Report On The Burden, Broader Determinants And Risk Factors Of Diabetes In Australia And Critical Analysis Of A Framework For The Prevention Or Management Of Diabetes

Running Head: DIABETES 1

REPORT ON THE BURDEN, BROADER DETERMINANTS AND RISK FACTORS OF

DIABETES IN AUSTRALIA AND CRITICAL ANALYSIS OF A FRAMEWORK FOR THE

PREVENTION OR MANAGEMENT OF DIABETES

Name

Institution

DIABETES 2

Contents

Introduction ..................................................................................................................................... 3

Diabetes and its Burden in Australia ........................................................................................... 4

Broader Determinants of Diabetes .............................................................................................. 5

Risk Factors Associated with Diabetes ....................................................................................... 7

Innovative Care of Chronic Diseases Framework....................................................................... 8

Critical Analysis of the ICCC Framework .................................................................................. 9

References ..................................................................................................................................... 12

DIABETES 3

Introduction

Chronic diseases and conditions such as cancer, stroke, type 2 diabetes, obesity and other

diseases cause a lot of pressure and burden on the global health due to the cost of preventing and

maintaining them. A chronic disease, in this case, refers to conditions that persist for a long time

and the patients have to be put on continuous medication to maintain the condition or to cure the

disease (Al Tunaiji, Davis, Mackey & Khan, 2014). A chronic illness can be defined as a

condition that can last for three or more months when the patient is still under treatment. Most of

the chronic diseases cannot be prevented using vaccines or can they be treated but can just be

maintained through regular medication and lifestyle. Statistics show that about eighty percent of

adults in Australia have at least one chronic disease (Baird, Funderburk, Whitt & Wilbanks,

2012). Research also shows that most of the chronic diseases are caused by damaging health

behaviors such as smoking, poor eating habits, and lack of physical activity.

As the number of people suffering from chronic diseases continues to rise, the health

facilities and the governments face the burden of providing care for people with these diseases.

Chronic diseases are becoming common, costly and burden the families, the health facilities, and

the government. According to the Center for Disease Control and Prevention (CDC), chronic

diseases such as diabetes 2, stroke, lung diseases, and cancer account for the highest number of

deaths in most parts of the world (Begic, Arnautovic &Masic, 2016). The diseases are the major

cause of deaths, sicknesses and the high cost of health care in Australia and other parts of the

world. Chronic diseases are responsible for about six in every ten deaths in Australia every year

and the covers the largest percentage of the health care costs.

The paper herein looks at the burden of Diabetes as a chronic disease in Australia. The

paper looks at the specific burdens that diabetes has had both on the health sector, on the families

and the government as far as providing care for the people who have diabetes is concerned. The

DIABETES 4

research would also look at the broader determinants affecting diabetes, assess the risks and

finally give a description of the framework for the prevention of diabetes.

Diabetes and its Burden in Australia

Diabetes is a chronic disease that occurs when the pancreases fail to produce enough

amount of insulin or when the body fails to use the insulin produced effectively. Insulin is the

hormone that is responsible for the regulation of the blood sugar, and if the body fails to produce

it, then there are chances of having abnormal sugar levels in the blood. The high blood sugar

levels often lead to damage of vital body organs which include the nerves and the blood vessels

(Birlouez-Aragon, 2010). The most common type of diabetes is type 2 diabetes and it results

from the inability of the body to utilize the insulin produced by the pancreases hence leading to

the damage of the various tissues and vital body organs by the high levels of sugar present in the

blood.

Diabetes is considered as a 21st-century epidemic that continuous to confront Australian

health system and the government today. According to a report by Diabetes Australia, about 280

people develop diabetes every day in Australia which means that after every five minutes one

person develops diabetes (Burrow, 2016). At this faster rate of development, about 1.7 million

people in Australia have diabetes which includes all types of diagnosed diabetes and the silent

undiagnosed diabetic conditions (Christl, 2012). The statics also show that more than one

hundred thousand Australians developed diabetes in the past one year. For every individual

diagnosed with diabetes, there is always a family member who is also living with diabetes in

support, which means that diabetes affects an estimated number of about 2.4 million people in

Australia every day. Australia incurs an annual cost of diabetes care of about $14.6 billion (El

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Saghir et al, 2011). The money is mainly spent on diagnosis, medication, and treatment of related

diseases resulting from diabetes.

Apart from the financial burden that diabetes has put in Australia, the disease also affects

people in various ways. For example, people living with diabetes risk developing other related

complications such as blindness, swelling of legs and other conditions which greatly affect the

quality of their lives (Espinoza, 2016). Amputations are also common occurrences among the

people living with diabetes, and it leads to many deaths and disabilities which put a lot of burden

on the patients and their families. Diabetes is also the fastest growing chronic disease in

Australia ahead of cancer and heart diseases.

Broader Determinants of Diabetes

Diabetes is one of the major problems facing most communities today across the world.

The occurrence, prevention, and management of the disease are determined by many factors that

also affect the coexistence of the society as a whole (Gerber et al., 2005). There are various

factors which are external to the individual which affects the prevalence of diabetes as a chronic

disease. Achieving a sustainable improvement in health care requires a deeper understanding of

the social, political and economic determinants of the disease. The social determinants refer to

the socioecological factors that affect the general health of the people.

The environment where one lives can significantly affect his life especially while living

with diabetes. The components of physical environment such as safety, transportation and access

to healthy food are important determinants that may influence the process of managing people

with diabetes (Shrivastava, Shrivastava & Ramasamy, 2016). When people with diabetes face

challenges of limited transport access, inaccessibility to healthy food and other factors, there is

the likelihood that they will not have access to proper care and the condition may worsen. In

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most cases, people living with diabetes may need to walk outside the local community to other

areas to access healthy food, and health care facilities and hence limited transportation in the

countryside may affect their recovery rates (Harford et al., 2011). Lack of public transport in the

local neighborhoods may affect traveling hence affecting the access to healthcare. Community

safety is another factor that may have an impact on the people living with diabetes. For instance,

urban areas may have high levels of crime that affect the overall safety of the area prohibiting

access to quality health care service. Congestion in urban areas may also lead to lack of walking

paths and grounds to encourage physical activity which is considered as one of the preventive

measures of diabetes (Nuño, Coleman, Bengoa &Sauto, 2012).

Also, there is a strong connection between the health of individuals in a society and their

socio-economic status. Many factors explain the degree of relationship between the social

character of people in a community and their health. For instance, the level of education, family

income, and employment influences the socioeconomic status of people and therefore their

health (La Merrill, Cirillo, Krigbaum & Cohn, 2015). Higher levels of education have a direct

link with greater health outcome which is associated with the ability to access health care on time

and also capacity to live a healthy lifestyle (Nicolucci, 2013). Education also leads to a higher

access to health information that in turn leads to a better response to diabetes.

Information about diabetes should be made available to the public to create awareness

about diabetes and its possible effects on the life of people. Forums such as social media,

televisions and other forms of media should be used to talk about diabetes so that people can

know when to go for screening and when they suspect that they may have diabetes (Luo et al.,

2013). Establishing programs that promote diabetes prevention practices is a major step in

encouraging people to live a healthy life. Helping people with diabetes to take health insurance

DIABETES 7

covers is also a significant move to ease the burden on the families who have to spend huge sums

of money in taking care of their patients. As a result of the above analysis, it is evident that

diabetes has a significant influence on the social, physical, emotional and cultural lives of the

people in Australia and other countries across the world (Ouwens et al., 2005).

Risk Factors Associated with Diabetes

There are many risk factors related to diabetes. Most of the diabetes risk factors are

associated with the lifestyle choice that people take. Some of the risk factors related to diabetes

include the family history, race, age, gestational complications, environmental factors, weight,

and inactivity among other factors. Overweight and obesity are considered as major predictors of

diabetes specifically type2 diabetes (Organization, 2008). Research shows that almost ninety

percent of the people living with diabetes are overweight or have obesity. Having too much

weight adds pressure to the body and affects its ability to utilize the insulin to control the blood

pressure (Shrivastava, Shrivastava & Ramasamy, 2016). Obesity or overweight strains the body

cells affecting their ability to use the insulin hormone and hence people who are overweight are

likely to develop type diabetes. For example, there has been a significant increase in the number

of people suffering from obesity in Australia and this increment is associated with the growing

prevalence of obesity and overweight in the country.

Inactivity is also considered as a risk factor for developing diabetes as the less active one

is, the higher the chances of developing diabetes. Physical activity is connected to the weight

gain or loss and hence it is important in controlling the weight (Organization, 2008). When

someone engages in physical activity, he or she uses the glucose as energy and reduces the

amount of glucose in the cells hence making the cells more sensitive to the presence of insulin

hence lowering the risk of developing diabetes. However, people who do not engage in physical

DIABETES 8

activities may find it difficult to control their weight and hence stand high chances of becoming

overweight. Being physically inactive also reduces the rate at which one’s body uses glucose,

and hence the cells start becoming less sensitive to insulin hence increasing the risk of someone

developing diabetes (Rubin, 2017). The risk of developing diabetes also increases with age as

one tends to gain weight as he or she ages. The cells also grow old making them less sensitive to

the insulin produced by the pancreas. Age also reduces the chances of engaging in physical

activity hence leaving people more susceptible to weight gain and hence developing diabetic

conditions. Also, having a high blood pressure of more than 140/90 mmHg increases the risk of

developing type2 diabetes (Sayegh & Knight, 2012).

Genetics also play an important role on the risk of developing diabetes. There is

significant information that link diabetes and genetics and hence one is likely to inherit diabetes

from a family member. Therefore, people with family members suffering from diabetes stand

high chances of developing diabetes in their lifetime (Shrivastava, Shrivastava & Ramasamy,

2016). Dietary behaviors are also significantly associated with diabetes. Living with a poor diet

is likely to lead to overweight which in turn would increase the risk of getting diabetes. Eating a

balance diet and taking part in physical activities is likely to reduce the risk of developing

diabetes.

Innovative Care of Chronic Diseases Framework

The innovative care of chronic condition framework proposes that all health care systems

should reorganize their health care to ensure that they provide caution to the rising burden of the

chronic diseases (Shrivastava, Shrivastava & Ramasamy, 2016). The innovative care for chronic

framework alerts all the decision makers across the world to ensure that they create and

implement health care policies that aim at reducing the burden of the chronic conditions. The

DIABETES 9

innovative care of chronic diseases framework provides some fundamental components within

the health care organization, the patient, and the community.

The components are the building blocks which can be redesigned to improve the quality

of health care as well as manage the long term health problems. The ICCC framework consists of

three components namely, the macro, meso and micro levels (Zheng et al., 2012). The macro

standard of the ICCC framework provides the policies that determine the role of leadership and

advocacy in the management of chronic diseases. The micro level defines the functions of the

patients and their families in the process of chronic conditions care. Finally, the third component

which is the meso level covers the roles of the community and the entire health system in

managing the long term health problems (Nuño, Coleman, Bengoa & Sauto, 2012).

Critical Analysis of the ICCC Framework

The innovative care for chronic conditions framework recognizes the increase in the

number of chronic diseases the burden that the bugs are putting on the health care systems. The

framework then suggests a collaborative approach in dealing with the conditions and advocates

for the contributions of every stakeholder in the health care system ranging from the patient, the

family, the community and the government (Shah, Shamoon, Bikkina & Kohl, 2017). Every

decision-maker whose influence can improve the quality of care for the conditions is encouraged

to contribute in the management of the rising burden. The framework highlights that more

biomedical and behavioral management practices should be done to help in controlling chronic

conditions such as diabetes, HIV, and cancer (Valentine et al., 2012).

In summary, the innovative care for chronic disease framework suggests a paradigm shift,

management of the external environment, building an integrated health care system, align

departmental policies for health, promote value-based care and emphasize on the prevention

DIABETES 10

(Verma & Hussain, 2017). From the above suggestions, the framework covers the roles of the

health care systems, the government, and the community in improving the quality of care of

chronic diseases.

In most countries, the type of health care provided to the patients does not meet the needs

of the patients especially those suffering from chronic conditions. The health care providers and

the decision makers must realize that chronic diseases require an extended care that starts from

the hospital wards to the homes of the patients and runs throughout his daily activities (Wild &

Byrne, 2006). The ICCC suggests that health care providers should design care systems that keep

contact with the patients and monitors them throughout their recovery period. Innovation can

help the health care systems to maximize their returns by shifting their services to include

comprehensive care for the chronic conditions (Wild & Byrne, 2006). The macro component of

ICCC framework touches on the roles of the political leaders, health care leaders and all the

decision makers in forming policies that can help in improving the health care system. Having a

successful transformation towards care for chronic conditions requires bi-directional information

sharing to engage all the stakeholders and the political class to stand by the policies.

According to World Health Organization (2015), building an integrated health care

system is also another innovative way of improving the quality of care for the chronic conditions.

Chronic diseases require follow-ups, and hence an integrated health care system would ensure

that information is shared among the providers and that the patient receives the best quality of

care. The overall benefits of integrated health care systems are fewer wastes, less inefficiency,

and improved patient experiences.

Despite having important recommendations on how to improve the care for chronic

diseases, the ICCC framework still faces various challenges regarding how it can be

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implemented (Zwar et al., 2017). Some countries have implemented some of the components of

the framework while other countries are still far from implementing it due to various reasons.

Some countries have not successfully applied the provisions of the framework due to lack of

enough money, some due to political instability while others due to inadequate health care

systems (Dietz et al., 2015). Many questions have also been raised on the sustainability of the

framework due to the exponential rise in the number of people developing chronic diseases

across the world. As many countries and health care system are yet to start the implementation of

the ICCC framework, the number of patients suffering from chronic diseases is still expected to

increase, and the burden of diabetes in Australia would also continue to increase.

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