Diabetes mellitus has become a worldwide epidemic, affecting an estimated 285 million people. Effective changes in public health policy and practice toward more primary care-based approaches are necessary. This paper discusses the ethical, individual, organizational, and community issues involved in the development and implementation of public health change.
Diabetes Mellitus
According to the World Diabetes Foundation, diabetes mellitus is considered to be the fastest growing chronic condition in the world (Chorbev et al., 2011). The diabetes epidemic afflicted an estimated 285 million people in 2010, equivalent to 6.4% of the adult population of the world. Since diabetes is largely a preventable condition, public health efforts must be directed at primary care centered on awareness and education regarding, causes, risk factors, prevention, and treatment for diabetes. However, there remains a discrepancy between the direction public health should be heading and the current state of health care. The following discussion outlines the necessity for public health change, how it can be implemented, as well as theoretical bases for the projected success of change and progress for public health models involved in diabetes awareness, prevention, and care.
Creative tension is essentially a conflict between different or opposing viewpoints or approaches regarding an issue. This creative tension is viewed as positive and healthy, as it encourages exploration of how efforts regarding an issue can be improved, progress, and ultimately provide more benefit to individuals and organizations involved, as well as the community at large. In regards to public health and diabetes mellitus, creative tension exists between individuals and groups involved in the current public health practices that often times focus more on secondary care, treating symptoms rather than providing preventative care, and those proposing initiatives that are based around primary care, looking to the cause and risk factors associated with diabetes. The current reality encompassing healthcare is a focus on secondary care for diabetes, which is a limited approach that does nothing to remedy the development of the condition and does not recognize the abilities of individuals to prevent or alter diabetes through lifestyle modifications. This tension between proponents of primary and secondary care provides motivation for both approaches to investigate more effective means of preventing, diagnosing, and treating diabetes.
The public health change model proposed for this project focuses primarily on the promotion of primary care initiatives for the identification of individuals most at risk for diabetes as well as programs for prevention of the disease. A major focus will be placed on approaches emphasizing individual self-efficacy in making daily lifestyle changes associated with increased risk and occurrence of diabetes, including health diet and exercise regimens. Ethical concerns regarding this public health model involve ways of effectively engaging individuals in their own primary healthcare process, especially regarding lifestyle modifications.
Research has demonstrated remarkable effectiveness in diabetes prevention and treatment programs that are based in lifestyle intervention, although participation in these sorts of programs tends to be quite low (van Gils et al., 2011). A recent study by van Gils et al. (2011) recognized the low participation and adherence for these lifestyle intervention programs and investigated the effectiveness of financial incentives in encouraging willingness to participate among diabetes patients. Results of the study indicated that financial incentives do in fact positively affect participation in diabetes prevention and treatment programs that involve lifestyle intervention. However, how ethical is it to offer financial compensation to individuals to take care of their own health? Ethical issues such as this regarding maintaining patient involvement in their own healthcare and well-being need to be further explored and addressed in the public health context.
Effective diabetes prevention programs in primary care will need to be widely accessible to the general population and be highly visible. The use of technology and new media may be effective in allowing people to easily access and navigate diabetes prevention and treatment programs conveniently from their homes. Chorbev et al. (2011) investigated the efficacy of virtual communities for the promotion of education, self-help, discussion, and support regarding chronic diabetes. The authors of this study purported that this type of social networking could save lives through enabling individuals to make healthy lifestyle changes and stick to them, by improving access to and quality of education about diabetes, as well as keeping patients dedicated to their prevention and treatment programs (Chorbev et al., 2011). Changes in public health models emphasizing primary, could incorporate online social networking components in order to reach people from all walks of life and keep them interested in, engaged, and committed to diabetes healthcare programs.
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