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Literature review of an indigenous health program: The life! Essay Example

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9INDIGENOUS PEOPLE’S DIABETES

Indigenous people’s disease

Indigenous People’s Diabetes

Introduction

Over the last five decades, diabetes epidemic has been reported among the indigenous Australian where this prolonged disease was virtually unknown. According to statistics, diabetes has increased over the years across Australia as well as in different other countries (Levin et al., 2008). The lives of the indigenous Australians have changed radically from pre-contact period to today. Before, the indigenous cultures used to live in balance with their surrounding and created social foundation that kept the community in a good healthy state. Changes that took place due to colonialism and assimilation policies affected the social structure and living dynamics of the indigenous people thereby disrupting the existing natural balance leaving them vulnerable to diseases and health conditions that were previously unheard of. Today, diabetes has emerged within the indigenous population at epidemic proportions (Couzos et al., 2003). According to a research, one in four indigenous individuals living in Australia has type 2 diabetes compared to two in twenty in the rest of the population. This paper will review a number of literatures that will highlight the burden of type 2 diabetes among the indigenous Australians. The paper will state the factors that have led to the development of diabetes, and how diabetes can be managed and controlled in Australia.

Diabetes Prevalence

According to Carrin (2009), findings on general health issues among the indigenous Australians state that the most prevalent health issue is diabetes, substance abuse and violence. The first case of diabetes health condition among the indigenous community was reported in Adelaide in 1923. The detailed study of diabetes among the indigenous population was not undertaken until 1960s. These studies showed that there was a direct correlation between the evolution of the westernized lifestyle and the rate of growth of type-2 diabetes among the indigenous people (Couzos et al., 2003). Since 1960s, diabetes has been reported to be one of the most critical health issues for the indigenous people living in Australia.

Early studies that took place with regard to the indigenous population before development of western lifestyle showed no likelihood of type 2 diabetes. However, today, the diabetes health issue is recognised as a very critical health issue among the indigenous people. It has been recorded to be three times more likely to take place than in the general population- non-indigenous population (Couzos, et al., 2003). The effect of diabetes among the indigenous Australians can be measures by the number of individuals having diabetes, the number of individuals in hospitals due to diabetes or the number of individuals succumbing to death due to diabetes. Diabetes among the indigenous Australians is perceived as an outcome and effect of loss of culture and traditional activities and belief systems (Hail and Patrinos, 2012). When an individual seek medical help, the main reason for going to the hospital is often recorded. Often diabetes is not written down as the main reason for going to the hospital since it is linked to a number of illnesses including stroke, heart disease, and kidney problems to name few.

The exact number of people seeking medical assistance due to diabetes among the indigenous peoples is thus not known (Couzos et al., 2003). However, the rate of indigenous individuals seeking medical assistance due to diabetes is higher than the rate of non-indigenous individuals. Diabetes is one of the fundamental causes of death among the indigenous Australians. Deaths caused by diabetes among indigenous male were 7.5 times more than for non-indigenous males whereas the number of deaths caused by diabetes among the indigenous females were 10 times more than for non-indigenous female’s in 1999-2003. For individual between the ages of 35 and 54, the number of deaths was 21 times for the indigenous compared to the non-indigenous people. These alarming statistics clearly show how serious diabetes is among the indigenous population (Carrin, 2009).

Factor Causing Diabetes among Indigenous People

There are so many factors that contribute to indigenous population living in Australia to develop type 2 diabetes (McLeish and Rogan, 2008). A number of researches have linked type-2 diabetes among the indigenous Australians to genetic susceptibility of an individual. A good number of the indigenous Australians have a ‘thrifty genotype’ that has supported their hunter-gatherer lifestyle. Their bodies are genetically set to have high blood cholesterol levels and glucose intolerance in order to maintain body weight especially during lean times. According to Leonard et al., (2002), the presence of western diet available for the indigenous population leads to obesity, heart diseases and diabetes. In addition, sedentary lifestyle with regard to dietary changes is another factor that has contributed to development of type 2 diabetes. Modern indigenous people take up diet with high fats and sugar and low nutritional values that leads to diabetes. According to Leonard et al., (2002), the modern diet taken by the indigenous people also causes obesity particularly among women and children. An obese person is more likely to develop type 2 diabetes compared to an individual with normal weight. Type 2 diabetes is very common among the indigenous women than indigenous men. Obesity among the indigenous people has prevailed due to lack of physical activities and poor dietary intake. Traditionally, indigenous people lived very physically active lives.

However, with the development of western diets, no hunting or gathering is required for indigenous people to survive. A sedentary lifestyle is linked to the development of risk factors such as obesity that leads to type-2 diabetes (Leonard et al., 2002). Reduced access to healthcare is another common factor contributing to the development of type 2 diabetes among the indigenous Australians. A number of research conducted show that culturally sensitive health care is limited in Australia for indigenous individuals living in the remote areas. For this, indigenous Australians with type 2 diabetes are at very high risk of complications due to unmanaged diabetes. Some examples of complications that indigenous individuals may have include: bacterial infection, kidney diseases; neuropathy etc. Indigenous Australians experience poor standard of living. There is a direct correlation between health problems such as diabetes and low socio-economic status. According to Joslin and Kahn (2005), person with low income, few employment opportunities or low level of employment is likely to take part in behavioural activities that enhances the risks of diseases. Examples of these behaviours include smoking cigarettes and substance abuse. Indigenous Australian population are among the most social and economically disadvantaged in Australians.

Management of Type 2 Diabetes

Type 2 Diabetes amongst indigenous Australians should be managed by the following ways. First and foremost, screening should be carried out amongst the locals. This ought to include recognition of modified risk factors, namely obesity, body mass index, unhealthy eating habits and physical inactivity. Diabetes screening should be done in a period of about 1 to 2 years for individuals having risk factors that are greater than 1 (McDermott, McCulloch and Campbell, 2007). Frequent screening should also be done to children who are considered obese having a BMI greater than 99.5 percentile and a follow up plan should be devised. Fundamental prevention should also be carried out to the Aboriginal community through their leaders, in collaboration with healthcare experts, funding agencies in order to exercise and encourage environmental changes which in turn reduce the chances of diabetes. This is done by precluding childhood as well as adult pre-gravid obesity, control of diabetes during the early stages of pregnancy in order to reduce the chances of offspring contracting diabetes. Such partnership aids in keeping the community on toes in issues related to diabetes by keeping the knowledgeable of the risk of type-2 diabetes (Gilliland, Azen and Perez, 2002).

This collaboration helps in developing programs within the community that will encourage traditional activities and foods provided they are safe and acceptable (Rowley et al., 2000). Lifestyle intercession programs should be introduces amongst the indigenous Australians with type-2 diabetes. This program should aim at improving their diets, their discipline regarding exercising (Gilliland, Azen and Perez, 2002). This helps in reducing weight, calories intake, glycemic control and also diastolic blood pressure. In order for the program to work successfully, cultural appropriateness should be the key component in ensuring proper discipline among the Aboriginal people. According to Bailie and Robinson (2004), working with healthcare professionals within the community ascertains the use of local resources and assures that any emerging challenges such as geographic location and access to healthy diets can be considered and addresses the community’s needs. Intervention studies have evaluated the effects of clinical outcomes, lifestyle changes and patient satisfaction. This has led to the expansion of scope of nurse practices increasing the need for safe and quality care and establishment of lifestyle programs aimed at targeting patient’s needs.

Conclusion

In Australia, type-2 diabetes incidence is higher among the indigenous population compared to the non-indigenous population. The higher rate of the development of type two diabetes has been attributed to a number of factors such as genetic susceptibility, sedentary lifestyle, reduced access to health care, historic-political factors to name a few. Diabetes has been linked to death incidence among the indigenous Australians that has led to the urgent need for management and primary diabetes prevention. Prevention of diabetes should largely focus on the diabetes risk factors such as prevention of obesity and management of diabetes among the pregnant women. In addition, diabetes screening should be conducted to identify modifiable risk factors and comprehensive management programs should be conducted in the remote communities in order to reduce the development of type 2 diabetes. It is evident from the literatures reviewed that diabetes incidence among the indigenous Australians is higher expanding the scope for programs for prevention and maintenance of diabetes.

References

Carrin, G. (2009). Health systems policy, finance, and organization. Amsterdam Boston: Academic Press.

Couzos S, O’Rourke S, Metcalf S, Murray R (2003). Diabetes. In: Couzos S, Murray R, eds. Aboriginal primary health care: an evidence-based approach. 2nd ed. South Melbourne: Oxford University Press.

Hall, G. & Patrinos, H. (2012). Indigenous peoples, poverty, and development. New York: Cambridge University Press.

Joslin, E. & Kahn, C. (2005). Joslin’s diabetes mellitus. Philadelphia, Pa: Lippincott Williams & Willkins.

Leonard D, McDermott R, O’Dea K, Rowley KG, Pensio P, Sambo E, Twist A, Toolis R, Lowson S, Best JD (2002). Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people. Australian and New Zealand Journal of Public Health, 26(2): 144-149.

Levin, M., Neal, L., Bowker, J. & Pfeifer, M. (2008). Levin and O’Neal’s the diabetic foot. Philadelphia, PA: Mosby/Elsevier.

McLeish, M. & Rogers, S. (2009). VCE health & human development Units 3 & 4. Cambridge: Cambridge University Press.

R.A. McDermott B.G. McCulloch S.K. Campbell, 2007. Diabetes in the Torres Strait Islands of Australia: better clinical systems but significant increase in weight and other risk conditions among adults, Med J Aust., 186, 505-508

R.S. Bailie D. Si G.W. Robinson, (2004). A multifaceted health service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care, Med J. Aust., 181, 195-200

Rowley KG, Daniel M, Skinner K, Skinner M, White GA, & O’Dea K (2000). Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community. Australian and New Zealand Journal of Public Health; 24(2): 136-44

S.S. Gilliland S.P. Azen & G.E. Perez (2002). Strong in body and spirit: Lifestyle intervention for Native American adults with diabetes in New Mexico Diabetes Care, 25(1): 78 83