Body

 NHPA that stands for the National Health Priorities Areas concentrates the attention of public and health policy upon such areas in the community that contributes most towards the increasing rates of disease, especially if it may be reduced. Diabetes is one of such identified areas. In this case, Rhonda who is 42 years female is suffering from diabetes. Her physical condition was not very good. She has become overweight and because of this she has to face many problems in the society. Nobody is her friend, people at her workplace called her cruel; she is all alone, her mother died when she was 22. Her mother also had diabetes.  In this report, the role of a nurse in primary health care will be discussed. How health professions can develop their capacity for empathy and understanding of the lived experience of Vulnerable Population Groups will be discussed. In this report role of a primary healthcare nurse in educating the society about the health equity will be discussed.

A person is said to be diabetic when the glucose level in the blood is increased because of the deficiency or resistance of insulin in the body. According to NHPA it is on number seventh among the leading cause of death in Australia. It can lead to many other complications such as stroke, heart disease and kidney failure. In the given case, Rhonda is also suffering from diabetes. She is only 42 and overweight; she works in a company where nobody talks to her. Her diabetic nurse put her on a low calorie diet only 500 calorie a day. She is advised by her nurse to exercise daily 30 minutes but the atmosphere where she lives is not favorable for her to do exercise or to go for a walk. People call her cruel due to her physical appearance and she is very upset and hurt by the people behavior towards her. The cases of diabetes are rising day by day across the world. According to the WHO, in the year 2025 there will be more than 200 million diabetic patients in the world. There are generally two types of diabetes, type 1 and type 2 but gestational diabetes is also prevalence in Australia and other countries. Premature mortality is very common in people having diabetes. Diabetes mortality rate is higher in females than males. The main cause of death in people with diabetes is the cardiovascular diseases which occur as the long term complication of diabetes. Diabetes contributes more to the burden of other diseases. High blood pressure, high cholesterol and obesity are often found associated with diabetes. Mental healths of the people are greatly affected due to the presence of symptoms of diabetes and the behavior of other people towards the patient.

Diabetes Mellitus

There are many risk factors for diabetes including genetic and environmental factors. For type 1 diabetes, if one member in the family is having diabetes then other member are at higher risk of having diabetes because of the presence of the genetic components. There are some environmental factors responsible for the destruction of ß cells. The children who are fed with cow’s milk instead of mother’s milk are more prone to develop Type 1 diabetes. Type 2 diabetes occurs due to inability to produce insulin. Insulin maintains the glucose level in the body and is produced by the ß cells of the pancreas. Insulin resistance is the important risk factor of type 2 diabetes. Genetic component is also the main risk factor for this diabetes. Other risk factors include obesity, physical inactivity, diet and age. 

Diabetes has long-term consequences as it can lead to many complications including cardiovascular diseases, macrovascular and microvascular complications. The people having diabetes are at a higher risk of getting cardiovascular diseases like heart attack, strokes and blood vessel diseases. Microvascular complications include nephropathy which is a major complication associated with diabetes in which protein is detected in the urine. This is more common in the people with long duration of diabetes. Diabetic nephropathy can develop and results in to renal disease which then requires dialysis or kidney transplantation for the survival. Diabetes can also lead to the eye related problems like retinopathy in which loss of vision is the main problem. The blood vessels in the retina are damaged but can be treated by laser therapy. Glaucoma and cataracts are also two eyes problems that can lead to loss of vision. Diabetic patients are more prone to eye complications. Neuropathy include damage to nerves is another complication of diabetes. In this, the nerves that control and coordinate the body functions like sensory and motor nerves are damaged. Other than the physical complications social and emotional consequences are also there in the diabetic patients.

Rhonda, a 42 years old female is suffering from diabetes, she is overweight. Her nurse has put her on a very low calorie diet and told her to exercise at least 30 minutes a day. Her condition is deteriorating day by day as she didn’t have any time left for doing exercise. Her nurse warned her that if she will not follow what is advised to her than she might have to take insulin for treating and managing her diabetes. Her mother has also died because of diabetes. Rhonda is experiencing not only physical harm to her body due to diabetes but also mentally and socially. She is very hurt by the behavior of people towards her at her work place. Nobody is her friend and nobody supports her to deal her with her disease. She might suffer from the depression because of this unsupported behavior of the people in the community. Such behavior of the people needs to be changed. For this, various educational sessions are organized by the primary healthcare nurses to educate the people how to behave and provide support to the people suffering from any kind of disease.  

Risk-Factors

Social determinants of health are those non-medical factors which influences the outcomes of the health. These are the environment where people are born, grown up, live and work. These factors play an important role in the health inequities. In this case, Rhonda faces many problems since her childhood. Her mother was diabetic and her father didn’t support her in any manner. Rhonda’s childhood spend in stress. She never had a peaceful and happy environment. When she grew up she didn’t have any social group. When her mother died, she was only 22, her father left her and she remained alone. As a genetic factor, she also acquired diabetes. At her work place also, she didn’t have any friends. People call her ugly, cruel and bad. Such behavior affects the mental health along with her physical health. Socioeconomic factors affects the health, lower socioeconomic position lower the health. Children who grow up in socioeconomically stressed environment face many physical challenges, they often experience psychological and emotional stress such as conflicts among parents and family members. In this case, Rhonda’s parents share an unhealthy relation that affects the upbringing of Rhonda. Also, improper food habits and lack of proper resources affect the physical and social health of a person.

After justifying the need for an education session, it was conducted with Rhonda and her physical and social conditions were discussed.

Me: Where do you live?

Rhonda: I live in Australia.

Me: What is your ethnic or cultural background?

Rhonda: I have grown up in a stressed environment. My mother was also diabetic.

Me: What is your age?

Rhonda: I am 42 years old.

Me: What physical problems are you facing presently?

Rhonda: I am obese and diabetic. My nurse has put me on a very low calorie diet and asked me to do exercise otherwise I have to take insulin.

Me: What are the impacts of these physical conditions on your lifestyle and well-being?

Rhonda: Due to my physical conditions people keep distance to me, they call me bad, cruel. I don’t have any friends and not any social life.

Me: What is your story?

Rhonda: My mother was also diabetic and she died when I was 22. My father never cares for us. I have grown up in a very stressful environment. There was no peace in my life.

Me: Do you work?

Rhonda: Yes, I work in an office.

Me: How is your financial status?

Long-Term Consequences of the Condition

Rhonda: I work and earn money for my survival. I need support from the people emotionally.

Conclusion

This report concludes that Social determinants of health have a major impact on the physical and social as well as economical condition of people. In this report, the selected NHPA is diabetes which is the leading cause of death in Australia. This report explains the physical and mental health of a 42 years old lady Rhonda, who is suffering from diabetes and face many socioeconomic challenges in her life. This report contains the risk factors for developing the health condition of Rhonda. Long-term consequences of diabetes including cardiovascular diseases, eye related problems and kidney failures are discussed. Various health issues and risks related to Rhonda is discussed. Many social determinants are responsible for the physical health conditions of the people that are included in this report. It is very important to educate the people about the community behavior that they should follow with the people suffering from any kind of disease. As a primary healthcare nurse it is very important to take educational session of the people associated with such behavior. Social and genetic causes of the diseases are mutually connected. It is very important to understand them and try to remove or reduced them so that health conditions of people can be improved. Primary health care generally have three components including meeting with peoples, addressing social determinants of their health, educating the people, community and the family to improve the health conditions.

References

Alonaizi, M., Al Sarraf, A., Rao, M., & Kilarkaje, N. (2020). Determining the long term consequences of diabetes on hippocampal function. The FASEB Journal, 34(S1), 1-1. https://doi.org/10.1096/fasebj.2020.34.s1.09401

Castricum, A., Inge, P., Goulding, L., Perera, N., & Orchard, J. (2018). Exercise as medicine–Evidence for prescribing exercise for Australia’s nine national health priority areas: An umbrella review. Journal of Science and Medicine in Sport, 21, S5-S6.

DOI:https://doi.org/10.1016/j.jsams.2018.09.016

Castrucci, B., & Auerbach, J. (2019). Meeting individual social needs falls short of addressing social determinants of health. Health Affairs Blog, 10. 10.1377/forefront.20190115.234942

Davis, W. A., Peters, K. E., Makepeace, A., Griffiths, S., Bundell, C., Grant, S. F., … & Davis, T. M. (2018). Prevalence of diabetes in Australia: insights from the Fremantle Diabetes Study Phase II. Internal medicine journal, 48(7), 803-809.https://doi.org/10.1111/imj.13792

Donkin, A., Goldblatt, P., Allen, J., Nathanson, V., & Marmot, M. (2018). Global action on the social determinants of health. BMJ global health, 3(Suppl 1), e000603.

Farahvar, S., Walfisch, A., & Sheiner, E. (2019). Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review. Expert review of endocrinology & metabolism, 14(1), 63-74.https://doi.org/10.1080/17446651.2018.1476135

Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., … & Haire-Joshu, D. (2021). Social determinants of health and diabetes: a scientific review. Diabetes Care, 44(1), 258-279. https://doi.org/10.2337/dci20-0053

Khaledi, M., Haghighatdoost, F., Feizi, A., & Aminorroaya, A. (2019). The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta diabetologica, 56(6), 631-650. https://doi.org/10.1007/s00592-019-01295-9

Kulzer, B. (2022). Physical and psychological long-term consequences of diabetes mellitus. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. DOI: 10.1007/s00103-022-03517-y 

Lau, L. H., Lew, J., Borschmann, K., Thijs, V., & Ekinci, E. I. (2019). Prevalence of diabetes and its effects on stroke outcomes: a meta?analysis and literature review. Journal of diabetes investigation, 10(3), 780-792. https://doi.org/10.1111/jdi.12932

Mobasseri, M., Shirmohammadi, M., Amiri, T., Vahed, N., Fard, H. H., & Ghojazadeh, M. (2020). Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health promotion perspectives, 10(2), 98. doi: 10.34172/hpp.2020.18

Nanayakkara, N., Ranasinha, S., Gadowski, A. M., Davis, W. A., Flack, J. R., Wischer, N., … & Zoungas, S. (2018). Age-related differences in glycaemic control, cardiovascular disease risk factors and treatment in patients with type 2 diabetes: a cross-sectional study from the Australian National Diabetes Audit. BMJ open, 8(8), e020677.

Nguyen, B., Bauman, A., & Ding, D. (2019). Association between lifestyle risk factors and incident hypertension among middle-aged and older Australians. Preventive medicine, 118, 73-80. https://doi.org/10.1016/j.ypmed.201

Pease, A., Earnest, A., Ranasinha, S., Nanayakkara, N., Liew, D., Wischer, N., … & Zoungas, S. (2018). Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA). Cardiovascular diabetology, 17(1), 1-12.  https://doi.org/10.1186/s12933-018-0726-8

Wan, C. S., Abell, S., Aroni, R., Nankervis, A., Boyle, J., & Teede, H. (2019). Ethnic differences in prevalence, risk factors, and perinatal outcomes of gestational diabetes mellitus: a comparison between immigrant ethnic Chinese women and Australian?born Caucasian women in Australia. Journal of Diabetes, 11(10), 809-817. https://doi.org/10.1111/1753-0407.12909