Type 2 diabetes

Public Health 

Further guidance on Plan assignment 2018

As this is a ‘plan’, it should suit how your mind thinks about the ‘Main’ task, so we don’t want to be too prescriptive about format for this task. So, bullet points, mind maps etc can be used if you wish.

That said, we are listing below some pointers for the MAIN assignment, as we wish to see an indication in your Plan of what you intend to include for each of these. At this stage, of course, you may have fuller information for some sections, but are quite sketchy for others – but try to give some indication for all of them.

…………………..

Download and use the Cover Sheet template (entering your student ID number, not your name).

Give a title, eg “Plan for main ‘Foundations’ assignment, on the topic of xxxxx”.

1) BACKGROUND TO YOUR TOPIC. a) Why and how is your topic considered to be a Public Health concern? Use data as part of stating your case (with sources, of course).

b) What, on balance, appear to be the main causal factors that need to be addressed to improve the public’s health?

2) PUBLIC HEALTH INTERVENTIONS ON YOUR TOPIC. What assumptions are being made in work on this topic :

· About health: eg. is the focus on prevention (pathogenic), or is a salutogenic/positive health perspective being adopted?

· About evidence/data: eg. Is professionals’ data on health the main source of evidence, or citizens’ own subjective perception of their health?

· About people & power: When a decision is made to take public health action, is it made by professionals/elites, or by citizens?

To help explain the above, you should relate the interventions/approaches to at least one of our 5 models of Health Promotion/Public Health, as well as discussing any specific theory that might underlie a particular approach (eg behaviour change theory), though this will vary for different topics & approaches.

c) On balance, do the types of interventions/approaches fit well with the main causal factors mentioned in your background, or is there a mismatch?

3) ETHICS. This may have been touched upon in earlier sections, but if not yet done, you should consider the interventions on your topic in terms of an ethical framework (eg Nuffield, which we will cover later in the module).

4) HISTORY & POLICY/POLITICS FOR YOUR TOPIC INTERVENTIONS. These may be covered as part of the Background, or later. On policy, a key consideration is: Does policy (eg of the current UK government) fit with the evidence on causes, or is there a mismatch?

Don’t use too many words on excessive historical detail – only if it adds context.

5) CONCLUSION. Summarise (briefly) at least one key point from each of the above 4 sections.

State what your actual word count is (& even if you write in prose/essay-style, try not to exceed, say 700 words for the Plan).

6) REFERENCES. Ensure these are all present, and in Harvard format. They are not included as part of your word count.

Khizar Hayat Public Health Foundation Type two diabetes

Assessment Coversheet and Feedback Form

Faculty of…. School of….

First Marker Name:	Aldo Mussi	First Marker Signature:	AM	Date:	Jan’20
Feedback: General comments on the quality of the work, its successes and where it could be improved
Hi Khizar – Thank you for submitting your work. However, there are a number of things which must be strengthened to bring it up to Level 7 standard. Right from the background, good, recent sources are often lacking, and your exploration of causes is far too brief (Indeed, you don’t even refer to a basic ‘energy in – energy out’ equation for T2D). Your selection of interventions appears arbitrary and poorly supported, with no real attempt to examine ‘Health-Evidence-People’. Crucially, for Level 7 work, some attempt at critical analysis is needed. You could use your Beattie model to analyse the interventions, and your ethics discussion should apply a framework to those interventions. The policy discussion should examine a current government example. A number of whole paragraphs are without a source, so you referencing needs serious attention.	Provisional Uncapped Mark Marks will be capped if this was a late submission or resit assessment and may be moderated up or down by the examination board.
37 %
Feed Forward: How to apply the feedback to future submissions
Please arrange a tutorial to debrief this feedback, and seek support from the Centre for Academic Success.

Table of Content

Contents
INTRODUCTION 4
BACKGROUND 4
PUBLIC HEALTH INTERVENTIONS OF TYPE 2 DIABETES 6
Beattie’s Model of Health Promotion 10
ETHICS 11
HISTORY AND POLICY FOR TYPE 2 DIABETES INTERVENTIONS 12
CONCLUSION 12
REFERENCES 13

Type two Diabetes and Public Health

INTRODUCTION

Type 2 Diabetes was chosen to be the topic of discussion in this assignment as it is a common type of diabetes, making it a public health issue. This occurs when the blood sugar level has surpassed the normal level, basically the blood sugar, comes from the food eaten and I is the main source of energy needed to run our bodies. Whereby hormones made by the pancreas and insulin aids the glucose to get into our body cells to provide the energy needed. The connection comes in whereby the glucose or blood sugar level is much more than needed which makes the insulin not to be enough or the insulin that is present is not used well. Basically, that is the general description of type two diabetes. Therefore, the result is that too much sugar remains in the blood and the cells lack enough to run the body on a daily basis. This type of diabetes mainly affects people of every age, it cannot be considered as a condition for only people. This type of diabetes affects at every age even age childhood. Comment by Aldo Mussi: Rethink this (with Refs).

But generally, it affects most people who are middle aged and older people, especially under predisposing aspects such as family history of diabetes and obesity. Based on demographics there are specific people who are affected by diabetes such as Hispanic, Asian American, African American and American Indian. Whereby health problems such as High blood pressure and physical inactivity acts as a risk factors of type two diabetes; which adds to other factors such as prediabetes. Therefore, the general causes of type 2 diabetes include; physical inactivity, obesity and overweight, Insulin resistance and genes. The symptom on the other hand develop slowly over several years which makes it hard for someone to identify of they are affected by diabetes. These symptoms include blurred visions, sores that do not heal and fatigue. Comment by Aldo Mussi: Recent trends in children? Comment by Aldo Mussi: Source? – USA only?

BACKGROUND

Diabetes being a serious, common, manageable and costly disease. In the UK it is one of the top leading causes of death mainly due to the lifestyle choice. In the united states it affects almost 26 million people, 7 million undiagnosed and additional 18 million diagnosed with diabetes, which definitely makes it a serious issue. It is also with great concern that diabetes comes with vast menu of health issues; like for instance kidney failure, recent cases of blindness and amputations of the lower limb. Additionally, diabetes type 2 contributes majorly to cardiovascular diseases which is the leading cause of death in the country. In the sense that almost 70% of people suffering from diabetes die from cardiovascular related diseases (CDC 2011). According to the global diabetes community, in the year 2012, diabetes solely caused the nation around 11.718 billion pounds that was incurred both in direct and indirect costs, this narrative tells the story of how this qualifies to an urgent public health issue that needs to be dealt with various health care teams such as Pharmacy, podiatry, optometry and dentistry providers who will provide extensive and integrated care. Comment by Aldo Mussi: Reserve judgment on this until later. Comment by Aldo Mussi: Much better, with a source. Comment by Aldo Mussi: Ref?

As mentioned before this diabetes mostly affects middle-aged or old people; therefore, the data to support this notion is that most of all diagnosed cases of diabetes is this type of diabetes. This starts out mildly as insulin resistance disorder whereby the cells do not utilize insulin properly, whereby as the need for insulin increases the pancreas becomes unable to produce more insulin. Therefore, making this type of diabetes to be more associated with obesity, old age gestational diabetes, family history diabetes, impaired glucose metabolism, race/ethnicity and physical inactivity. Type 2 diabetes is still rare in children adolescents but still diagnosed in the above-mentioned race of ethnicities (Center for Disease Control and Prevention, 2011). Comment by Aldo Mussi: More recent & appropriate source?

Therefore, there need to be a balance to take of this disease, or in other words recommendation from experts in public on this issue can be tackled. At the moment the only remedy that is 100% effective; is educating people about the type 2 diabetes. But again, this has some challenges that make it a struggle for the personnel in the public sector who wish to get rid of this pandemic. Health promotion campaigns face different challenges such as to persuade people to willingly change their lifestyle; because lifestyle choices majorly would change the statistics of diabetes if people would follow the right channels like dieting or being physical active. This is a challenge because people are willing to change their lifestyle when they have mild heart attacks or are told that diabetes is the cause of their ill health but once everything goes back to normal and they feel better; it is back to the old ways. The motivation to make permanent change results from the perception of the severity of the condition and if the individual thinks that at this point, “I need to change, because I might die, when I can control that outcome through changing my lifestyle.” Comment by Aldo Mussi: Source?

This has been identified in individuals who thought and seen that this condition is serious and determine to turn around their health status (Ogden, 2001). Therefore, this being identified as a major public health issue what the professionals engage in their best intentions is to encourage and educate, at the same making the advice tailor made to every individual who is willing to change. This is because exercise will restore blood sugar level and the same goes to blood sugar level. Whereby this is not easy because according to (Kinmond et al. 2003), “Motivation wanes and people take holidays from their diabetes.” Again, “Moreover, for some individuals, no amount of effort seems to yield the required results and they eventually stop trying. Allied to this is the incidence of depression. People with diabetes are twice as likely to experience depression as members of the general population.” (Diabetes UK, 2010).  Whereby this depression is considered to be bidirectional as it acts both as a complication and diagnosis for diabetes type 2 (Pan et al, 2010). Comment by Aldo Mussi: This should be part of a much-expanded section on Causes.

PUBLIC HEALTH INTERVENTIONS OF TYPE 2 DIABETES

The background mentioned different Intervention in Public health that were used to counter type 2 diabetes, but the main focus of intervention is education on this particular matter. This is because the direction taken is prevention is better than cure in this case therefore, as mention before a change in lifestyle will help in control of this public health issue. The main objective is to make people change their lifestyle or in other words their behavior and in this case, Behavioral change theory will better explain this aspect of Public Health Intervention. Typically, Public Health is a field that has the main aims of promoting a better quality of life, prevention of disease and death and finally creates an environment that is safe and disease free at the societal, community and institutional level. Comment by Aldo Mussi: Source?

Therefore, for the practitioners to effectively achieve these objectives there is need to accurately identify the public health problem such as the type 2 diabetes, assess the causes, determine population at risk and implement theory and evidence-based interventions. In this case among the various model of behavioral change theory; the Health Belief model is used to make sure that the affected individuals are to change their lifestyles. This model derives from the behavioral and psychological theory which is based on two major components of health behavior. These are the need to get well and avoid illness if affected by the type 2 diabetes and believing in a specific action because it will cure or prevent the illness. The issue is that the course of action of the individual depends on the perception of the barriers and benefits that comes with such a particular health behavior. Comment by Aldo Mussi: Source?

Between the year 1990 and 2001, self-reported diabetes increased to around 61% in the United states which affected mainly the middle-aged individuals. This does not differ from the statistics that other parts of Europe report such as in the United Kingdom (Mokdad et al. 2000). As mentioned before type 2 diabetes is majorly associated with weight gain and obesity, the projection is that almost 29 million people will be diagnosed with diabetes with type 2 diabetes by the year 2050 if no appropriate actions will have been taken immediately (Boyle et al. 2010). Therefore, there are already interventions in place that have been there since time in memorial, the only difference is that know the interventions are studying in an evidence-based manner to establish their effectiveness. Comment by Aldo Mussi: Outdated source.

Marlow et al. worked with youths specifically adolescents in Nebraska, targeting the Indian adolescents in a particular reservation. Here the main objective was to develop culturally appropriate education which would fit this particular demographic to initiate physical activity and improve healthy eating among the adolescents. Behavioral adaptations were supported by activities and stories which were based on the Native American culture in a four-day workshop. There were tests that were used to measure the change *specifically knowledge*, eight out of nine achieved increased diabetes score. Comment by Aldo Mussi: Why this example – & what Ref?

In another study (Holcomb et al, 1998), which targeted specifically a Hispanic population; 5th grade students, together with their teachers on the Texas-Mexico Border were put through a program. The program, designed to encourage healthy living infused in the curriculum mainly focusing on improving self-efficacy, behaviors and knowledge based on type 2 diabetes, exercise and diet. Thereafter there was pretests and posttests that were administered to establish the knowledge of food, exercise, diabetes related behaviors and exercise self-efficacy. The use of this program showed significant self-efficacy and knowledge improvement; in addition to the exercise-related and self-efficacy change behavior. Whereby at the end the program was effective with or without the training that was seen to be mandatory. Comment by Aldo Mussi: Again, outdated – & no critical analysis.

Bjaras et al. on the other hand targeted type 2 diabetes major risk factors, among the residents of a municipality in Stockholm. The risk factors were designed to be improving the intake of healthy food, improving the levels of physical activity and reducing the levels of obesity. Through this article there is a review of the results of this campaign on the target residents on one municipality in which the residents were not exercising on a regular basis. Information on attitudes and knowledge about health was obtained through questionnaires that were self-report, knowledge on the link between physical activities and other various chronic diseases was high, whereby almost half of the participants believed that diabetes could prevent type 2 diabetes. Comment by Aldo Mussi: Ref?

Source.

Geographic location; Target audience.

Study Design and Duration.

Aim (s) for prevention of type 2 diabetes

Intervention.

Cultural Relevance (community involvement)

Knowledge, Attitudes, Behaviors.

Clinical marker.

Prevalence of diabetes.

Holcomb et al.

· Webb County, Texas, Mexico border (94% Hispanic)
· 5th grade students (aged 10–12 years) in 14 schools
· n = 835 (completed both pre- and posttests)

· Quasi-experimental; comparison group
· ≈3 months

Encourage healthier lifestyles; improve knowledge, self-efficacy, and behaviors

Curriculum-based program that integrates program’s goals into reading, writing, mathematics, science, and physical education and encourages students to eat low-fat foods and exercise regularly

Not discussed

Significant gains in knowledge about diabetes, self-efficacy, and healthy dietary-and exercise-related behavior from pretest to posttest; also from posttest through 4 weeks of follow-up, but on fewer variables

Not targeted

Not targeted

Marlow et al.

Winnebago Indian reservation, Nebraska.
Adolescents of the age 13-18 years

Quasi experimental; no control group.

Use aspects of Traditional Indian culture to develop culturally sensitive program.
Provide opportunity for adolescents to take leadership role in diabetes education.

Educational Intervention designed to provide information about diabetes prevention through physical activity and good nutrition within a cultural context.

Use of Native American Stories and games.

One nine sets of matched presets and posttests of knowledge, 89% achieved higher scores

Not targeted

Not targeted

Beattie’s Model of Health Promotion Comment by Aldo Mussi: Populate it with actual examples of interventions.

Authoritative

Individual

Mass Media
Behavior Change
Health Education
Advice

Legislative
Policy
Health Surveillance

Collective

Counselling
Health Education
Clinical Consultation

Community -Development.
Empowerment
Action Research
Skill Sharing

Negotiated

At this moment it is clear that type two diabetes has become a public health challenge in the UK, therefore through such models (Beattie’s Model) (Beattie, 1991), is where a long-lasting solution can be identified through health promotion; which basically is the framework that has been followed through the Interventions in this assignment. Therefore, in this model the professionals/ practitioners have the role of being the facilitators or the authority figures (Naidoo and Wills, 2000). Therefore, the four main paradigms that are most important in this case are health persuasion; which we have seen through the community initiatives and using the behavioral change theory. Personal Counselling; that basically looks at public health practitioners. Community Development; engaging community driven initiatives to encourage lifestyle change and finally legislative action that involves policies aimed at eradicating type 2 diabetes such as adding type 2 diabetic education into school curriculum. Comment by Aldo Mussi: In place of this description, use it to critique some actual examples.

Through these four paradigms represented in the figure, help in coming up with action plans for partnership working through the country. But most importantly for the Beattie model to be successful the patient should have the intention to change behavior, as explained in the theory of planned behavior (Ajzen, 1991). Through the planned behavioral change, the following three steps are used to make the intervention a s success. Comment by Aldo Mussi: Why ‘patient’, and why a particular focus on behaviour?

· The attitude of the individual

· The expectation of others

· The individual’s perceived belief to change.

Each partner involved in this intervention is required to utilize the exact model in the support of their own contributions while creating a multi-partnership approach.

Comment by Aldo Mussi: What about legislative change, eg sugar tax?

ETHICS

Based on the interventions, it involves a lot of aspects not only dependent on the aspect of health education to the patents suffering from type two diabetes or who already have prediabetes. After education these individuals on diabetes there is definitely tests that will be taken to advice further on what will be done, as changing the lifestyle at time might not be enough. For instance, genetic testing; to establish whether the illness is within the family, or to establish family history with the disease. Testing for this illness is as serious as any other chronic illness, and the impact of the testing on the family members should treated as an ethical consideration. This is because the implication of results of the test for the immediate family members raises the question if whether to discuss the result will all the family members. This is because the tested individual would not want the results to be shared with the other family members so that they can be able to maintain their relationships with the other family members. This is because normally would lead to them being hesitant to contact distant and estranged family members and at the same time feeling guilty (Knowler et al., 2002). Although the result being positive will demand a change in lifestyle and probably save the lives of the individuals or at least prevent extreme illness and medical procedures; the individuals who are tested should make ascertain whether their results should be discussed with other family members prior to the discussion of their results. Comment by Aldo Mussi: Did you identify genetic factors earlier? Comment by Aldo Mussi: Why not apply a framework to the interventions you identified?

As seen before the number of patients has increased and it will continue to increase. This has not only been seen as a business opportunity but the private sector has found a lucrative market opportunity, because as mentioned before diabetes has almost cost 245 billion annually to maintain. Therefore, there is the aspect of market driven research that does not look into the interests of the patients. Market driven research has led to companies no creating more extensive treatment modalities. Like for instance there is no longer cheap insulin, mainly because the demand of the insulin has risen and its rising so the demands drives the price. This shows how the health-related strategies are driven by the market and not by the needs of the patients. Whereby in a medical point of view the replacement of the human insulin by the analogs mainly because the price of one has been exaggerated creates an ethical issue which goes against the principle of public health. In the sense that finding along lasting solution on this type public issue will not be easier anymore as the treatment is expensive (Harrison et al., 2008).

Driving is a complex task, that requires various cognitive, motor and visual abilities. Safe driving significantly implicates the financial and physical well-being of the patients and the community in general. Therefore, should people with type two diabetes be prohibited to drive? As mentioned before this type of diabetes causes loss of visual acuity and peripheral vision specifically in dim light. Therefore, based on ethical and legal issues American Diabetes Association stands with the position that diabetic patients should be assessed individually taking into account their medical history and potential related risks (Daniel et al 2013). Whereby additionally professionals in healthcare should discuss with patients on technicalities that might arise in the event of diabetes and driving. Comment by Aldo Mussi: If driving is significant to the population, mention it early on.

HISTORY AND POLICY FOR TYPE 2 DIABETES INTERVENTIONS

The development of diabetes is as old as the First World War, but through the years it has been looked into by public health professionals who have made various contributions to control this aspect. For instance; the development of insulin and glucose inhibitors later on through the years used to combat type 2 diabetes. These are some of the developments that have been made through history, but also through the years this being identified as a public safety issue has caused the development of bodies such as the British Diabetic Association, whereby this in addition to other bodies are responsible for the policies that govern all diabetic based aspects. Mainly the policies protect the common patient from, genetic discrimination, protection during Direct to consumer Testing and mainly Appropriate Age Testing as genetic testing for children is highly discourage even if it is done for providing possible solutions (Hull and Prasad., 2001). Additionally, through such bodies have been instrumental in pushing the interventions mentioned above. For instance, public education about type 2 diabetes; a good example is the taking control campaign; that was aimed to reach decision makers and politicians across the UK, who would later help to implement policies that aid the development of diabetes education courses. The policies put in place sure that every individual with type 1 and type 2 diabetes, have access to the educational information required and support that they might need to manage diabetes. This lies hand in hand with the Public Health interventions that was developed by the above-mentioned authors as a remedy to type 2 diabetes. Comment by Aldo Mussi: Ref? Comment by Aldo Mussi: Critique a current example of government policy.

CONCLUSION

Research based interventions in our communities, is still in the early phases as seen in the reviews that are from the studies used in this paper. The studies used mainly have been doe in communities that have been affected by diabetes, either through initiating or collaborating with researchers. the involvement of the communities helps to come up with evidence-base solutions when it comes to educating these individuals. Affectionally it is only through the communities in which the behavioral change can be successfully. This is because based on the behavioral change theory, only through the establishment of the importance of health is where the individuals can be able to change their lifestyles. This is because it is not through the advice of health practitioners to change diet or be involved in physical activity; but it is through the peers in the community is where an individual can be able to feel the urge to take initiative and actually see it through. Additionally culture affects the willingness to change and take a stand but only if the cultures of the mentioned ethnicities engage in coming up with specific cultural measure to tackle type 2 diabetes and therefore the affected members of the community will se that it is worth taking a chance therefore, fulfilling the public health objective of getting rid of diabetes (Saltus et al. 2013). Comment by Aldo Mussi: ? Comment by Aldo Mussi: First mention. Comment by Aldo Mussi: First mention.

REFERENCES

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Beattie, A. (1991) Knowledge and control in health promotion: a test case for social policy and theory. In: Gabe, J., Calnan, M., Bury, M. (eds) The Sociology of the Health Service. London: Routledge/ Taylor and Francis.

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Boyle JP, Honeycutt AA, Narayan KMV, Hoerger TJ, Geiss LS, Chen H, Thompson TJ: Projection of diabetes burden through 2010. Diabetes Care 24:1936–1940, 2001.

Bjärås, G., Härberg, L.K., Sydhoff, J. and Östenson, C.G., 2001. Walking campaign: a model for developing participation in physical activity? Experiences from three campaign periods of the Stockholm Diabetes Prevention Program (SDPP). Patient Education and Counseling, 42(1), pp.9-14.

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