Health disparity and disease process:
The United States is a culturally diverse country. It took African Americans many years to have equal rights to basic needs and resources, and even after such rights were granted, it also took longer to recognize them. The country has strived to eliminate the inequalities (Noonan, Velasco-Mondragon, & Wagner, 2016). However, health disparities among the minority population remain a crucial factor that exposes these minority groups to significant health issues such as increased certain health conditions, higher mortalities, and lower life expectancy. The ten leading health indicators in Healthy People 2020 identify racial health disparities as one of its national health objectives.
One of the chronic diseases attributed to racial health disparities among African Americans is diabetes. According to Noonan, Velasco-Mondragon, & Wagner, 2016), forty-six percent of African Americans have cardiovascular diseases, which is the leading cause of death in America. Besides, the office of minority health under the Department of Health and Human Services shows that African Americans adults approximately sixty percent likely to suffer from diabetes and be diagnosed by a physician than white adults.
Diabetes is a lifestyle condition that people get as a result of unhealthy lifestyles and preexisting health conditions such as hypertension. African Americans are susceptible to diabetes because of the kind of lifestyles that most of them live and the lack of information regarding the disease process.
The Census Bureau in 2017 shows that most African Americans are millennium, unemployed (rate twice that of whites), lives at poverty level (twenty percent), and a median household of $40,165, which means they have to do anything to thrive. Their poor lifestyle, coupled with unequal health care access, resource availability, lack of health literacy, predispose them to diabetes, which quickly exacerbates leading to comorbidities. Since they cannot access timely health care, most of the diabetes cases go undiagnosed until they exacerbate to worse cases due to the asymptomatic nature of diabetes.
Nursing diagnosis and associated comorbidities: One of the nursing diagnoses in the case of diabetes is the deficient knowledge of diabetes (its risk factors, pharmacological and non-pharmacological management, prevention, signs and symptoms, impacts and complications) related to unfamiliarity with diabetes and its management as evidenced by a show of concern and development of some avoidable complications. Knowledge is power and elucidates people’s role in ensuring quality life and health (Noonan, Velasco-Mondragon, & Wagner, 2016). Diabetes is a fatal disease that needs close monitoring and patient participation to avoid complications and the development of comorbidities. Some of the comorbidities include hyperlipidemia, hypertension, obesity, non-alcoholic fatty liver disease. Also, diabetes may lead to neuropathy resulting in ulcer and amputation, retinopathy, which may lead to blindness, nephropathy exposing individuals to renal diseases, which are often fatal, and, lastly, increases individuals’ susceptibility to infections and prolong their recovery time.
Why the topic is necessary: The impact that racial health disparities have on African Americans, the United States healthcare system, and the economy, as well as the world at large, is well-known. Health-wise, health disparities expose the already vulnerable African American community to some of the most fatal and chronic health conditions such as diabetes, which affect the immune system of vulnerable minority groups and recovery time as well as their quality of life. According to the office of minority health under the center for Medicare and Medicaid services 2017, the majority of African Americans are less likely to receive timely and safe and quality care, which exacerbates diabetes and increases risks of complications. American Association of diabetes shows African Americans have almost fifty percent chances of developing diabetic retinopathy compared to their white colleagues.
Additionally, African Americans are 2.3 times more likely than whites to be hospitalized due to diabetes (Office of minority health under the center for Medicare and Medicaid Services, 2017). The likelihood rate of death from diabetes of African Americans in 2017 was twice that of non-Hispanic whites. Moreover, the American diabetes association shows that at least one American is diagnosed with diabetes every seventeen seconds. National Institute of Health 2018 reveals that African Americans had higher risks of diabetes than whites and links that this to biological, neighborhood, psychological, socioeconomic, and behavioral factors among African Americans to diabetes. The study confirms that biological risk factors attributed to lifestyle, and preexisting cardiovascular conditions are the primary cause of health disparities among African Americans.
It is anticipated that by 2050 about one in every three adults in the United States will have diabetes if no proactive action is taken (Davies et al., 2019). The government spends over two hundred and fifty billion dollars on diagnosing and management of diabetes annually. The significant prevalence of diabetes cases is caused by health disparities, which leads to risky and harmful lifestyles, behaviors, and practices. Thus, adequate strategies to address health disparities, inequalities, and inequities within the African Americans and other minority communities are necessary to curb the prevalence of diabetes and other cardiovascular diseases and promote the health of African Americans and Americans at large.
History of health disparity and its health impacts: Health disparities of African Americans community date back to the period of slavery in what is now known as the United States of America (Noonan, Velasco-Mondragon, & Wagner, 2016). Africans were transported to America, and the mode of transportation showed how the whites destroyed blacks’ health for personal gains. Once the African Americans were in the United States, they lived under harsh physical and social conditions, and their health had little to no value to their bosses who were whites. They suffered psychological, physical, and mental brutalization for over two hundred and fifty years since they had no right to any basic needs, including the right to live.
African Americans thought that the end of slavery could be an achievement and that they could finally live healthy lives and have some rights. However, they have endured systematic discrimination and oppression one hundred and fifty years following the abolishment of slavery, which they still experience up to date, although to a lesser extent (Noonan, Velasco-Mondragon, & Wagner, 2016). This history of harsh times during slavery and racial discrimination has led to the immeasurable impact and continued suffering among African Americans health-wise, socioeconomically, and in other ways. For instance, they endure unequal health care delivery and financing, which leads to inequitable and inadequate health care access and service availability in their areas. These negatively impact their health and exposing them to fatal and chronic conditions such as diabetes due to their risky behaviors and practices to adapt to the nature of their lives. Since they have limited and unequal access to health care, diabetic cases among this minority group are hardly diagnosed on time.
Demographics data: According to the United States Census Bureaus, about 41.4 million Americans are black, and diabetes affects all ages. However, the majority of diabetes-related mortality cases are evidenced among the elderly populations. The Office of Minority Health shows that New York, Louisiana, New Jersey, Illinois, California, North Carolina, Georgia, Texas, and Virginia are among the states with the largest population of African Americans, which has shown an increase in the number of diabetes cases due to increased African American populations. Eighty-six percent of the African Americans above twenty-five years have at least a high diploma, and twenty-one percent have bachelor’s degrees or higher in 2017. Also, more black women have bachelor’s degrees compared to black men. However, though some African Americans are educated and wealthy, some still are unfamiliar with the American health care system, and diabetes literacy thus increased diabetes prevalence due to a lack of knowledge of diabetes and limited care access. Census Bureau in 2017 showed that African Americans had a median household income of $40,165, and about twenty-two percent of them were thriving at the poverty level. The unemployment rate among African Americans was twice that of whites. Most African Americans are millenniums and generation Z and younger in 2017.
Related socioeconomic issues: Numerous studies show how socioeconomic status affects people’s health outcomes and the type of health care they access and predispose them to diabetes and other chronic conditions (Arpey, Gaglioti & Rosenbaum, 2017). Individuals from low socioeconomic families report worse health, diabetic management outcome, and prolonged recovery, have a lower life expectancy, and often suffer from numerous comorbidities, which exacerbates quickly due to lack of timely care compared to those from higher socioeconomic status.
Office of minority health shows that while the number of people with insurance coverage has increased, the difference in insurance coverage between the African Americans and the whites has remained the same. This has limited the diabetic diagnostic tests, medication, and health care that they can access because they cannot afford most of them due to their socioeconomic status. Moreover, people from low socioeconomic status are likely to engage in risky and harmful behaviors and practices, work in harsh environments and eat unhealthy foods leading to diabetes and other cardiovascular diseases, which will ultimately exacerbate diabetes. Limited access to health care and other health disparities further impoverished the African Americans community making them more susceptible to diabetes and its comorbidities.
Teaching Plan
Teaching goals: Diabetes, as stated earlier, is mostly a lifestyle-associated condition. This means that healthy lifestyles may be effective at preventing suffering from diabetes or its exacerbations (Khan & Misra, 2020). The four teaching goals aiming to prevent and control diabetes within the African American community include the following. The first goal is to equip the community with adequate knowledge of diabetes, its signs and symptoms, pathophysiology, risk factors, and possible complications. Knowledge is power, and one who knows what they need to do is more likely to take the right precautions to ensure a healthy life. When the African American community has comprehensive knowledge of diabetes, they are likely to see its impacts on their health and be responsible for their health hence promoting individual and community health.
The second goal is to teach the community how to prevent, control, and live healthily with diabetes. When individuals already know about diabetes, it becomes easy to guide them on how to prevent its occurrence. Teaching African Americans preventive measures such as a healthy diet and physical activity, as well as adherence to medications and self-management of diabetes, will increase their life expectancy and quality while promoting their health (Glantz et al., 2019). The third goal will be to empower the community and help them identify the community resources that may help prevent and control diabetes. This will help the African American community to learn that preventing and living with diabetes is not costly and that they only need to do simple things to live happily and healthily. Also, it will assist them in creating community groups which they can use to encourage one another and seek funds to promote and advocate for the diabetes-free community.
The last goal will be to encourage the community members to be one keeper and help one another seek health care. The best way to improve the broad community health is to create a caring community. Diabetes management requires a healthy lifestyle, some of which may be undesirable since one has to drop certain behaviors that they have lived to enjoy. Thus it may be hard to cope. However, a caring community will motivate one another, facilitate the referral of struggling persons for comprehensive care, and encourage others to live a healthy lifestyle to avoid diabetes.
Evaluation of the effectiveness of teaching: The teaching will be divided into four sessions (each taking two days) with each session aiming to achieve one goal according to how they are listed above. The community will be divided into groups based on the households with the help of the community leaders and community health volunteers, with each group led by two nurses, one who will be a public health nurse. The nurses will deliver diabetes education with the help of community health volunteers and some identified diabetic health champions. The community members will be given some questionnaires about diabetes to fill before and after every session. Their responses will be evaluated by comparing the initial responses and those after diabetes education to determine the effectiveness of the teaching. Also, two months after the completion of the teaching, a random section of the community will be selected for evaluation to determine the impact that the teaching in the community. It will involve distributing questionnaires to the selected community members and community and family health providers on the same. The responses will be computed and qualitatively analyzed.
How safety is a priority: While delivering diabetic teaching, safety will be a priority. Patients, who in this case, are African American community must always remain safe, so do healthcare providers who will be delivering the health education and other aspects of care. Safety impacts every aspect of health, particularly in this low socioeconomic community, where people engage in unsafe behaviors to earn a living (Jackson et al., 2019). The community will be made to understand that though they must survive, their safety comes first. Diabetes stems from risky and unsafe behaviors, which implies anything that will negatively impact health quality. They need to analyze the situation, the work, and their behaviors to ensure that they are safe enough before engaging in them. There are cultural practices that are accepted according to the norms but are unsafe. The community will be tactfully made to understand the impacts of such on their health and will be advised on safe cultures and practices.
Collaboration with other healthcare professionals: Public health nurses and other allied health providers such as family nurse practitioners, geriatric nurses, and family physicians are crucial professionals whose support is necessary to ensure health promotion and prevention of diabetes complications (Bancks et al., 2017). The diabetic teaching team will incorporate all these professionals during and after the delivery of diabetes health education. Firstly, the diabetic teaching team will collaborate with the public health officers to ensure that various community resources are available, and any needed resources are provided to promote wellness (Matsushita, Tang & Selvin, 2019). They will also be crucial at implementing and overseeing the implementation of health policies that aim to ensure a healthy culture in the community.
The identified community diabetic health champions and community health workers will liaise with the public health department to report any case on unethical practices that may negatively promote unhealthy lifestyles and practices in the community. Secondly, nurses and physicians at both family and community levels will help in diagnosing, referral, and provide first responses to community health concerns. They will work closely with the community leaders, champions, and community health volunteers to promote a healthy lifestyle and timely health care to individuals.
Conclusion: Health disparities among the African American community significantly impact their health, leads to risky behaviors and unhealthy lifestyles, exposing them to lifestyle-associated conditions such as diabetes. Limited access to health care and resources exacerbates diabetes cases among the African American community since it hinders timely diagnoses and initiation of care. Hence, proactive actions are necessary to curb the increasing prevalence of diabetes among African Americans and Americans at large, necessitating health equalities and equities across all races.