When analyzing a person's health, considering Social Determinants of Health is a significant part of understanding any conditions they may be at risk for. Diabetes has a considerable prevalence in Canada, with 29% of the population living with prediabetes or diabetes (Diabetes Canada, 2020). Understanding the risk factors for this condition and creating a nation-wide plan to address these issues is instrumental in managing this condition. Using a Social Ecological Model can help understand how the various levels within society intertwine, helping develop a better plan to address chronic illness issues within a population.
What is Diabetes?
Diabetes is a condition where the body cannot properly process food to be used as energy (Centers for Disease Control and Prevention, 2020). For a person without diabetes, the human body will take food and turn it into glucose or sugar that our bodies can use for energy (Centers for Disease Control and Prevention, 2020). This glucose needs a hormone called insulin to help it get into the cells to be used by our bodies for energy (Centers for Disease Control and Prevention, 2020). When a person has diabetes, they either aren't producing enough insulin, or their body doesn't use the insulin as efficiently as it should (Centers for Disease Control and Prevention, 2020). This deficiency causes the glucose to build up within the bloodstream, leading to many serious complications, including kidney failure, heart disease, blindness, and lower-extremity amputations (Centers for Disease Control and Prevention, 2020). There are three main types of diabetes, Type 1, Type 2, and gestational diabetes (Centers for Disease Control and Prevention, 2020). Type 1 diabetes is caused by an autoimmune reaction that causes the body to stop producing insulin. Type 2 diabetes is when your body cannot properly use the insulin produced. This is usually caused by unhealthy lifestyle factors and some non-modifiable risk factors, and develops over many years (Centers for Disease Control and Prevention, 2020). Gestational diabetes is a type of diabetes that develops in pregnant women who have never had diabetes before and usually goes away after birth (Centers for Disease Control and Prevention, 2020).
Risk Factors
The risk factors for Type 1 diabetes are still unknown, but there are many known risk factors for Type 2 diabetes (Centers for Disease Control and Prevention, 2020). Some of these risk factors include prediabetes, being overweight, being 45 years or older, having a family member with type 2 diabetes, having a lower level of income or education, lack of physical activity (less than three times a week), and being African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk) (Centers for Disease Control and Prevention, 2020). There are also many factors relating to social determinants of health that can influence whether someone develops diabetes in their life. These factors include education, food security, income, social support, environment, and healthcare access.
Social Ecological Model
The Social Ecological Model (SEM) is a framework used to understand society's multifaceted levels and how interactions work within a social system (Chang, J., et al., 2013). This model has many different factors and determinants that fall into all health levels, which makes control, prevention, and intervention most efficient when addressed using this model (Chang, J., et al, 2013).
Retrieved from: https://www.researchgate.net/figure/Evaluated-obstacles-to-diabetes-management-by-level-of-influence-in-the-socio-ecological_fig8_316312501
Social Ecological Model and Diabetes
Considering the risk factors associated with developing type 2 diabetes, the Social Ecological Model seems to be the best fit for analyzing the social determinants of health for this condition. Considering 29% of Canadians live with diabetes or prediabetes, Health Canada decided to implement a healthy eating strategy that aims to improve Canada's food environment, which will, in turn, decrease the risk for type 2 diabetes and other chronic diseases (Diabetes Canada, 2020). To support this initiative, Health Canada plans to restrict unhealthy food marketing, make labeling of food clearer to identify high sugar, fats, and salt within foods, work with various restaurants and manufacturers to make food healthier, and increase the accessibility and availability of nutritious food (Diabetes Canada, 2020). Health Canada seems only to have a policy approach to managing the diabetes population in the country. Diabetes Canada has made recommendations to improve the community and interpersonal support through education and funding for people living with diabetes as it is quite costly. Since people with lower incomes have been identified as being at a higher risk for developing diabetes, it would be incredibly beneficial to reduce these costs (Diabetes Canada, 2020). From the SEM model, it is evident that there is a lack of education for diabetes, which causes a massive gap in Canada's healthcare system. There is also a lack of focus on specific ethnic populations that are more at risk and how this risk factor will be improved.
References:
Centers for Disease Control and Prevention. (2020). Diabetes Basics. Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html
Centers for Disease Control and Prevention. (2020). Diabetes Risk Factors. Retrieved from https://www.cdc.gov/diabetes/basics/risk-factors.html
Chang, J., Guy, M. C., Rosales, C., de Zapien, J. G., Staten, L. K., Fernandez, M. L., & Carvajal, S. C. (2013). Investigating social ecological contributors to diabetes within Hispanics in an underserved U.S.-Mexico border community. International journal of environmental research and public health, 10(8), 3217–3232. https://doi.org/10.3390/ijerph10083217
Diabetes Canada (2020). Diabetes in Canada. Retrieved from https://diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Backgrounder/2020_Backgrounder_Canada_English_FINAL.pdf
Mentock, S., Vanessa Y. Ng, Narayana, R., Ullal, H., Kumari, S., Badiger, S., Shetty, A. (2017). Treatment-seeking behavior and obstacles to treatment compliance in diabetic patients in Mangaluru, India. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 11(2), 617-622. Retrieved from https://doi.org/10.1016/j.dsx.2017.04.014.
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