The United States is a culturally diverse country
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. However, health disparities among the minority population remain a crucial factor that exposes these 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 disparities as one of its national health objectives. Socioeconomic status such as income and employment, lifestyle, education, culture, health literacy, and access to preventive and excellent care, among other factors, plays a crucial role in health disparities among this minority group. The low level of education among African Americans is correlated with the increased prevalence of obesity, physical inactivity, and smoking, and other risky behaviors and practices among African Americans, which negatively impact their health leading to diabetes and other cardiovascular conditions. Besides, lack of familiarity with the United States healthcare system within the African Americans community poses a significant barrier to accessing appropriate, safe, and quality health care hindering timely diagnoses and early initiation of diabetic management. Apart from the stated factors, there are significant inequalities and inequities in how health care is delivered and financed in the United States, which drive to racial and ethnic health disparities. Unequal access to health care and treatment of people based on their cultural backgrounds and physical attributes plays a pivotal role in promoting health racial and ethnic health disparities in the United States health care and health status. Eliminating health disparities within the African American population necessitates equal access and financing to health care and establishing culturally suitable and honest ways to solve certain health needs of African Americans.
One of the chronic diseases that is attributed to racial health disparities 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 non-Hispanic white adults. Diabetes is a lifestyle condition that people get as a result of an unhealthy lifestyle and preexisting health conditions such as hypertension. African Americans are susceptible to diabetes because of the kind of lifestyle that most of the lives and the lack of information regarding the disease process. Most African Americans engage in risky behaviors, practices, and lifestyles, such as physical inactivity, unhealthy diets, and works that impact their health significantly, exposing them to cardiovascular conditions such as hypertension and ultimately leading to diabetes. 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 commodities. Since they cannot access timely health care, most of the diabetic cases go undiagnosed until they exacerbate to worse cases due to the asymptomatic nature of diabetes.
One of the nursing diagnoses in the case of diabetes is the deficient knowledge of diabetes (it risk factors, pharmacological and non-pharmacological management, signs and symptoms, 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. It helps prevents preventable diseases and promote health. 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 result 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.
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. In women, for instance, diabetes may eliminate the protection that they often experience against coronary heart diseases. This is because hyperglycemia and hyperinsulinemia, which come with diabetes, undermine estrogen’s protective effect. 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 white to be hospitalized due to diabetes. 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 biological, neighborhood, psychological, socioeconomic, and behavioral factors among African Americans to diabetes. The study confirms that biological risk factors attributed to lifestyle, and preexisting 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. 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.
Health disparities of African Americans community date back to the period of slavery in what is now known as the United States of America. 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. 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. Thes 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.
According to the United States Census Bureaus, about 41.4 million Americans were black. African Americans comprise the second majority of the American minority population, with most of them leaving in the southern part of the United States. 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 representing about fifty-eight percent of the whole black community. Eighty-six percent of the African Americans above twenty-five years had at least a high diploma, and twenty-one percent had a bachelor’s degree or higher in 2017. Also, more black women had a bachelor’s degree compared to black men. 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.
Socioeconomic status significantly affects health care access, delivery, and health of the subjects. 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. Individuals from low socioeconomic families report worse health, diabetic management outcome, prolonged recovery, have a lower life expectancy, and often suffer from numerous chronic diseases, which exacerbates quickly due to lack of timely care compared to those from higher socioeconomic status. Office of majority 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
Diabetes, as stated earlier, is a lifestyle-associated condition in most cases. This means that a healthy lifestyle may be effective at preventing suffering from diabetes or its exacerbations. 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 impact 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 increases, will increase their life expectancy and quality while promoting their health. 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.
Additionally, it will help them create community groups which they can use to encourage one another, 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.
The teaching will be divided into four sessions (each taking two days) according to the goals 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. The nurses will deliver diabetes education with the help of community health volunteers and some identified diabetic 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 some community members and community healthcare and family health providers on the same. The responses will be computed and qualitatively analyzed.
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 to the community. Safety impact every aspect of health, particularly in this low socioeconomic community, where people engage in unsafe behaviors to earn a living. 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, 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.
Public health nurses and other allied health providers such as family nurse practitioners, geriatric nurses, family physicians are crucial professionals whose support is necessary to ensure health promotion and prevention of diabetes complications. 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. 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 practice that may negatively promote an unhealthy lifestyle against the set health policies. Nurses and physicians at both family and community levels will help in diagnosing, referral, and first response 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.