnosed case is present in the community. 4 In addition, 13.6% of all Mexican Americans beyond 20 years old have diabetes. 5 California follows a similar diabetes incidence trend among Latinos. In fact, one in five individuals of Mexican origin beyond 50 years old in California has been diagnosed with diabetes. 6 In 2000, half a million Latinos in California were inflicted with diabetes, majority of whom were of Mexican roots. 7 In California and nationwide, diabetes is the 5th leading cause of death among Latinos, and the 4th leading cause of death among women and the elderly. 8 More facts are provided in the California Health Interview Survey of 2001 (in the UCLA Center for Health Policy Research, 2003) 9, which is the biggest survey of its kind conducted in any state. The following facts about the incidence of diabetes among Latinos are presented: 1) Among Latinos with diabetes, nearly one out of three is primarily a Spanish speaker (31.3%), more than one out of three are non-citizens (39.7%), and nearly three out of four (68.6%) have incomes below 200% of the Federal Poverty Level. 2) One out of five Latino adults with diabetes report being uninsured compared to one out of ten uninsured Whites. 3) Among adults with diabetes, Latinos are nearly also four times more likely to have no conventional source of care. 4) Insured Latinos with diabetes are significantly more likely to report medication use (72.5% vs. 48.9%) and daily glucose monitoring (39.4% vs. 21.7%). 5) Among adults with diabetes, Latinos are nearly also four times more likely to have no conventional source of care. 6) Insured Latinos with diabetes are significantly more likely to report medication use (72.5% vs. 48.9%) and daily glucose monitoring (39.4% vs. 21.7%). Source: 2001 California Health Interview Survey 10 Rates of having a usual source of care and insurance by language, citizenship, and Federal Poverty Level (Latino adults with diabetes, 18 years and older, California, 2001) *Source: 2001 California Health Interview Survey 11 Risk Factors The following risk factors have been cited for diabetes as a health disparity among Latinos: 1) Family history of diabetes 2) Gestational diabetes 3) Age over 40 years old 4) Smoking: the current smoking prevalence among Latino adults is 18.6% 12 5) Constrained access to healthcare: among adults inflicted with diabetes, Latinos in California are nearly four times more likely to have no conventional source of care than Whites (12.3% vs. 3.4%). 13 6) Obesity or being overweight: adults of Mexican roots, especially women, have significantly higher obesity rates than non-Latino White women in the United States. 14 7) Sedentary lifestyle: Latinos are less likely to engage in physical leisure activity than non-Latino White and Black Americans. 15 Obesity is a major risk factor for diabetes, and among Latino women, 38.1% are obese. 16 This is attested to by the higher rates of gestational diabetes among Latina women, as compared to non-Latino white women. 17 Among Latino youth, contemporary reports demonstrate a rise in the incidence of Type II diabetes among those below 18 years old, specifically those who are considered overweight. 18 Complications On the other hand, the following are the complications of this debilitating disease: 1) Heart disease is the leading cause of death among Latinos afflicted with the disease. 19 2) Complications attributed to diabetes include blindness, kidney failure, amputation of the lower limbs, heart disease, and stroke. 20 3) Diabetes is considered the foremost cause of adult blindness, amputation, and kidney failure. 21 4) Moreover, diabetes is the leading cause of end stage renal disease (i.e. kidney failure), being responsible for 43% of novel cases. Among diabetics, Mexican Americans are 4.5 to 6.6 times more probable to be afflicted by end-stage renal disease. 22 5) Other complications arising from diabetes include nerve disease, pregnancy complications, sores, poor circulation, gangrene, and dental disease. 23 Diabetes Management Diabetes management has several aspects, encompassing proper use of medications, and consistent home glucose monitoring. While not all individuals afflicted with diabetes require medication, utilizing apt medications is a primary component in diabetes management for majority of adults. While there may be awareness for these needs, procuring the materials and medications to make home glucose monitoring may be arduous and costly. For instance, in California, only 67.5% of Latinos expressed that they are taking medications, in contrast with 78.2% percentage for non-Whites. Moreover, while self-monitoring of blood glucose is a critical part of diabetes management for prevention of complications, only one out of three Latinos with diabetes (35.6%) report that they undertake glucose monitoring daily. This is in contrast with the parallel percentage of 54.6% of non-Whites. 24 Recommendations for Overcoming Barriers to Healthcare Access of Latinos Health disparities represent inequities in economic and environmental conditions that pull up the risk of illness and injury. Moreover, these decrease chances for good health. Unequal treatment and unequal access are the outcomes of social injustice arising from such health disparities. 25 Possessing healthcare insurance and a conventional source of care are critical for individuals afflicted with diabetes to aptly manage the disease. However, there are noted obstacles to healthcare access such as language, non-citizen status, and low income, which cause reduced access to health care services of Latinos. 26 To enhance such access, the following courses of action are recommended for Latinos with diabetes to gain increased and improved access to healthcare services Given these alarming findings it is recommended that outreach and enrollment efforts are expanded to guarantee that all qualified Latinos, specifically Spanish speakers, non-citizen, and adults with lower income. Moreover, the promotion of culturally and linguistically apt healthcare and health education materials is encouraged. The advertisement of additional programs for both the insured and the non-insured individuals, that encompass cost of medications and materials for routinary glucose monitoring. 27 Serving the uninsured must be a primary focus. There must be strong advocacy for finding these individuals. Concrete steps have been recommended in Uninsured, Latino, and with Diabetes.28 First, these members of the uninsured sector must be appropriately identified. Next, we are encouraged to serve them with all our resources. Moreover, the creation of additional services available to them must be undertaken. Another recommendation is to find allies and encourage others to help. There should also be an integration of fragmented systems to enhance advocacy for this group. Thos among this group that are afflicted by diabetes should be educated in a systematic and timely manner, including the immediate community to which they belong. 29 More than addressing the problem with those already suffering from the disease, prevention is equally important, and perhaps, wiser. We are then encouraged to help prevent being overweight and obese in schools; providing adequate training for schools; promoting physical exams as a protocol for detection of the disease and its early detection, among others. 30 References 1Chawla, N., Rodriguez, M., Babey, S., & Brown, E. (2003). Diabetes among Latinos in California: disparities in access and management. UCLA Center for Health Policy Research. 2American Diabetes Association. (2000). National diabetes fact sheet national estimates and general information on diabetes in the United States. Retrieved from www.cdc.gov/diabetes/pubs/pdf/ndfs.pdf 3 ibid. 4 Diabetes Control Program of the California Department of Health Services. (2000). The burden of diabetes in California counties. 5American Diabetes Association. (2000). National diabetes fact sheet national estimates and general information on diabetes in the United States. Retrieved from www.cdc.gov/diabetes/pubs/pdf/ndfs.pdf 6 Diamant, A., Babey, S., Brown, E., Chayla, N. (2003). Diabetes in California: nearly 1.5 million diagnosed and 2 million more at risk. Los Angeles: UCLA Center for Health Policy Research. www.healthpolicy.ucla.edu/pubs/files/Diabetes_PB_final_R2_pdf 7 Diabetes Control Program of the California Department of Health Services. (2000). The burden of diabetes in California counties. 8 National Vital Statistics Report. (2000). 48, 11. 9 UCLA Health Policy Research Center. (2003). The California Health Interview Survey of 2001. California: UCLA Health Policy Research Center. 10 ibid. 11 ibid. 12 Centers for Disease and Control Prevention. (2002). Cigarette smoking among adults – United States. MMWR, 51, 642-644. 13 Chawla, N., Rodriguez, M., Babey, S., & Brown, E. (2003). Diabetes among Latinos in California: disparities in access and management. UCLA Center for Health Policy Research. 14 Centers for Disease and Control Prevention. (2002). Cigarette smoking among adults – United States. MMWR, 51, 642-644. 15 ibid. 16 National Vital Statistics Report. (2000). 48, 11. 17 National Diabetes Information Clearing House. (2002). Diabetes in Hispanic Americans. http://diabetes.niddk.nih.gov//dm/pubs/hispanicamerican/index.htm 18 Neufeld, N., Raffel, L., Landon, C., Chen, Y., Vadheim, C. (1998). Early manifestation of type 2 diabetes in Mexican-American youth. Diabetes Care, 21, 80-86. 19 National Institute of Health. National Diabetes Education Program. Understanding the link between diabetes and heart disease in Hispanic Americans. ndep.nih.gov/get-info/hispanicfacts_eng.htm 20 Chawla, N., Rodriguez, M., Babey, S., & Brown, E. (2003). Diabetes among Latinos in California: disparities in access and management. UCLA Center for Health Policy Research. 21 California Diabetes Prevention and Control Program. (2001). Diabetes facts and figures. http://www.caldiabetes.org/html/rs-factsfigures.cfm 22 American Diabetes Association. (2003). Diabetes among Latinos. http://www.diabetes.org/main/info/risk/default8.jsp 23 Centers for Disease and Control Prevention. (2003). National health interview survey. National Center for Health Statistics. 24 UCLA Health Policy Research Center. (2003). The California Health Interview Survey of 2001. California: UCLA Health Policy Research Center. 25 Latino Coalition for a Healthy California. (2003). Retrieved on November 15, 2005 from http://www.aafp.org/PreBuilt/11latino.pdf#search=diabetes%20among%20the%20Latino%20community%20in%20California 26 UCLA Health Policy Research Center. (2003). The California Health Interview Survey of 2001. California: UCLA Health Policy Research Center. 27 ibid. 28 Uninsured, Latino and with diabetes. (2005). Retrieved on November 15, 2005 from http://www.aafp.org/PreBuilt/11latino.pdf#search=diabetes%20among%20the%20Latino%20community%20in%20California 29 ibid. 30 ibid. Read More