Contents
1.Introduction 3
2.Innate individual traits: age, sex, race and biological factors 3
3.Individual behaviour 4
4.Social, family and community networks 4
4.1 SOCIAL 4
4.2 FAMILY 4
4.3 COMMUNITY 5
5. Living and working conditions 5
6. Broad social, economic, health and environmental conditions and policies at the global, national, state and local levels 6
7. Conclusion 7
8. Reflection 8
8.1 Process 8
8.2 Strengths and Weaknesses 8
8.3 Challenges and Improvements 9
8.4 Conclusion 10
1. Introduction
Health is a particularly broad term, expanding much further than the individual. The ecological model of health is a structure that can be examined to identify the individual, social and communal factors that influence the health of a population. This report will apply the ecological model to diabetes mellitus, which can be classified into two primary subsets: type 1, and type 2.
This report will focus particularly on Type 2 diabetes mellitus (T2DM), a disease identified by hyperglycemia (abnormally high blood sugar) due to an inadequate production and response to insulin. The ecological model of health will be used to unpack the occurrence of Diabetes Mellitus within Australia (with particular interest given towards Indigenous communities), in order to provide a holistic understanding of the complexity of health.
2. Innate individual traits: age, sex, race and biological factors
There are certain unmodifiable factors that heavily influence weather or not a person is at risk of developing T2DM. These traits include one’s age, sex, race and a mix of biological factors. The prevalence of T2DM increases with age however, 14% of Australians over the age of 35 suffer from T2DM making this age bracket the most affected.
As shown in Figure 1, a greater percentage of males suffer from T2DM than females (4.9% to 3.8%). Additionally, Indigenous Australians are 3 times more likely to suffer from T2DM in comparison to their non-indigenous counterparts.
Genetics also play a part, despite the research involving this being currently undefined. It has been shown that around 20 separate regions of the human genome have some effect, with two particular regions – the Insulin Gene and the Human Leukocyte Antigen – being most influential. (Pociot, 2002).
There are no interventions to cure/prevent these innate traits, but instead need to be monitored. This can be done through the Australian Type 2 diabetes risk assessment tool (AUSDRISK), which determines the likeliness of developing T2DM in the next 5 years, with Indigenous Australians with high risk factor being eligible for free risk evaluations.
3. Individual behaviour
The behaviour of an individual is essential in preventing the onset of T2DM, as well as management once already developed. Lifestyle choices, such as exercise and diet, influence the health of an individual due to their role in the aetiology of the disease. The Diabetes Prevention Program Research Group (2002) conducted a research study that supports the hypothesis that T2DM can be prevented by lifestyle interventions. It was found that exercise reduced the incidence of T2DM by 58% in individuals that were at high risk. Furthermore, Tuomilehto et al. (2001) elucidates that improved diet choices result in the prevention or postponement of the onset of T2DM in high risk individuals. This is especially true in Indigenous populations as opposed to non-Indigenous populations.
Among Indigenous communities the prevalence of T2DM in remote geographical locations is 5% higher than those who live in the city (ABS, 2013). Azzopardi et al. (2012) states that Indigenous people with a family history of T2DM are also at a greater risk of developing T2DM due to poor lifestyle choices which are transgenerational. Additionally, Indigenous people of remote communities rely heavily on packaged foods and drinks which are high in fat and sugar content. Artificial foods make up a significant proportion of the dietary intake in remote communities due to limited access and high cost of fresh fruit and vegetables (Nguyen, Chitturi & Maple-Brown 2016).
4. Social, family and community networks
4.1 SOCIAL
Social networks refer to personal relationships, and can involve the promotion of certain health behaviour. In responding to such, individuals will generally adopt the lifestyles of their peers. Excessive weight gain is often a consequence of poor social networks, and is a key contributor of T2DM. Indigenous Australians (above age 15) were reported to have 37.0% of their population within the obese range within 2012-13, compared to 20.6% of the non-Indigenous population within the same bracket (ABS, 2013). Such discrepancies in weight can be attributed to social networks through the lack of nutritional and exercise advocacy in those groups.
4.2 FAMILY
Similarly, family networks provide the foundation for education relating to diabetes, whereby nutrition and exercise should be the major advocacies. However, such advocacies are not limited through a lack of motivation, but rather through financial sustainability, particularly in relation to adequate housing. Poor housing affects health both directly and indirectly, and is noted as a major contributor to the difference in life expectancy between Indigenous and non-Indigenous counterparts (Andersen, Williamson, Fernando, Redman and Vincent, 2016). Within Indigenous communities, overcrowding is a particular issue associated within family households, where participants within a study described the households as “communal”, struggling to cope with space, privacy and basic amenities, resulting in poor nutrition and exercise (Andersen et al. 2016).
4.3 COMMUNITY
Continually, community networks are an extension of social networks. Within major cities, 99% of the population are non-Indigenous, resulting in easier access to diabetes management services. Comparatively, 45% of the population within areas classed as rural are Indigenous, reducing access to services that assist with the prevention of diabetes (ABS, 2013). This is compounded by the fact that the proportion of Indigenous Australians with T2DM is highest in very remote regions, as shown in Figure 2.
Although there are management programs run by the Unity of First People of Australia (Australian Indigenous Wellness Program), these programs are only run in specific regions, thus having minimal impact on very remote regions. (Caritas Australia, 2018). In contrast, diabetes management services are more prevalent within metro areas, including Diabetes Clinics, multidisciplinary Diabetes Centres and the Inpatient Diabetes Service (O’Dea, Rowley, Brown, 2007).
5. Living and working conditions
Living and working conditions relate primarily to socioeconomic status (SES), which in turn is influenced by education and occupation. Indigenous Australians on average achieve lower in both those factors, consequently they are a higher risk group for the development of T2DM. The strains of lower SES may also eventuate to produce psychological stresses which in turn contribute to T2DM.
Educational attainment, and consequently employment, are proxies of SES, and
are important determinants of T2DM. Typically those who lie in a lower band of the educational standard will also exhibit higher incidence of T2
DM (Schillinger, Barton, Karter, Wang, & Adler, 2006). The achievement gap between Indigenous Australians and non-indigenous Australians is evidenced by NAPLAN results across all states and territories of Australia, including a 50 percentage point gap in Northern Territory (Ford, 2013). As education often determines the grade of employment, this is a contributing factor to the higher prevalence of T2DM amongst Indigenous Ausralians. In addition, those of lower income brackets are more exposed to obesogenic environments such as high-energy diets and inactivity (Connolly, Unwin, Sherriff, Bilous, & Kelly, 2000).
Occupation influences the level of job security, therefore, sense of stability. Psychological issues may arise such as depression, anxiety and tension, leading to further susceptibility to diabetes T2DM. Additionally, those of lower SES are more heavily affected by the burden of T2DM, as a greater proportion of their income will be utilised on therapies and management of the disease (Unwin, Whiting & Roglic, 2010).
6. Broad social, economic, health and environmental conditions and policies at the global, national, state and local levels
Broad social factors including socioeconomic status, access to healthcare and policies are all conditions which influence the incidence and treatment of diabetes. The Medicare Benefits Schedule (MBS) Health assessment has been a key policy in minimising such factors for the Indigenous community, particularly through increasing access to health care of Indigenous Australians. (Pink & Allbon, 2008). This has shown great success with increasing health checks for Indigenous Australians at all age levels, as shown in Figure 1.
On a local level, access to public health care is another significant factor in the prevalence of diabetes. The role of the National Aboriginal Community Controlled Health Organisation (NACCHO) is in management and treatment Indigenous Australians with T2DM in rural areas. Each program is tailored to the needs of a specific community and respects the desire to have those in their own community in patient management. By taking these considerations into account, the NACCHO has been shown to have better clinical outcomes in Aboriginal communities throughout north Western Australia (Stoneman, Atkinson, Davey, & Marley, 2014).
In targeting the broader Australian incidence of diabetes, The Australian Government has implemented several policies on a national scale, including the National Partnership Agreement on Preventative Health, with the goal of “reforming Australia’s efforts in preventing the lifestyle risks that cause chronic disease.” This involves educating Australians of the benefits of a healthy lifestyle, encouraging food suppliers to offer healthier options and attempting to embed healthy behaviours by managing smoking, nutrition, alcohol intake and physical activity (SNAP). (Harfield et al.)However, as seen through Figure 2, this has been largely unsuccessful as the broader incidence of diabetes in Australia has shown no noticeable downwards trend.
Moreover, Australians have not incorporated the healthy lifestyle this program had prioritised, as shown by the increase in overweight or obesity rate from 61.2% to 63.4% between 2007 and 2016. Whilst no causal relation can be established, it is evident that such national policies have been inadequate in addressing broad social factors pertaining to diabetes. (Li & McDermott)
As a result, the government launched the Australian National Diabetes Strategy 2016-2020 program in an attempt to prioritise the management of diabetes amongst all levels of government. This strategy emphasises the minimisation of factors contributing to Type 2 Diabetes whilst increasing the expenditure on its prevention. In 2017, the campaign Don’t Make Smokes Your Story was launched as part of this strategy, which targeted the Indigenous community to reduce smoking. This has been very successful, as follow-up reports suggest that 58% of Indigenous Australians with exposure to this strategy had made changes regarding their smoking within four months, including 9% suggesting they quit. (Australia, 2017)
7. Conclusion
It is clearly highlighted through an abundance of research that lifestyle choices, namely diet and exercise, are pivotal in the prevention and management of T2DM. However, some Indigenous people’s lifestyle choices are inhibited due to family or demographic constraints. Consequently, these constraints are primary contributors to the disproportionate rates of T2DM in Indigenous people in contrast to non-Indigenous people. The wider impacts of society, community and government must be taken into consideration when examining the pandemic that T2DM has become in Australian health. By exploring these factors a holistic approach to prevention and treatment of T2DM can be developed.
8. Reflection
8.1 Process
Within Scenario Group (2), we were advised to select particular topics which appealed to us. Diabetes, a particularly popular topic, was selected by four members. Members were noted to have selected the topic based off numerous reasons, which included personal experience and lack of knowledge concerning the disease.
Shortly after selecting our chosen topic, the group met together to develop a plan for the upcoming task. The group framed a timeline, which included the dates of future meetings, objectives of particular meetings and specific deadlines. After generating a scheme for our task, each member was allocated a particular area of the ecological model of health, with emphasis upon Indigenous Health. The group agreed to write the sections headed Introduction, Innate Individual Traits and Conclusion collectively, in order to ensure efficiency. Other major headings of the ecological model were allocated to group members based on preference, strengths and weaknesses. Subtopics were researched and compiled individually, before reporting back to the group.
Once particular subtopics were comprehensively researched and paragraphed, the group agreed to collate information in a fluid and coherent manner. We achieved this by allocating one person to proofread and edit the entire group’s work, as a means of attaining a cohesive report. Two other members also took turns editing the work, ensuring the report did not appear stagnated through differences in writing styles.
In our final group meeting, we began creating our PowerPoint for our report, and outlined the structure of presentation. Particular members of the group were recognised as adept presenters, and were given the role of leading the presentation. The other two members of the group were responsible for developing the PowerPoint, ensuring relevant information was included within the presentation in order to ensure audience engagement.
8.2 Strengths and Weaknesses
In completing our first group project of undergraduate medicine, there were obvious weaknesses that hindered our work. We determined that the timetable that had been generated in our first meeting was too inflexible, and did not reflect other priorities and commitments that members had. Although it was not entirely unrealistic, the plan had placed unwanted stress on members, and directed their attention away from earlier deadlines, including the individual assignment. Moreover, another weakness of the group included our limited research skills. Only one member had experience in using medical databases such as Medline and EMBASE, whereas others relied on experience from t
he individual assignment. Consequently, members found it difficult in locating relevant academ
ic articles, particularly whilst linking diabetes to the Indigenous population. As a result, individuals had to expand their searches beyond medical databases, which can limit reliability of research conducted.
In the contrary, the group had many strengths which allowed the project to be compiled effectively and efficiently. Firstly, the group communicated regularly throughout the task. Although social media dominated our group’s overall communication, we would meet informally after scenario group sessions in order to track each other’s progress. It is through such continual communication which allowed the group to develop collective goals, resulting in a functional and methodical process. Moreover, another strength of the group included comradery. Such friendship allowed critiquing the work of others to be uncomplicated and honest, only for the benefit of the group. Consequently, the group was able to continually advance and better the assignment, as members would continually assess the work of others in an impersonal and truthful manner. Additionally, the work ethic of the group was certainly a vital strength that assisted in the project. Members would often go above what was required of them in order to assist the work of others, simply for the success of the group. Overall, the strengths of the group ensured a constructive process, able to overcome limitations which were associated with the group’s weaknesses.
8.3 Challenges and Improvements
Along with any group tasks, there are always challenges which arise throughout the process. However, it is the response to such adversities which allow a group to succeed. In response to such, our group experienced particular obstacles throughout the project. Specifically, our group struggled to stick to the rigid plan we had originally developed, as two members lived lengthy distances away from campus. It was unsuitable and unfair to ask such members to travel an extended time to campus for a half hour meeting. In overcoming this, our group found alternative methods of tracking process and communication. Firstly, the group discussed specific goals upon social media outlets such as Facebook. In addition to such online communication, the group created a google document, in which the content of each member’s work could be traced. Methods of such allowed for communication and progress without extensive face-to-face contact, whilst maintaining a high standard.
Continually, another challenge the group dealt with involved the overlapping of information throughout the report. The group determined there were significant comparisons between the paragraphs Social, Family and Community Networks and Living and Working Conditions. The effect of repetition severely declined the quality of report, as areas did not flow coherently. In order to overcome this issue, group members took turns at undergoing the editing process in an attempt to remove repetitive material. This process was undertaken by all group members, to limit any subjectivity that could arise. In addition to this, we identified differences between writing styles of group members, which stagnated the report in certain areas. Some members of the group wrote in an evaluative and academic manner, in contrast to the analytical approach undertaken by other members. Although the editing process was a strategy to overcome this issue, the group rectified such differences through criticism of one another’s writing. As indicated within Strengths, the group experienced a deep sense of association with one another, with critique being received as impersonal, becoming beneficial for the group. Although conflicts occurred through such analysis, they were positive for the group’s success.
8.4 Conclusion
Overall, the group was extremely happy with their efforts regarding their first group task within undergraduate medicine. There were numerous challenges throughout the process, however, the group confided effectively by communication in order to overcome particular issues. The group project process was one of learning, in which we can utilise for our future studies within medicine.