Select a global health problem of interest to you and write a review and analysis of the health problem. In your paper, include the following components
1) A description of the health problem and people’s experiences of it. Define the problem and consider the experience or “face” of the patient with the problem.
2) An introduction to the epidemiology of the health problem and/or why this is a significant global health issue. What are the causes of the problem? How have people studied or learned about the causes of the problem? What gaps exist in our knowledge of and prevention and treatment approaches to the problem?
3) A description of the approaches to the problem (policy, public/global health and anthropological). What are the ways in which such studies have led to increased understanding of the problem, or ways in which anthropologists and global health professionals/researchers have helped to improve public health education or interventions?
4) A critical evaluation of the historical or contemporary interventions and efforts; essentially, an evaluation of why some programs did not work or a critique of the assumptions enmeshed within programs. What programs are effective in preventing the problem? What types of interventions have been done to learn what works? What are the challenges and opportunities for closing the gap between science and practice? What ethical, social, or political issues exist?
5) A concluding section that suggests future directions for anthropologists, global health, and/or public health practitioners in addressing the problem at hand.
You are limited to 3,000 words, excluding the references list. MRes students will be expected to attain a higher level of sophistication in their research and writing.
Choose one topic
Smoking and Tobacco Use
Acute Respiratory Infections (ARI)
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The essay will emphasize on selection of Diabetes as the global health problem, which will be critically reviewed and analyzed in the academic context. Diabetes refers to a condition, which takes the initiative of impairing the body’s capability of processing blood glucose, which is referred to as blood sugar. The main types of diabetes in the medical context are Type 1, Type 2 and Gestational Diabetes. The essay will primary reflects on the descriptive aspect of the health problem along with experience of the patient while dealing with the disease. The main cause of Diabetes will be identified along with critical reviewing of the epidemiology of the selected health issues. The essay will also emphasize on the interventions and approaches initiated to treat Diabetes. The essay will also seek a deep insight on the gaps that exist while treating Diabetes. The essay will also emphasize on the challenges and opportunities to close the gap between science and medical practices. Lastly, the essay will highlight the futuristic initiatives that need to be considered for handling the issues associated with Diabetes.
1.1 Description of the Health Problem
Hayashino et al. (2017); 246) has identified that the health problems or symptoms due to diabetes vary depending on the elevation level of the blood sugar. In type-1 diabetes, health problems seem to creep at a faster rate and become more severe. People suffering from pre-diabetes or type-2 diabetes might not be experiencing health problems initially. Some of the health problems or symptoms of type-1 and type-2 diabetes are enhanced thirst, extreme hunger, continuous urination, excess loss of weight, fatigue, blurred vision, slow rate of healing sores and irritability.
Furthermore, Baynes et al. (2015); 7) has mentioned that the occurrence of ketones into the urine, which is the byproduct of fat and breakdown of the muscles that occurs while there is scarce availability of insulin acclaims the severity level of diabetes. In addition, occurrences of frequent infections like skin or gums infections followed by vaginal infection are frequent. The health abnormalities leading to Type-1 diabetes can initiate at any stages of life. Extending to the Type 2 diabetes, which is mostly prevalent can also develop at any point of time in life, however it seems to be prevalent within the aging population.
1.2 Experience of Patients with Diabetes
As per Paddison et al. (2015); 472) patient experience has been measured by using a single item for assessing the overall occurrence in terms of services of primary care and six items for assessing experience of patients in specifically three domains related to primary care based on accessibility, continuity of care, as well as communication. A necessity for planning and living according to strict daily routine becomes a natural component of personalities and daily life and is experienced as imposing, difficult, feeling unable and limiting to relax because of persistently having to acquire blood glucose levels into account and the burdened effort that is required to maintain it in steadiness.
Figure 1: Survey responders reporting positive patient experience
(Source: Paddison et al. 2015); 473)
On the other hand, Purnell et al. (2017); 1758) has mentioned that living a life with diabetes and its associated management demands for every single day and years after years could be experienced as overwhelming and tough. It is exhausting in terms of both mentally and physically and with the passage of years it sorts of wears the patient down. The greatest challenge for patients is adhering to a working daily routine in terms of food which is a constant struggle of maintaining good blood glucose levels.
Bommer et al. (2017); 428) has mentioned diabetes is something which is to be ashamed of and necessitates to be concealed. It has been experienced by several patients as something which ruined their lives and impaired relationships with other family members or friends around. Hypoglycaemia, hyperglycaemia and fluctuations in blood glucose levels are experienced as barriers to everyday activities in terms of work, physical activity or educational activities and are described as draining as well as frustrating.
2.1 Epidemiology of the health problem
According to the research work of Hicks and Selvin (2019); 86) the risk factors involved in case of Type-2 diabetes in terms of alterations in lifestyle, genetic and behavioural factors of risk have been taken into consideration. Recently, researches are focusing on identification of offerings of epigenetic mechanics alongside the impact of the intrauterine environmental aspect. The data related to epidemiology has predicted an unsustainable as well as inexorable increment towards the global health expenses, which are attributable towards diabetes. Thus, prevention of disease should be highly prioritised. An integrated strategy is necessary for preventing diabetes and is due process heterogeneity should be recognized.
On the contrary, Zimmet and Albeti (2016); 883) has identified future research is necessary for better understanding of the role adopted by the determinants in regard to maternal environmental aspect and erstwhile life factors, alongside changes in global demographic trends, to help shaping of diabetes preventive programs. Occurrence of diabetes from obesity amongst ethnic groups is risky. From the perspective of metabolic surgery such epidemiological reality is significant to decision making.
2.2 Why is this a significant global issue?
Miller et al. (2016); 2298) has mentioned diabetes is considered as the global health issue whose prevalence is continuously rising in several nations. The International Diabetes Federation (IDF) has estimated that approximately half a billion of people (425 billion) is at present surviving with diabetes in regard to global population. The numbers are huge concerning acute comprehension. For instance, diabetes is a country then it is taking a larger shape that US and in behind countries like China and India in terms of population.
On the contrary Ligita et al. 2019 has mentioned patients surviving with Type-1 diabetes is in between 5 and 10% whereas the remaining patients of approximately 90-95% are burdens of Type-2 diabetes. In the first case people fails to produce enough insulin whereas in the latter case people fails in properly utilization of the insulin they are producing. Alarmingly at present, four out of five diabetes patients are living in low-to-middle income level nations where an adequate resource for prevention and management of diabetes is in acute scarce. In 2017, IDF estimated that four million deaths occurred due to diabetes with half of those occurring prematurely caused by renal and cardiovascular complications.
2.3 Causes of Diabetes
Asper Mohamed et al. (2019); 338) the interim cause of Type-1 diabetes is due to environmental factors and presence of genetic susceptibility. The immune system inside the body that normally fights harmful viruses and bacteria destroys by attacking cells which produce insulin within the pancreas and leaves the individual with no or little insulin. Other than transporting into body cells, sugar is built up in blood stream.
The causes of type-2 diabetes is strongly linked with overweight however not everyone. In this type, the body cells become resistant of taking actions of insulin and the pancreas becomes unable to produce ample insulin for overcoming such resistance. Instead of transferring into body cells where it is necessary for energy production, sugar is built up within the bloodstream.
Gestational diabetes is caused during pregnancy, when the placenta produces specific hormones for sustaining pregnancy, which make the cells extensively resistant towards insulin. Excess glucose gets into the cells and much stays in the body which results in gestational diabetes.
2.4 How people have learnt about the Diabetes causes?
Klaprat et al. (2019); 42) has mentioned diabetes education is found to have a positive impact on self-management of patients suffering diabetes, however less evidences are known regarding the practice by which they absorb information. Receiving and seeking diabetes related information have been diagnosed whereby it has been found that previously people having diabetes recognised or noticed the symptoms and then accumulated information regarding their disease through passive and active techniques of learning.
Welsh et al. (2016); 1302) has mentioned once those information sources are diagnosed, they aggressively seek information regarding the managing of diabetes disease, clarifying relevance to therapies being utilised and finally explanations concerning the reasons for changing in the body related to medication used. Passive learning means receiving or listening to information provided by other people, generally health care professionals (HCP), without requesting for data themselves. The situation occurs when an individual suffering from diabetes has appointment with healthcare facilities such as during hospitalisation or an outpatient clinic. The information is offered as element of clinical consultation or at stances of hospitalisation by HCPs while caring for patients.
2.5 Experience of Gap in knowledge, prevention and treatment measures of Diabetes
Blonde et al. (2017); 176) has identified there are significant gaps in this field, which includes lack of effective cohort knowledge utilizing serial measurement of regular physical activity and severe disease followed by no availability of highly powered, multicenter, randomized controlling trials of physical activity and long termed outcomes of health. There is negligible data on the role of innovative technologies for supporting physical activity related behavioral changes.
Furthermore, Litchman et al. (2019); 468) has mentioned that there are no such trials, which involve diabetes patients in the designing and executing physical activity based clinical trials. There is a huge gap in understanding physical activity behavior amongst adolescents as well as health outcomes in adulthood. Moreover, there are considerable gaps while understanding the dose, ole and long-term effectiveness of physical activity in relevance to mental health, and self-management of diabetes.
3.1 Application of approaches to the problem of Diabetes
The focus of healthcare systems is mainly on care rather than prevention. Majority of the European nations are having national health insurances, which takes the initiative of financing care for treatment of Diabetes. As the progress from low to higher risk for Diabetes happens as the continuous procedure, there is a need of implementation of certain policies and interventions for mitigating the adverse health consequences of Diabetes. As stated by Bergman et al. (2012); 3019) many transnational studies of research conducted within the real-life scenario have considered modified approaches of lifestyle interventions regarding clinical tests like Finnish Diabetes Prevention Program and US Diabetes Prevention Program. Government are implementing urban designing policies for facilitating physical activities, which plays a pivotal role in controlling Diabetes. Likewise, WHO takes active participation in promoting assessment approach of health impact for evaluating the influence of societal, environmental and fiscal policies towards Global Diabetes plan for implementing “health in all policies” preventive approach (zullig et al 2015): 139). There is availability of conclusive evidence regarding the fact that Diabetes can be controlled within individuals at higher risk by nutritional counselling, enhancement of physical activities and reduction of the modest weight. Implementation of the above-mentioned policies could mitigate adverse effects of Diabetes to a large extent.
Anthropological interventions and perspectives are suggestive as one of the ways to examine the dimensions of Diabetes. Barry et al. (2017); 6538) argue that anthropology is mostly applicable to analyze the complex dynamics associated with the disease. Irrespective of the fact the literature of anthropology is extensive by nature, it is often not appreciated and mis-used within the research of mainstream health. For instance, anthropologists have taken the initiative of exploring health beliefs and conceptualization models of the illness, illustrating how the changes in a way that the patients realize the etiology of the health issue significantly influence the preventive measures initiated and managing of Diabetes. The mainstream of the health research has taken active participation of adopting the insights through the framework of health behavior for analyzing the context of diabetes effectively. The anthropologists also highlighted the fact how values of core culture take active participation in influencing the dynamics and procedures (Borovoy and Vine, 2008); 25). The ideology of culture influencing health has received acceptance amongst the broader community of health research, however, the main inclination is towards bundling of the cultural constructs or using them as the proxies to understand the health behavioral pattern of the populations that represents a coherent form of grouping in a superficial manner. The interpretation of Diabetes health amongst the Hispanics takes into consideration application of a framework which takes the initiative of emphasizing on the cultural constructs determined by the anthropological aspects as the core context of the cultural values: which comprises of Familismo, Simpatico and Reciprocidad. Mnedenhall (2016); 468) states anthropological aspect do not presume the cultural conceptualization and practice interventions as normative and universal. The researchers take active participation in investigating the specific aspect of the societal procedure while analyzing the context of Diabetes effectively.
3.2 Ways through which anthropologists and global health professionals have assisted in improving the public health education and interventions
Medical anthropologists have taken the needful initiatives of assisting the biomedical communities for untangling the societal roots of the Diabetes and investigates critically why the diseases is spreading rapidly across the globe. It tends to initiate a holistic intervention of the complex issues associated with Diabetes. The preventive initiatives that needs to be taken for treating diabetes are subjected to eating of healthy foods, losing weight and exercising as much as population. Appropriate treatment procedures and changing of lifestyle plays a pivotal role in treating Diabetes, however, these preventive measures alone cannot solve the issues associated with Diabetes. Kirchengast (2017); 50) states that as per anthropological perceptions certain factors such as the history of the family and ethnicity also needs to be considered while treating Diabetes. As a result, community-oriented Diabetes programs were initiated which created awareness amongst the patients for treating Diabetes effectively. Anthropologists contributed towards early detection of Diabetes by tracking previous family records and symptoms. Mon (2017); 376) states that in most of the cases, it is identified that patients do not believe at times that treatment alone could cure Diabetes. The patients are hesitant in following the instructions properly. Anthropologists took the initiatives of identifying the beliefs and caution the patients to take the necessary steps for avoiding further damages to health due to prevalence of Diabetes. Interventions were initiated which focused on documenting various stages in treatment of Diabetes rather than only providing a direct medical diagnosis only. Too much of stress and poverty are also major contributors towards formation of Diabetes. Anthropologists identified that Diabetes is subjected to the expression of the dietary preferences. They mainly prioritized how they can influence the ways patients sets values in life along with considering the treatment procedures of treating Diabetes. On the other hand, White et al. (2015); 147) states that the health professionals mainly improved public education by emphasizing on more conduction of physical activities, stress management and reducing obesity for treating Diabetes effectively. Messages related to healthier lifestyle was spread amongst the population for minimizing the adverse impact of Diabetes. Getting abundance of Fiber and prioritizing more usage of whole grains were considered as top priorities by the heath professionals for controlling Diabetes effectively. They also prioritized upon the urgency of seeking doctor checkups at regular intervals instead of taking individual decisions or neglecting Diabetes as it could be a life-threatening disease if left untreated.
4.1 Critical evaluation of history and contemporary intervention of diabetes
Previously, there was a belief that Diabetes was a disease related to Kidneys and there were no effective measures of treatment procedures for curing of Diabetes. Individuals used to die untreated within weeks to months after the onset of the disease. The physicians at an early stage believed that Diabetes could be cured with conduction of exercise. Powers et al. (2017); 50) doing exercise on horsebacks were also considered effective for treating the diseases. Use of Narcotics in the form of Opium and wormseed were considered useful for treating the patients suffering from the diseases. Consuming foods that are easy to digest and even fasting was considered effective for treating Diabetes. There was less priority on treating patients with medicines in the early days.
As far the modern-day interventions are concerned, various treatment procedures came into effect for treating Diabetes effectively. Application of insulin analogs in modern days were found to be more effective in treating Diabetes effectively (Putiri et al. 2017); 59) The selection of a healthy diet and lifestyle changes are considered as a treatment procedure in modern days for treating Diabetes effectively. Initiation of non-insulin therapies are also considered these days for mitigating the adverse impact of Diabetes. Thomas (2015); 10) states Usage of Metformin, Sulfonylureas and Pramlintide are also considered as a preventive measure for treating Diabetes effectively. Use of Sodium Glucose Cotransporter are also effective in managing Diabetes successfully. A wide usage of oral medicines in the modern era has made the treatment procedure simpler for treating Diabetes effectively.
4.2 Programs effective in prevention of Diabetes
Foundational research ensures that Diabetes can be treated with changes in Lifestyle. It could be noticed that conduction of exercises and following of proper diets can reduce the ill effects of Diabetes to a larger extent (Nathan 2015); 1058). The foundational research prioritized becoming more physically active and healthy and losing extra weight for staying fit for longer duration of time. Application of aerobics exercising, and resistance training served as a control measure for treating Diabetes effectively. Intaking of low carbohydrate diets can also reduce the ill effects to diabetes to a wider extent. These preventive measures were considered key for managing spreading of Diabetes further.
Effectiveness of medicines in treating Diabetes are readily available in low cost for treatment of Diabetes. Interventions were initiated where the disease was diagnosed and treated early. Application of biochemical, physical and clinical assessments were implemented for detecting Diabetes at an early stage. The formula of treating Diabetes is not only dependent on proposing medicines. Application of self-management educational programs also contributed towards management of Diabetes successfully (Becks et al. 2017); 36). More attention was given to individuals suffering from Diabetes in educating them to initiate the preventive measures themselves for leading a healthy lifestyle. Application of Population based approaches also proved effective for treating Diabetes where teams of primary care involved in assisting the patients suffering from Diabetes.
4.3 Challenges and opportunities in closing the Gap between science and practice of Diabetes
Irrespective of the fact, education is considered as a key constituent of management of Diabetes, it is relatively low within the practical priorities of the clinicians. Matteucci and Giampietro (2003); 302) stated that while education more simply offers data regarding the controlling of Diabetes, but its infrequent incorporation within the practices are contradicting the efficiency of resources. In this context, Ba-Essa (2018); 68) commented strategies of quality improvement could be utilized for improving the quality of diabetes care that is delivered, thus mitigating the gaps and barriers which are existing amongst the recommended diabetes and evaluation of practices. Several opportunities are existing for better alignment of clinical science and practices within the diabetes care. There the focus should not be only towards development of practice guidelines, but also towards facilitation of the application within the practice.
4.4 Social and ethical issues concerning Diabetes Care
Diabetes has plagued several nations across the globe. One of the major social issues are barriers of accessing of care. Akhter, Turnbull and Simmons (2016); 308) stated that poor transportation system, absence of health care providers in some areas and lack of insurance coverage are affecting proper care of Diabetes. Some individuals do not have the capability of treating Diabetes with the help of medications. Poor building of the community infrastructure is also affecting proper management of diabetes care. In this context, Crowshoe et al. (2018); 54) stated that areas lacking side walking and recreational portions often results in obesity, which is one of the main contributors towards Diabetes. Lack of proper education is also affecting the onset of Diabetes, as individuals who are less educated seem to be less aware and reluctant towards treatment of diabetes.
The potential health hazards from intensifying of the health therapies for effective lowering of the level of glucose takes active participation in representing the ethical dilemma amongst the aversion of risk factors from the overtreatment and prevention of future harms from raising level of blood glucose. However, the ethical dilemma which are experienced by the medical practitioners regarding contemplation of prescriptions for initiating insulin had received lesser attention from the medical communities (Basu and Sharma, 2018); 328). The ethical dilemma usually comes into effect due to lesser availability of the needful drugs, diagnosing and time of physical consultation in regards to patients suffering from Diabetes. However, in some cases, evidence-based practice which serves as a standardized initiative, is missing in certain medical settings. Therefore, medical practitioners are solely reliant only the clinical judgements, which could be prone to mistakes from a medical perspective.
On an overall note, scientists are still looking forward of considering several options for treating Diabetes more effectively. Immunotherapy could be a breakthrough intervention in managing Diabetes in the mere future. An emerging option of treatment is artificial pancreas which will assist in glucose controlling in an effective manner. On an overall note, it could be stated that availability of treatment options along with effective changes in lifestyle measures can assist in controlling Diabetes. Anthropologists are always looking for options to improve the quality of patient’s life by boosting their confidence, spreading awareness and initiating stress management programs for treatment of Diabetes. The health professionals are continuously working upon using of new media and social media to educate patients about the necessary steps that needs to be considered for minimizing the onset of Diabetes effectively.