Health promotion is more pertinent to our society today than ever as it seeks to address various public health issues. The expression “health promotion” was coined by Henry E. Sigerist, a prominent medical historian, in 1945 (Pelicand, Fournier, Le, & Aujoulat, 2015). Henry outlined four primary duties of medicine; they include illness prevention, rehabilitation, promotion of health, and patient treatment. He claimed that health promotion incorporates aspects such as the provision of decent living standards, good working conditions, physical culture, education, recreation and rest, and the coordinated efforts physicians, educators, industries, and statesmen. Health is largely impacted by factors outside the health sector domain that determine the circumstances in which individuals live, grow, age, and work; these factors include political, economic, and social aspects (Pelicand et al ., 2015). The attainment of high health standards is, therefore, dependent upon a holistic and comprehensive approach which integrates aspects such as community involvement, and the involvement of health providers and various stakeholders.
The Prevalence of Diabetes Mellitus in the United States
Demographics
According to the 2010 estimates, ten million Americans amid the ages of sixty-five and more were diagnosed with diabetes. Pre-diabetes prevalence derived from the results of hemoglobin or fasting glucose A1c testing among this demographic was significantly higher in 2010 than in 2008 by approximately fifty percent (Ries, 2018). The results indicate that around eight in ten older American adults have some dysglycemia. A country-wide survey data revealed that the prevalence of diagnosed diabetes amid individuals amid the ages of sixty-five and seventy-nine years increased by sixty-five percent from the year 1997 to 2003. During the year 2010, there were approximately 390,000 new cases of diabetes diagnosis among individuals aged sixty-five years and more (Pelicand et al., 2015). Amid the year 1980 and 2004, the approximated number of Medicare beneficiaries diagnosed with diabetes increased from two million to approximately 5.8 million. During this period, diabetes accounted for roughly thirty-two percent of Medicare spending. In 2016, the incidence of diagnosed Type 2 Diabetes (T2D) in the U.S was estimated at 8.6 percent (21.0 million adults). The incidence of diagnosed T1D was estimated at 0.55 percent (1.3 million) U.S adults during the same year. Non-Hispanic White adults recorded a higher incidence of diagnosed Type 1 Diabetes (T1D) than Hispanic adults According to Morbidity and Mortality Weekly Reports, non-Hispanic blacks recorded the highest incidence of diagnosed T2D (11.52 percent). The prevalence of diagnosed T2D among non-Hispanic Asians (6.89 percent) was significantly lower compared to non-Hispanic Whites (7.99 percent) and Hispanics (9.07 percent). 8.5 percent of adults aged eighteen years and above were diagnosed with diabetes. During the year 2016, the prevalence of T1D was higher among males (0.64 percent) than among females (0.46 percent). Adults aged between sixty-five years and above recorded the highest prevalence of T1D (Pelicand et al., 2015).
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Socioeconomics
The latest statistics from the NHIS (National Health Interview Survey) for 2011 to 2014 and 1999 to 2002 reveal that socio-economic disparities in diagnosed diabetes prevalence among adults in the U.S are widening through time (Yildiz &Kavuran, 2018). Factors such as low income and limited education often drive these disparities and lessen the efficacy of interventions in reducing the prevalence of T2D in various ethnic groupings. People of color often face higher rates of cancer, heart disease, stroke, obesity, and diabetes than Whites. The risk of diabetes diagnosis among African-Americans in the U.S is significantly higher (seventy-four percent) than among Whites. The risk of diabetes diagnosis among Hispanics is sixty-six percent higher than among the Whites. In addition to high rates of chronic disorders, inadequate insurance coverage and low wages among non-whites greatly limit their ability to access treatment. Due to inflation, stipend by middle-income earners and the poor in the U.S have declined over the years, and since non-whites are disproportionately represented among low-income earners, there is a significant wealth gap amid ethnically and racially diverse households (Yildiz &Kavuran, 2018). For instance, during the year 2017, the percentage of uninsured Hispanics, African-Americans, American-Indians, Asian-Americans, and Alaska natives was significantly higher than the uninsured White Americans.
Environmental Hazards
Environmental attributes are hypothesized to increase the exposure to T2D risk factors by constraining or enhancing physical, psychosocial, and behavioral stressors. The social and physical environment can influence behaviors and choices. The proximity and accessibility to recreational resources, open spaces, green spaces, walkable destinations, and well-designed public places may encourage social interaction and physical activity. Individuals residing in walkable environments are likely to exercise more, thereby, reducing obesity risks. Additionally, having shopping centers around one’s residential place may also encourage the consumption of healthy food and the access to local amenities, physical activity, and social activities. Social disorders, crime, and unsafe neighborhood may encourage fear and social isolation and impede physical activity. Social activities may be impeded in sprawling regions due to the increased reliance on cars. The accessibility to community resources, social support, and the establishment of constructive social norms through social networks and interactions can enable healthy behaviors and choices (Yildiz & Kavuran, 2018). Air pollution often changes the endothelial functioning, trigger insulin resistance, and trigger inflammation and it leads to high risks of hypertension. Road traffic noise and air pollution may significantly impact the levels of blood lipid, which may, in turn, influence the risk of T2D and blood pressure.
Access to healthcare
During the year 2015, approximately 15.4 percent (47 million) of the U.S population lacked health insurance coverage, and amid January and September 2015, the estimated value increased to around 50 million (Ries, 2018). Health care access, for instance, insurance coverage, plays a significant role in preventive services. Insufficient insurance coverage and the lack of medical insurance coverage are associated with the decreased use of preventive services. Additionally, the lack of adequate physicians acts as a barrier to the control of non-communicable diseases such as hypertension. The lack of medical insurance has also been associated with the increased risk of general health decline amid late-middle-aged adults. Diabetes control and preventive care practices may prevent or delay diabetes complications. Uninsured patients with diabetes are less likely to get the needed care and to efficiently manage the disorder than those who are insured (Ries, 2018).
Morbidity and Mortality Risk Factors
Cardiovascular Diseases
Diabetes fastens the atherosclerotic activity, and it increases cardiovascular disease risks, and therefore, it is highly prevalent amid older adults with a long history of diabetes. A 2010 self-reported survey data revealed that forty percent of diabetic patients in the U.S amid the ages of 65 and 74 had CVD, 9.1 percent had suffered a stroke, and 26.8 percent had coronary heart disease (Yildiz & Kavuran, 2018). Various cohort studies revealed that CVD prevalence was significantly higher amid older Americans who’ve been newly diagnosed with diabetes than among non-diabetic peers.
Diabetic Retinopathy
During the year 2016, the estimated incidence of diabetic retinopathy amid diabetic Americans aged amid sixty-five years and more was 29.5 percent (Pelican et al., 2015). The incidence of vision-threatening diabetic retinopathy was estimated at 5.1 percent. The estimates of age-standardized incidence for diabetic retinopathy have significantly increased since the year 1998; these rates are predicted to replicate amid Americans aged between forty years and more by the year 2050. Diabetes may increase the risk of cataracts among older adults which impacts fifty-million Americans amid the ages of sixty-five and more. Diabetes may increase the threat of primary open-angle glaucoma amid individuals of the female gender (Pelican et al., 2015).
Neuropathies
Peripheral neuropathy is a large grouping of disabling motor and sensory nerve malformations that are prevalent amid older individuals and patients with diabetes mellitus. Peripheral sensory neuropathy is a widely recognized form of neuropathy among diabetic individuals. Among older patients with diabetes, PSN has been correlated with impairments in gait, balance, increased prevalence of recurrent fractures and falls, and the manifestation of low-extremity peripheral artery disorder (Yildiz & Kavuran, 2018). PSN contributes to non-traumatic amputations, deformity, and low-extremity ulceration.
Chronic Kidney Disease
Significant micro-vascular complications of diabetes which affect the eyes and kidneys impose considerable burdens on individuals. Older patients with diabetes are at a high-risk exposure to chronic kidney disease. Amid the year 1999 and 2010, the estimated incidence of CKD among American adults aged between sixty years and more was significantly higher amid those with diabetes (fifty-eight percent) than amid those without diabetes (forty-one percent) (Ries, 2018). Early phases of CKD may lead to disability, frailty, decreased cognitive and physical function, and ESRD (end-stage renal disorder).
Health Promotion Activity
Health promotion programs for the elderly often have three basic objectives: increasing and maintaining functional capacity, improving or maintaining self-care, and promoting one’s social network. The purpose behind these strategies is to promote a longer self-sufficient, and independent quality of life. Behavioral modification through therapeutic alliance is an example of an effective health promotion activity for cardiovascular diseases. Examples of behavioral modification activities aimed at promoting one’s health include physical activity, consumption of a healthy diet, and avoiding smoking and alcohol consumption. A health promotion activity for diabetic retinopathy is health education aimed at promoting health screening practices. Health screening incorporates the application of tests on individuals who are not exhibiting the symptoms of a particular disorder and the categorization of patients based on the likelihood of suffering from a specific disorder (Ries, 2018). A health promotion strategy for chronic kidney failure is the implementation of a CKD surveillance initiative aimed at tracking the national prevalence of the disorder, risk factors, evaluating quality improvement strategies, and care practices that impact CKD control and prevention. An effective health promotion activity for neuropathies is the implementation of health education aimed at providing an up-to-date information regarding complex regimens associated with non-pharmacologic and pharmacologic strategies since these patients often need guidance and support to help them master the coping skill and self-management required to reduce pain flares while optimizing functioning and mood (Ries, 2018).
In conclusion, health promotion often seeks to empower communities and individuals to implement actions that promote their health, promote public health leadership, foster the institution of effective public health policies, and the establishment of sustainable health systems within the society. Diabetes mellitus is associated with various health risk factors which include cardiovascular diseases, diabetic retinopathy, neuropathy, and chronic kidney disorder. Health promotion activities often aid in increasing and maintaining functional capacity, improving or maintaining self-care, and promoting one’s social network.
References
Pelicand, J., Fournier, C., Le Rhun, A., & Aujoulat, I. (2015). Self-care support in pediatric patients with type 1 diabetes: bridging the gap between patient education and health promotion? A review. Health Expectations , 18(3), 303-311.
Ries, E. (2018). Community Health Promotion: Reaching Beyond the Clinic. PT In Motion , 16-23.
Yildiz, E., & Kavuran, E. (2018). The validity and reliability of the type 2 diabetes and health promotion scale Turkish version: a methodological study. Scandinavian Journal of Caring Sciences , 32(1), 417-421.
