This Essay Will Address the Role of Health Screening and Health Promotion in Regards to Diabetes Mellitus
The National Health Priority Action Council (NHPAC) highlighted that ‘the direct health care expenditure on diabetes in 2000-01 was $812 million’(NHPAC 2006, p. 7). This essay will address the role of health screening and health promotion in regards to diabetes mellitus. It will discuss the topics of morbidity, mortality, and aetiology as well as strategies to reduce incidence and prevalence, current strategies for health promotion, the role of health screening, future planning, and the effectiveness of such strategies.
There are a variety of classifications of diabetes, which include Type 1 diabetes, Type 2 diabetes, gestational diabetes, and other less common types of diabetes. Mosby’s Dictionary of medicine (Harris, Nagy & Vardaxis 2006, p. 520), defines diabetes mellitus as ‘a complex disorder of carbohydrate, fat and protein metabolism that is primarily a result of a deficiency of absence of insulin secretion by the beta cells of the pancreas or resistance to insulin. ’ According to the NHPAC (2006, p. 6), diabetes is the sixth most significant cause of death in Australia.
Due to the predominance in the disease across Australia, the Australian Institute of Health and Welfare (AIHW) listed the disease as a National Health Priority Area, affirming that the disease contributes to ‘ill health, disability, poor quality of life and premature death’(AIHW DPA 2011, p. 1). Diabetes mellitus results in considerable amounts of morbidity and mortality across the Australian population (Zimmet & Magliano 2011). The International Diabetes Federation (IDF) noted that in 2010 an estimated 4 million deaths could be attributed to the disease (2009, p. ) .
Current research (American Diabetes Association 2011, p. 1), highlights that the complications of diabetes include heart disease, stroke, high blood pressure, blindness, kidney disease, neuropathy, and amputation. Of such complications cardiovascular disease is the most likely to result in death as a result of diabetes, kidney disease is the second highest cause of death (National Public Health Partnership 2003, p. 4). Once diagnosed with diabetes you are 2 to 4 times more likely to have a stroke or die of heart disease (American Diabetes Association 2011, p. ).
The AIHW estimates the morbidity rate of diabetes in Australia between 2007-2008 to be over 898’000 and has since risen (AIHW DPA 2011). The AIHW (2011, p. 6), summarizes that type 2 diabetes occurs approximately 9 times more frequently than type 1 diabetes and the proportion of people with diabetes in the varying areas and regions of Australia remained similar. Men are more likely than women to be diagnosed with the disease and only 4% of people with diabetes are under 35 years of age (AIHW DPA 2011).
Current research (AIHW DPA 2011) clarifies that ‘it is not known how many Australians currently have undiagnosed diabetes’ and there for it should be acknowledged that the actual figures of the morbidity rate of diabetes is higher than recorded. The highest morbidity rates occur from the age of 65 years to over 80 (AIHW DPA 2011). According to the current research from the AIHW (DPA 2011, p. 21), 4. 4% of the population has currently or previously been diagnosed with diabetes and ‘1. 6% of the allocatable recurrent health expenditure’(NHPAC 2006), was used towards diabetes between 2000 and 2001.
Such statistics support the decision of the Australian health minister to include diabetes as one of the national health priority areas (NHPAC 2006) and highlight the importance of health screening and health promotion. In order to decrease the prevalence of the disease it is important to understand the aetiology in order to address preventative factors of diabetes mellitus. Marieb and Hoehn (2010, p. 622), affirm that the disease of diabetes mellitus is a ‘homeostatic imbalance’ which ‘results from either hyposecretion or hypoactivity of insulin.
The World Health Organization (WHO) describes diabetes mellitus as ‘a metabolic disorder of multiple aetiology’ (2011, p. 1), as the varying classifications of the disease occur from varying origins. Type 2 diabetes, which is the most common, is caused by mostly modifiable health factors, which include ‘obesity, lack of physical activity, and unhealthy diets’ (WHO 2011, p. 2), although it is also related to increasing age, strong family history of diabetes, and ethnicity (Zimmet & Magliano 2011). This type of diabetes is most likely to decrease if there is an increase in health promotion.
Type 1 diabetes ‘usually develops in childhood or adolescence’ (WHO 2011, p. 2), and will result in death if the disease is not treated by consistent insulin injection. This type of diabetes is slightly more complex as it is substantially caused by gene mutation (WHO 2011, p. 2). The World Health Organization (2011, p. 2), describes the aetiology of the disease as the ‘autoimmune destruction of the beta cells of the pancreas. ’ Gestational diabetes, which is much less common, only occurs during pregnancy and is caused by a resistance to the actions of insulin brought on by the hormones a woman’s body releases during pregnancy (WHO 2011, p. ).
Once diagnosed with gestational diabetes mellitus you are at a greater risk of developing type 2 diabetes later in life (Zimmet & Magliano 2011). For this reason it is particularly important to use preventative measures and consistent health checks. Health screening is an important tool, which can provide an early diagnosis of the disease before severe complications arise. The WHO (2003, p. 2), notes that there is a large portion of people with diabetes who remain undiagnosed and the disease is increasing worldwide.
Such research (WHO 2003, p. 2), also highlights that with treatment cardiovascular disease can be prevented in people with type 2 diabetes, before the symptoms arise. Diabetes is diagnosed by deciphering the level of glucose in the blood (WHO 2003, p. 1). Those at high risk or those of a high-risk ethnicity such as Aboriginal or Torres Strait Islander should be tested more frequently (NHPAC 2006). The Australian Diabetes in Pregnancy Society recommends that all pregnant women should be tested for gestational diabetes (NHPAC 2006).
Some strategies aimed at health promotion and early detection for diabetes include the National Health Priority Area, the National Diabetes Strategy, the Diabetes Australia Strategic Plan, the National Diabetes Council, the National Chronic Disease Strategy, and Active Australia. The Australian health minister’s action to include diabetes mellitus as ‘one of the five national health priority areas’ would assist in reducing the prevalence and impact of the disease; as well as ‘funding $7. 7 million over three years for activities that would improve the awareness and the management of diabetes in Australia’ (Commonwealth of Australia 1999, p. ).
The national diabetes strategy (Commonwealth of Australia 1999, p. 1), was put in place to ‘improve the prevention and management of diabetes in Australia’. The national diabetes strategy (Commonwealth of Australia 1999, p. 8), highlights five key goals to be achieved in their action to combat diabetes and include activities and measures to achieve these goals. Such goals include: Goal 1Improve the capacity of the health system to deliver, manage and monitor services for the prevention of diabetes and the care of people with or at risk of diabetes. Goal 2Prevent or delay the development of Type 2 diabetes.
Goal 3Improve health related quality of life and reduce complications and premature mortality in people with Type 1 and Type 2 diabetes. Goal 4 Achieve long term maternal and child outcomes for gestational diabetes and for women with pre-existing diabetes equivalent to those of non-diabetic pregnancies. Goal 5Advance knowledge and understanding about the prevention, delay, early detection, care and cure of Type 1, Type 2 and gestational diabetes. (Commonwealth of Australia 2009, p. 8) The National Health Priority Action Council (2006, pp. 67-68), suggests nine priority actions for change.
The council (NHPAC 2006, p. 67), argues that these priority actions highlight the essential areas of change. The National Service Improvement Framework (NHPAC 2006, p. 67), also specifies various strategies that would promote the positive management of diabetes through out Australia. The suggested strategies include: The establishment of state and territory diabetes plans;… improved access to services; the improvement of care for regional, rural and remote communities; strengthening training and professional development;… and planning strategies for the future. NHPAC 2006, p. 67)
Yet, another strategy aimed at reducing the incidence and prevalence of diabetes mellitus in Australia is the Diabetes Australia Strategic Plan (DASP). The DASP has created five key focus areas, which advocate their mission for change (Diabetes Australia 2011, p. 2). Such focus areas are awareness, prevention, detection, management, and cure (Diabetes Australia 2011, p. 2). These five principles clearly highlight the main target areas to reduce the prevalence of the disease. The DASP later outlines detailed strategies to be acted on to create change.
The key result areas of these strategies can be summarized as the ‘National Policy Agenda; access and affordability; national programs supporting people with diabetes; research; advocacy and lobbying; communication of key messages; and partnership programs’ (Diabetes Australia 2011, p. 3). As well as the numerous strategies aimed at reducing the incidence and prevalence of the disease there are also a number of health promotion strategies specifically aimed at diabetes. One such strategy is Planning for Healthy Communities (State Government of Victoria, Department of Health 2011, p. ), which is comprised of twelve chapters aimed at health promotion.
Focus factors of the report include: ‘preventing cardiovascular disease… preventing diabetes… promoting healthy weight, promoting physical activity, promoting healthy eating, reducing tobacco use, improving socioenvironmental conditions, and psychosocial factors’ (State Government of Victoria Department of Health 2011, p. 1). Other strategies for health promotion also include the World Health Organization’s Diabetes Program and the South Australian Strategy for Aboriginal and Torres Strait Islander people 2005-2010.
The Educational Management Package from the Royal Children’s hospital also focuses on health promotion and aims at preventing ‘Type II diabetes in young people at risk of developing the disease and the progression to Type II diabetes among obese children’ (Queensland Government Queensland Health 2004, p. 13). There is little research to display the effectiveness of such strategies although current reviews are being developed. The Australian Government Department of Health and Ageing (2011, p. 10), implemented the National Diabetes Strategy between 2008-2009.
The annual report from 2008-09 states that the program was ‘implemented on time and within budget’ (Australian Government Department of Health and Ageing 2011, p. 10), but does not state the progress. The U. S. Department of Health and Human Services (DHHS) has also implemented various strategies aimed at reducing the impact of diabetes and they have concluded that the ‘costs associated with poor diabetes control are higher than the cost of interventions aimed at achieving good diabetes control’ (2011, p. 1).
The U. S. DHHS (2011, p. ), also claims that lifestyle interventions aimed at early screening and treatment, lowering blood sugar and cholesterol, and prevention strategies for those in high-risk categories have proven to be effective in reducing both the impact of the disease and increased cost effectiveness. In conclusion, it is clear that the role of health screening and health promotion is vital in reducing the incidence and prevalence of diabetes mellitus. The large rates of morbidity and mortality due to diabetes are being addressed through various strategies, which, are aimed at reducing the impact of diabetes on the population.
Current research also takes into account the aetiology of the disease and how it could possibly be prevented before the disease develops. The effectiveness of the majority of the Australian strategies towards diabetes is currently being reviewed and other countries promote the use of such health programs and support their effectiveness.