Type 2 diabetes prevention and management policy for African-Americans

Health Policy to Prevent and Manage Diabetes

Health Issue and affected Population

In the United States and other part of the world, the type 2 diabetes have become a major health concern for policy makers and health planners. Although, there are three types of diabetes, however 90% of people diagnosed with diabetes have type 2 diabetes, which is one of the predominant non-communicable diseases. The type 2 diabetes is one of the major public health challenges. While more than 150 million people are suffering from diabetes globally, however it is projected that the case of diabetes can reach 299 million by the year 2025. The type 2 diabetes occurs when there is an underproduction of insulin leading to several health complications such as damages to organs such as kidneys, eyes, heart, nerves and blood vessels. Alternatively, type 2 diabetes occurs when the body is unable to effectively use the insulin. The insulin refers to a hormone that has been secreted from the beta cell used to regulate the blood sugar. Without insulin, the body will not have capacity to effectively absorb glucose, which can consequently lead to a dysfunction of the organs. Several complications that include kidney failure, coronary heart disease, foot ulceration and blindness have been associated with type 2 diabetes, and African-Americans are major ethnic group in the United affected by the type 2 diabetes.

This paper selects African-Americans as the target population because the African-Americans face the high risk of type 2 diabetes in the United States. Typically, more than 13.2% of African-Americans have been diagnosed of type 2 diabetes which are 1.7 times the number of non-Hispanic white suffering from type 2 diabetes. Based on the number of African-Americans suffering from diabetes, more African-Americans are likely to suffer from amputations, kidney disease, and blindness. By paying a greater attention to effective communication, the target population can enhance the health outcomes.

In the United States, large percentages of African-Americans above 40 years of age are generally being affected with type 2 diabetes. Moreover, type 2 diabetes affect large number of overweight and obese people in the United States, and 29.1 million people of the U.S. population have diabetes. (CDC, 2014). Although, lifestyle factors, genetics, and age are the major predictor of type 2 diabetes, however, African-Americans have higher rates of type 2 diabetes in the United States. While type 2 diabetes are more predominant among Native Americans, Asian-Americans and Hispanics, however, African-Americans record higher rates of diabetes prevalence. For example, African-Americans have 13.2% risks of diabetes, 12.8% risks for Hispanics, and 9% risks for Asian-Americans. While type 2 diabetes is rare among children, however, risk of type 2 diabetes increases with age.

The incidence of type 2 diabetes is also on increase globally, and over 382 million people live with diabetes. In the United States, the total medical costs of diabetes are $245 billion in 2012 where the direct medical costs are $176 billion and indirect costs are $69 billion. (CDC, 2014).

Two Scholarly Articles providing Effective Health Advocacy Program Addresses the Issue

Evelyn Chesla & Chun, (2011) argue that health education is the most cost effective strategy to prevent and manage type diabetes. The authors identify communication and persuasive program as an effective tool to deliver health message to people in order to prevent and manage type 2 diabetes. The program is based on five communication protocols:

"(1) the source, (2) the message itself, (3) the audience, (4) the channels, and (5) the destination or desired outcome." Evelyn (Chesla & Chun, 2011 p 68).

The source identifies the TV, and effective mass-media health communication strategy that health professionals can employ to reach large number of people. Moreover, healthcare providers can use health organizations, education/support groups and friends as source of information to people. However, expert opinion are more persuasive than non-expert sources because expert sources are more trustworthy and respected by large number of people.

Evelyn et al.(2011) further point out that messages to change positive health behaviors of people should be able to affect people's knowledge on the impact of diabetes on their health outcomes. Moreover, the persuasive message should emphasize on the social consequences and harmful effects of failing to comply with health message recommendations. One of the effective fear messages is to make people with diabetes to understand that lack of effective diabetes management may lead to foot amputation. Internet has become an effective communication intervention since large number of African-Americans have access to internet. Thus, electronic communication channel has become an effective tool to increase knowledge, achieve health outcomes and self-care behaviors.

The program also focuses on the intended audience, which is the African-American because the African-Americans face the high risks of type 2 diabetes since many African-Americans still indulge in unhealthy behaviors that can affect their health outcomes. Evelyn et al.(2011) identify SMS message or text message as channel of communication that can enhance short-term behavioral changes. Since "not all African-Americans are using these channels, and some are better addressed using older channels, such as telephones, newspapers, and doctors' messages." (Evelyn et al.2011 p71).

Analysis of the Programs Attributes that make it Effective

Destination is the desire outcome of the program revealing the attributes that makes the program to be effective. Evelyn et al.(2011) argue that the persuasive program has improved the knowledge of African-Americans about the self knowledge of type 2 diabetes. The increased knowledge with regards to self-management is correlated to lower blood pressure, A1C levels and weight. The program has made the target population to achieve 80% medication adherence. However, the program has not made the target population to be physically active because the blood glucose monitoring of participants is lower.

Jacob, & Serrano-Gil, (2010) also identify the DEHKO ("The Development Program for the Prevention and Care of Diabetes") (p 665) as an effective promotion strategy to prevent and manage diabetes. However, the DEHKO program focuses on health promotions towards high risks diabetes patients that include health education, monitoring, and screening. The DEHKO comprises of 10-year program that offers practical instruction to achieve an intensive lifestyle management. Moreover, the program offers a preventive measure to improve health outcome of type 2 diabetes patients.

The program also focuses on the health education to promote physical activities of patients through walking and cycling. The program also advocates the good nutrition for the entire population to assist in effective management of diabetes. Media communication such as TV, radio and press have been identified as effective tools to impact knowledge of entire population.

However, Jacob, & Serrano-Gil, (2010) point that health education is not sufficient to enhance effective behavioral change because it is one-way communication. A self-management is a problem-solving approach to motivate, empower and engage people to improve their health outcomes. More importantly, education interventions delivered by professional educators provide "the best opportunity to enhance and improve the patient outcomes." (Jacob, & Serrano-Gil, 2010 p 665)

Analysis of the Programs Attributes that make it Effective

The attributes that make the DEHKO effective is that the program has made large number of diabetes patients to aware of strategy to prevent and manage diabetes. The program has also made the target population to record lower HbA1c as well as low-density cholesterol.

Health Advocacy Campaign't to create a New Policy

Preventing and managing type 2 diabetes require a comprehensive health information. The paper suggests combination of video-based program, and traditional communication program to create effective health education for diabetes patients.

Program Objectives

The objectives of the program as follows:

To improve the health literacy of African-Americans with regards to type 2 diabetes.

To improve the health knowledge of African-Americans with type 2 diabetes with regards to medication adherence, indulging in physical exercise, and eating good nutrition.

To prevent and manage the prevalence of type 2 diabetes among African-Americans.

The paper suggests that health education using the video-based program is an effective strategy to improve patients' short-term knowledge because the strategy outperforms written materials. The animation production guided by video can improve the health literacy of African-American. Typically, the animation program has the benefit of being entertaining and educational. The program is an easy use cost-effective animation program that can be translated in multiple languages that include French, Spanish, Chinese, Korean and other Asian languages. The policy will also carry out a comprehensive health education using the new technology such as internet, and traditional promotion method such as TV, newspaper and radio to enhance health education.

Method

The strategy to influence the policy makers to support the program is to carry out an experiment to demonstrate the impact of the program on the target population. The program will sect 100 African-Americans with type 2 diabetes and 50 of the target population will receive health education on the strategy to manage their type 2 diabetes. These group will be an experimental group. On the other hand, the other 50 target population will consist of the control group who will not benefit from the health education. The experiment group will receive a comprehensive health education for three months. After three months, the program stakeholders will measure the glucose level, blood pressure, A1C levels and weight of the experimental group and control group. It is anticipated that experimental group will record lower blood pressure, A1C levels and weight. The results of the experiment will be presented to the policy makers showing the effectiveness of the policy. Moreover, the results will be published through the internet, newspaper, health promotion websites. The strategies will assist influencing the policy makers to support the policy.

Method ACA impact the Advocacy Efforts

The existing law will impact the advocacy effort by enacting law to reduce the readmission rates of diabetes patients. Typically, the policy will influence the law makers to penalize the hospitals and health institutions that have high rate of diabetes complication readmission. The strategy is to make large number of health care institutions to embark on comprehensive health educations for their patients. It is essential to realize that obesity is the major cause of diabetes among African-Americans since obese people have high risks of developing type 2 diabetes.

Thus, health promotion through physical activities is the major strategy to reduce number of obese adults in the United States. Thus, the existing law will influence health institutions enrolling in the Medicaid, Medicare and other federal and state health programs carry out an intensive health education to reduce the diabetes complications. In the United States, two third of adult population are obese. Moreover, increasing number of African-American are obese. The new policy with assistance of existing regulation will be able to reverse the trends through a comprehensive health education to make African-Americans to eat health good food, and indulging in daily physical exercise to prevent and manage diabetes.

Strategy to influence Legislators to support the Policy

A lobbying is an effective strategy to make the legislators to support the policy. The proposal will use three-leg lobbying strategizes to seek for the legislative support of the new policy. The first step will involve using the professional lobbyists to seek for the legislative support of the proposal. Milstead, (2013) argues that no bill can become law without the input of lobbyists. The proposal will use professional lobbyists who have special skills in influencing the law makers to support the policy. Essentially, the role of professional lobbyists are very essential given the complexity of law making process in the United States. The policy will use member of professional associations to lobby for the new policy.

The proposal will also use the grassroots lobbyists to convince the legislature to support the new policy. The grassroots lobbyists consist of constituents having knowledge and expertise in the proposal. For example, the proposal will use nurse constituents as grassroots lobbyists.

The proposal will also use money to influence law makes to support the policy. It is essential to realize that money is very critical to seek for the support of the new policy. Money will serve as the third step of the lobbying process to make the legislatures to support the new policy.

Obstacles Anticipating in the Legislative Process

The paper anticipates different obstacles in the legislative process. First, the time taken before the legislature finally approves the policy might take several years. If the proposal is not able to raise sufficient fund that will be used to lobby for the new policy, it might take much time before the legislature finally support the policy. The strategy to overcome the hurdles is to seek for the grants from the federal government, state government and different non-profit organizations to fund the program successfully.

Application of Ethical Considerations

The new policy anticipates to enhance health outcome of the target population, nevertheless, different ethical dilemma can arise with the implementation of the proposal. The code of ethics state that the health policy should not violate the human rights of the target population. Moreover, the policy should not misinform the target population about the health outcome. The health professional should implement professional standards to achieve health outcome of the target population. It is essential to realize that violation of these code of ethics can lead to ethical dilemma with reference to the implementation of the new policy.

Ethics laws and Reporting Requirements Applicable to Advocacy Campaign.

The privacy law is the existing law applicable to the advocacy campaign. The law stipulates that the health care institutions should protect the private information of the patients. Typically, the professional institutions should not reveal information of their patients to the third party without the consent of the target population. Violation of this law can violate the ethical code of conduct.

Special Ethical Challenges Unique to the Target Population

Stigmatization is the major ethical challenge of the health promotion. Since large number of African-Americans have diabetes, the advocacy can lead to stigmatization of the target population where other ethical groups view the target population as people with high prevalence of diabetes. For example, the advocacy could increase the stigmatization of obese African-Americans since it is generally believed that obese people have potential to develop diabetes complications.

Reference

CDC (2014).National Diabetes Statistics Report, 2014. U.S. Department of Health and Human Services.

Evelyn, Y.H. Chesla, C.A. & Chun, K.M. (2011). Health Communication With Chinese-Americans About Type 2 Diabetes. The Diabetes Educator.38(1):67-76.

Jacob, S. & Serrano-Gil, M. (2010). Engaging and Empowering Patients to Manage Their Type 2 Diabetes, Part II: Initiatives for Success. Adv Ther. 27(10):665-680.

Milstead, J.A. (2013). Health Policy and Politics: A Nurse's Guide. Chicano. Jones & Bartlett Publishers.