Running head: HEALTH IMPACT FRAMEWORK 1

Global burden of diabetes

Nayith Enciso

Delaware Technical Community College

NUR 310

Dr Kelly Davis

04/26/2019
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Abstract

In this manuscript we will explore the global burden of diabetes, which is a disease that is

consider a public health crisis that affects the economies of all nations ( ADA, August, 2013).

Diabetes is no longer consider a disease of wealthy countries. Diabetes continues to rise

specially in middle and developing countries ( WHO, 2016 ).

We will be incorporating the Health Impact Pyramid framework which is consider a

framework for public health action ( Frieden, 2010 ), to this disease and explore various

interventions and examine how the population is impacted. the Health Impact Pyramid

Framework is divided into five levels where as the top of the pyramid is design to help the

individual, and interventions at the bottom of the pyramid are designed to help entire

populations.
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Diabetes as global health problem

Diabetes is a disease that has steadily increase to the point where there is a worldwide

pandemic. According to the World Health Organization’s global report on diabetes indicates that

the number of people over 18 years of age living with diabetes has quadruple since 1980 to 422

million adults. This increase had been attributed to the increase in type 2 diabetes and factors like

sedentary life style, fast urbanization, obesity and overweight. Diabetes complications can lead

to heart attacks, stroke, blindness kidney failure and lower limb amputation. Diabetes is no

longer consider a disease of wealthy countries, this disease continues to rise specially in middle

and developing countries (WHO, 2016 )

Globally diabetes accounts for approximately 12% of the health expenditures in 2010 or

376 billion and it is expected to increase to 430 billion in 2030. The increasing prevalence and

associated health implications threaten to reverse economic gains in developing countries. With

limited infrastructures and diabetic care, many countries are not equipped to manage this

epidemic ( NCBI, March, 2010 ).

Worldwide burden of diabetes

The number of people with diabetes has risen from 108 million in 1980 to 422 million in

2014. The global prevalence of diabetes among adults over 18 years of age has increased from

4.7% in 1980 to 8.5% in 2014. The number of cases of diabetes has been rising more rapidly in

middle and low income countries ( WHO, 2016 )

An estimated 1.6 million deaths were linked directly to diabetes, and another 2.2 million

deaths in 2012 were attributed to high glucose levels in the blood. Almost half of all deaths
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attributable to diabetes occurred before the age of 70 years. The World Health Organization

considers this to be the seventh leading cause of death in 2016.

It is consider that based on YLL (years of life lost) diabetes has risen from twenty-

seventh place to nineteenth place on the list of conditions causing the most disability. Among the

causes of YLL, in males, diabetes is ranked at twenty-second rank for the world and eighteenth

rank for South Asia. Disability adjusted life years (DALY) are computed as a sum of YLL and

YLD (years, of life lived with disability. They represent a more accurate marker of disability due

to any disease. Diabetes is the fourteenth largest caused DALYs worldwide (NCBI, November

2014).

The health impact pyramid

The Health Impact Pyramid is a five tear graphical representation that depicts the

potential impact of different types of public health interventions, and it provides a framework to

improve health. Efforts to address socioeconomic determinants are at the base, which tend to be

more effective because they reach broader segments of society and require less individual effort.

Interventions at each of the levels of the pyramid can achieve the maximum possible sustained

public health benefit (Frieden, 2010). Followed by the next tear which is labeled “changing the

context to encourage healthy decisions” and it is designed to make healthy options the default.

Next is “long lasting protective interventions”in this level has less impact than the last two,

because it require the individual to attain those interventions. The next level “clinical

interventions”this level represents ongoing clinical interventions this could be hinder by a lack of

medical access.the fifth tear is “counseling and educational interventions, and it represents health

education provided during clinical visits.

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Socioeconomic factors

The socially and economically disadvantaged are at an elevated risk of diabetes. Forty

percent of the adults with diabetes have less than a high school education, inequalities in health

care or the lack of access have been attributed to risk factors for diabetes. This include poor

nutrition, overweight, particularly in the developing countries where basic healthcare systems are

fragile.

Here in our country The US Department of Health and Human Services has develop an

initiative called “Eliminating Racial and Ethnic Disparities in Health” which parallels Healthy

People 2020, the nation’s health goal for the next decade. The initiative focuses in areas of health

disparity that are known to affect racial and ethnically diverse groups of the population and at the

same time hold the promise of improvement; According to the World Health Organization the

initiatives like, WHO None Communicable Disease (NCD) Global Action plan as well as the

Sustainable Development Goals, the United Nations Political Declaration on NCDs has

guidelines that most countries bowed to follow and address diabetes.

Cultural factors

Culture is an important determinant of health. It is related to health behaviors, their

perception of illness, and the extend to which they use health services and forms of medicine that

they have practice traditionally (Skolnik, 2016, p 165). For example some people in Mexico and

Puerto Rico their belief is that diabetes is caused by eating too much sugary foods, and also that

God is punishing them for eating too many sweets.

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Changing the context

How do one change the context in order to encourage healthy decisions and one way to

do it would be to engage in community mobilization in this case, the efforts are focuses on

getting an entire community to engage in the effort of promoting more healthy behaviors.

Mass media could be another alternative, most people in low and middle income

countries to radio, which is often used for this purpose (Skolnik, 2016, p 154).

Long lasting protective interventions

Governments and concert with the private sector, need to set policies that promote

healthy nutritional and agricultural policies, favor modifications in the environment that

encourages weight loss, physical activity and make prevention affordable for all citizens at a high

risk (NCBI, 2015)

Clinical interventions

The fourth level of the piracy represents ongoing clinical interventions in which the focus

is on prevention of diabetes, A1c testing and reporting, medication adherence and personalized

behavioral interventions . Although evidence base clinical care can reduce disability and prolong

life, the combination of these interventions is limited by lack of access specially in countries that

don’t have universal healthcare coverage or uninsured (NCBI, 2015).

Counseling and education

The pyramid’s fifth tear represents education provided during clinical encounters and

other settings, in this stage one can enroll in diabetes education programs and services, meal plan

services and glucose problem solving, bringing their blood glucose logs and discuss the diabetes

control concerns in a group setting or on a one to one bases, or enroll in diabetes prevention
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programs and have a diabetes support group. During this level of the pyramid takes the most

effort and dedication on the part of the patient (Frieden, 2010).

Professional opportunities in global health

Nurses could ply a significant role on educating the public, or by assisting with the

development and promotion and management of public health initiatives, placing emphasis on

prevention and basic health education to help communities reduce disease. Initiatives such as

proper hand washing, collaborate with local health departments and other organizations to

provide health education (ANA, 2012).

Future recommendations to address the GBD of diabetes

One of my recommendations would be to place emphasis and resources on prevention

such as healthy body weight, proper diet, regular exercise and for those that have diabetes access

to health care should be affordable, lower prices for diabetic medications.

As per The World Health Organization. They have six recommendations.

Accord greater priority to NCD prevention and control including diabetes, strengthen

national capacity to accelerate country response, create, sustain and expand health-promoting

environment to reduce modifiable risk factors, strengthen and orient health systems to address

diabetes, promote high quality research and development, monitor trends and determinants, and

evaluate progress (WHO, 2016).

As the prevalence and number of people with diabetes continues to increase, so will the

already large health economic impacts of diabetes. This burden could be reduced through

effective actions. With sufficient life long management and regular follow up, people with all

types of diabetes ca live longer and healthier lives. The occurrence of type2 diabetes can be

reduced through population based and individual prevention measures that target key risk factors.
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Dealing with diabetes and controlling is integral to the success of the overall response to

NCDs. In most countries, commitments made through the Sustainable Development Goals to

reduce premature NCD mortality by a third by 2030, and achieve universal health coverage will

require attention on diabetes prevention and management.

Guidance for effective diabetes prevention and control is set out in the WHO Global

action plan for the prevention and control of NCDs 2013-2020 (WHO NCD Global ActionPlan)

( WHO, 2016).
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References

ADA, August, 2013 diabetes care. Retrieved from

Htpps://doi.org/10.2337/dc13-1161

American Nurses Association, 2012 Evolving Public Health Nursing Roles. Retrieved

from

Https://www.ojin.nursingworld.org/evolvingpoblichealthnursingrole/vol12/2012-no2

Frieden Thomas, R April, 2010. A Framework for Public Health Action: The Health

Impact Pyramid. Are tiered from

Https://www.ncbi.nih.gov/-Mc/articles/pmc2836340/?report=classic

NCBI, March, 2010 Global Healthcare Expenditure on Diabetes for 2010 and 2030

Retrieved from

Https:/www.ncbi.nih.gov/pub Ed/20171754

NCBI, World burden of diabetes November, 2014. Retrieved from.

Https:/www.ncbi.nim.gov/-Mc/articles/pmc4192997/

NCBI, 2015 Diabetes prevention global health policy and perspective from the ground

Retrieved from

Https://www.ncbi.nlm.nih.gov/-Mc/articles/pmc4556601

World Health Organization, 2016 Global report on diabetes. Retrieved from

Https:/www.who.int/diabetes/global-report/en/
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