Diabetes: Management Programs in the US and the Rest of the World - Essay Example

Diabetes: Management programs in the US and the rest of the world. Name Institution Module Instructor Date Introduction Diabetes is the seventh largest killer in the US. Globally, it is responsible for millions of deaths spread out both in the developed, developing and less developed countries. The disease has been around for centuries and is recorded in ancient Egyptian manuscripts dating back to the 16th century (Dos 2013). How these ancient people responded to the disease differ greatly with the modern responses. However, with cure yet to be discovered, all efforts in curbing the disease are geared towards prevention and proper management of confirmed cases to lower the risk of developing complications. This is carried out in the knowledge that diabetes is a group of ailments that is caused by the inability of the body, and in particular the pancreas, to regulate glucose levels in the body leading to severe body damage (IDF, 2013). Therefore, the disease is managed by controlling the glucose levels in the blood stream and minimizing exposure to risks and averting complications arising from the disease. Failure to control the sugar level can result to complications and organ damage. Common complications include loss of eyesight, lower limb amputations, kidney failure, stroke and cardiovascular illnesses among others (CDC 2012). Different governments and international bodies have responded in a number of ways of curbing the disease. Some are geared towards prevention with others geared towards managing confirmed cases. This paper compares the diabetes management strategies adopted by the US against the measures applied by other governments in the rest of the world. Diabetes Intervention strategies: US vs the rest of the world Among the 366 million people with diabetes globally, 80% of them are located in low middle income societies (WHO, 2013). A number of studies have revealed that poverty predisposes individuals to diabetes in many ways. These studies have further indicated that the poverty in regards to diabetes is not a regional issue but rather a personal one. Impoverished households and individuals are subject to increased exposure to “‘obesogenic’ environments, maternal malnutrition during pregnancy which increases future risk of diabetes in such infants, and marginalised populations face barriers to care” (IDF, 2013b). The IDF report further notes that government, NGOs and other international bodies have not responded effectively to the connection between poverty and diabetes. This is despite several studies such as by Rabi, Edwards, Southern et al. (2006) showing that diabetes is two times more prevalent in low income populations compared to the wealthy populations. There is need to view and consider between the forwards relationship between diabetes and poverty but also the backward relationship where poverty is seen as a cause of increased exposure to diabetes. As aforementioned by the report by IDF, poverty is a major cause of malnutrition or poor diet among pregnant women which increases risks to diabetes for children and grandchildren. This study was carried out on mice and further studies are need to on humans to further cement the evidence (NHS, 2013). The report by NHS indicates that though past studies have indicated a clear link between poverty and diabetes, little intervention programs have tried to use financial or socioeconomic empowerment as an intervention strategy. The nutrition and diet of pregnant mothers is an intervention point for diabetes management. Obese or malnutritioned pregnant mothers increase the risk of their unborn children developing diabetes later in life this means that there is need to control the diet of pregnant mothers (NHS 2013). In the US, a significant percentage of the population especially among the Hispanics and African Americans are obese. These not only increases their risks of developing diabetes but also that of their unborn children in pregnant mothers. Alternatively, malnutrition has the same impact on unborn children as obesity. In developing countries, malnutrition contributes to the high incidence of diabetes due to poor diet during pregnancy. Pregnant mothers especially in low income households do not have access to proper nutrition (Vorster, 2010) thereby exposing their unborn children to the risk of developing DT2 later in life (NHS 2013). In the US, federal and individual state governments have developed their own programs to improve the health of pregnant mothers. The federal Special Supplemental Nutrition Program, under the department of agriculture targets low income pregnant and lactating women, infants and children and is commonly referred to as WIC. Eligible persons are pregnant mothers and post-partum mothers (up to six months after birth) and infants below one year. Further to that, their total annual income must fall at or below 185 per cent of the US poverty income guidelines. Such people may also qualify if they are already enlisted in programs such as Medicaid, TANF (Temporary assistance for needy families) all of which target persons and households of low income (American Pregnancy Wellness, 2013). The program thus only addresses the women facing malnutrition and the poor and not the obese. The program further educates the participants on nutritional matters, provides breastfeeding support and also facilitates access to healthcare and other social services. Nutritional support involves issuance of food vouchers and EBT cards that can be used in a number of selected stores. The vouchers can be used to buy baby formula, cereals including whole grain rice, peanut butter, cheese, eggs, legumes, vegetables, fruits, milk and soy milk among other healthy foods. Some products such as chips as, burgers and ice-cream are burned from being purchased using the given vouchers. In essence, the program has a list of food items that are deemed healthy and necessary for pregnant and lactating mothers that can be purchased through the program. Such healthy foods programs not only help lower the risk of diabetes in unborn children but also avert low birth weight, reduce child mortality and boost the immunity of infants. The success of the programs in diabetes management is yet to be assessed. In Europe, there are similar intervention measures that have been enacted. However, not much of these measures are geared towards diabetes intervention but are aimed at addressing other chronic illnesses. Nonetheless, the European Commission, in a report prepared by Hills (2012) acknowledges that pregnant women and lactating mothers face unique challenges in the face of diabetes. In one of the conferences organised by the European commission, it was agreed that there was need for better measured and more detailed study of the environment facing pregnant women and lactating ones before conceptions and after conception. In Europe the Public health guidance, PH11 – Issued March 2008 provides a framework to guide health practitioners in providing necessary care and information to low income pregnant women. The guidance however calls for emphasising the need for taking vitamin supplement for pregnant women and providing them with starter vitamins but does not actually provide them with the supplements over the pregnancy (Foster 2000). This strategy does not compare to other attempts in developing countries which not only support the nutritional needs of such mothers but also seek to empower them socioeconomically through community projects. Another major program in the US addresses eating habits in school children. School feeding programs have been drafted into the program with the intention of ensuring that school going children access healthy foods and that consumption of fats and too much salt or sugar is limited. In the US, the debate to ban junk food in schools and fast food outlet near schools has been widely debated. California state government banned junk food in school cafeterias six years ago and the results have been overwhelming. A report indicates that California high school students consumer 160 fewer calories that students from other states (O’Connor 2012). Other legislations have targeted regulation on processed foods. A total of 12 states have enacted legislations seeking to make foods healthier. Some states have also provided subsidies to manufacturers and retailers making and stocking healthy foods (CDC, 2013). The Healthy, Hunger-Free Kids Act popularised by the first lady in the US is one of the major blanket attempts by the US federal government to reign in on the health of the public. These legislations are also accompanied by numerous healthy eating campaigns targeted at different age groups. The intention has been to cut down on the number of obese people in the US and cut down exposure to risks such as diabetes, cardiovascular illnesses among others. Similar In the Sub-Saharan region, school, feeding programs are not geared towards fighting diabetes but rather keeping children in school in response to hunger and famine. The programs are active in famine prone regions where UNICEF, WFP and NGO’s are involved in providing food to school children in remote arid areas facing starvation. Provision of food in schools is meant to encourage school attendance especially among pastoralist and nomadic communities (UNICEF 2013). In Europe, the situation is similar to the US where programmes have been set up to ensure that children access junk food-free meals in school and eat healthier foods. The region has not developed a framework but uses policy paper developed by WHO to guide on healthy food eating during childhood and adolescence (WHO 2013). Working closely with the school feeding program is the physical activity promotion programs in the US. The American Diabetes Association has published a number of policy papers and launched media campaigns to promote physical exercise in a bid to lower the risk of exposure to a number of diseases including obesity, high blood pressure, colon cancer, weakened bones, cardiovascular illnesses and diabetes among others. The association recommends performing resistance exercise three times a week (ADA 2013). The CDC also acknowledges the importance of physical activity and notes that physical exercise is not just an avenue of maintaining a healthy weight but also a necessary tool in fighting diseases. The CDC (2013) has thus sponsored a number of studies to understand the contribution and need of physical activity in various occupations in America. Some of the studies have indicated that some occupations such as office jobs which involve long hours of sitting calls for regular activity as opposed to other physically engaging activities such as gym instructors. In the European region, similar moves have been made by WHO and the European Network for the Promotion of Health-Enhancing Physical Activity (HEPA). Foster (2000) notes that HEPA develops country specific programmes that take into consideration available physical-involving activities that individuals can engage in to stay healthy. Closely tied to nutritional and physical fitness needs are educational needs for communities, people living with diabetes and persons at risk of diabetes. In Europe, the European Commission has funded projects and organized a number of public health conferences geared towards improving public health through health education empowerment. The program, Better control in paediatric and adolescent diabetes in the EU: working to create Centres of Reference (SWEET) is one such project that aims at improving secondary prevention diagnosis and control of DT1 and DT2. Another project is the European Best Information through Regional Outcomes in Diabetes (EUBIROD) project that aims at the sustainability of complex systems of health indicators that require being regularly maintained and updated. The project aspires to develop an action plan that will be enacted in all member states to collect aggregated data and produce systematic EU reports in the major diabetes indicators in the region (European Commission 2013). Studies showing that diabetes is highly associated with poor nutrition in pregnant women and poverty have led to a global paradigm shift in diabetes prevention. The IDF reports in Africa for instance, there has been a change in diabetes screening activities with a focus on the impoverished communities as opposed to the opulent where obesity is assumed to be more prevalent. One such initiative that targets diabetes complications among lower income earners in the sub-Saharan region is the Diabetes Africa Foot Initiative (DAFI) which seeks to prevent lower extremity amputations by affected persons across Africa (IDF, 2013) Increased cases of diabetes in the US, same case as other countries has only resulted to population wide screening but not intervention programs targeting the high prevalence regions or at risk groups. Screening has improved in the US in the number of people involved (American Diabetes Association, 2013). The body notes that nearly all countries have responded to calls for regular diabetes screening as recommended by WHO (2013). Barker et al. (2011) notes as a result of increased screening, a clearer diabetes belt can be observed in a number of countries. However, WHO and IDF have failed to show the significance of early detection through scientific research. Additionally, whether screening should be carried out for persons perceived to be at risk or population-wide remains unclear (WHO, 2003). For this reason, WHO and IDF combine to provide a basic framework to guide countries developed their own policies in diabetes. In the US and in other countries, screening is largely part and parcel of national governments health policy. In the US, the Preventive Services Task Force (USPSTF) is responsible for handling all diabetes screening activities alongside other screening activities for other diseases such as cardiovascular ailments and HIV/AIDS. The taskforce “recommends screening for type II diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg” (USPSTF, 2013). In sub-Saharan African, majority of the health efforts are directed towards screening, prevention and management infectious diseases including Malaria and HIV-AIDS (IHME 2013). The report by IHME further indicates that this is because the two are the most common diseases and have the greatest disease burden although the incidence of stroke, diabetes and cardiovascular illnesses among the upper middle income countries in the region. Although the region is relatively low income zone, it has among the lowest diagnosed diabetes cases in the world. Nonetheless, the burden of diseases associated to diabetes has increased at an alarming rate in the region by 88% from 1990 to 2010. This means that to the majority of the population, diabetes is a relatively new illness and there is a huge need for increased public awareness and education to assist patients and care givers in managing the diseases and reducing the disease burden. For instance, in Mauritius and Namibia, diabetes cases grew by 186% and 123% respectively over 20 years putting the two nations’ health infrastructure under great strain (IHME). A report by Mbanya et al. (2010) attributes the increasing prevalence to growing life expectancy because the risk of diabetes increases with age. However, Mbanya et al. further notes that a specific strain, Ketosis-prone atypical diabetes, is more common in sub-Saharan Africa which points to possible genetic predisposition. However, no research has proven this epidemiological link. Unfortunately, no specific programme or response by governments in the region has been enacted to carry out extensive studies in the population to understand diabetes regionally. The Millennium development goals which are a group of targets set for sub-Saharan governments capture the extent and challenge of diabetes. The millennium development goals identify the amount of national GDP that should be dedicated to health and also diabetes and maternal and child health as important areas that need to be addressed. However, the MDGs’ do not identify specific strategies to address diabetes. However, UNICEF has launched several programmes in a number of countries in the region aimed at assisting pregnant and lactating women in their nutritional needs (IDF, 2013). Conclusion The global situation in regards to diabetes is dire. From the discussion above, it is clear that the US is way ahead in responding to the disease compared to others especially the developing world. Sub-Saharan Africa could be affected more by the diseases that the current figures reflect. The low prevalence figures are attributable to poor access to healthcare services and screening services. However, it is no longer in doubt that the poor have a higher risk of diabetes. This report therefore calls for national governments to carry out and sponsor population wide diabetes screening to facilitate early detection and avoid development of complications. This way, the disease burden on the country and the people will be greatly reduced and the quality of life significantly improved. 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