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“What you don’t know can kill you ” or “There are dangerous obstacles on our journey” Lillian Tom-Orme, Ph.D., MPH, RN, FAAN Research Assistant Professor Health Research Center/DFPM University of Utah
Diabetes (DM) Problem • DID YOU KNOW? • Affects at least 18 million Americans; 1/3-1/2 do not know they have DM • >90% of those with DM have type 2 DM • 5th deadliest disease in the U.S. • 16 million have pre-diabetes • Has no cure but can be prevented • 1 of every 10 health care $ spent on DM on the U.S. • “Minority” populations have highest rates of type 2 DM; represent the majority of children with DM
Ethnic Populations & Type 2 Diabetes • DID YOU KNOW? • AI/AN have DM rate >2-5X White rate • AI/AN have 2.5-6X the rate of ESRD • AI kids obesity rates 2X that of others • Akimel O’odham have highest rate in the world • African-Americans have >4X the rate of ESRD • At least 25% of AA & Mexican-Am women are overweight (BMI >25) • Hispanics/Latinos are 2X likely to die from DM • DM-related amputations are 3-4X higher in AIs
DM-related complications • DID YOU KNOW? • Vessel/nerves damage: eyes (blindness), nerves, kidneys lower extremity amputations, stroke, coronary heart disease, infections, periodontal disease • High risk pregnancy –congenital malformations, delivery complications • Those with DM are 2-5X more likely to develop CVD
Health Disparity Issues • DID YOU KNOW? • Health care differences • Nutrition – access & affordability • Environmental influences – rural, frontier • Poverty • Education- literacy rates • Cultural beliefs & practices • Health care provider supply • Ethnic health care professionals
Special Issues in Life Cycle • Preteen/Teen: eating disorders, smoking, image, peer/school pressure • Reproductive age: pregnancy, yeast infections, employment, marital stress, obesity, onset of complications • Mid-adult years; progression of diseases, hospitalizations, education & job issues, mental health • Senior years: complications, medical bills, QOL, health/home care, economics, inactivity, death
Provider Availability • Minorities Are More Likely Not to Have a Regular DoctorQuality care comes from a doctor that knows you, but not everyone has a regular doctor. According to the Commonwealth 2001 Health Quality Survey: • 43% Hispanics in this country do not have a regular doctor • 32% of African Americans do not have a regular doctor • 30% Asians Americans do not have a regular doctor, and • 20% of white Americans do not have a regular doctor.Source: The Commonwealth Fund 2001 Health Quality Survey • Indian Health Service used by ~60% of 2.4 million AI/ANs
Tobacco + DM = Early Death • Smoking causes damage to nerves, kidneys, and eyes in those with DM; leads to more premature death from Heart Disease. • AI women have the highest tobacco use rate vs. general population; Alaska & Northern Plains have highest rates • Cigarettes available 1/5 of cost via internet • Advertising uses Indian logos/names
NIH/NIDDK’sStrategic Plan on Minority Health Disparitieswww.niddk.nih.gov
Diabetes Prevention Program/NIDDK • Diet & exercise can reverse type 2 DM in ~10 million with IGT in U.S. • 30 minutes/day of moderate exercise or 150 minutes per week • Low-fat & goal of 7 lb wt. reduction • 1 year free of DM= 1 year life free of disability, suffering from DM • 45% from 4 main ethnic groups
American Diabetes Association • www.diabetes.org • Programs for AA (Diabetes Sunday), Native Americans (Awakening the Spirit), API, Hispanic/Latino (DAR) populations • Recipes • Risk test • Advocacy
CDC and Prevention • http:www.cdc.gov • BRFSS • YRBSS • MMWR • Chronic Disease Division- diabetes, CVD, etc. • Training • Funding
Health Body Healthy Mind • www.healthybodyhealthymind.com • Video clips • Ethnic populations
Entering non-traditional territory • Schools • Churches • Women’s Support Groups • Family-centered activity • Fast food counters • Athletic/Sports clubs • Talking/healing circles
Role of Traditions & Indian Medicine Teaches us about walking, running, exercise Teaches us about dancing, song, humor Provides stories about survival Promotes sharing with family & community Promotes eating properly – balance and moderation Keep things sacred- tobacco, prayer, song Keep traditions strong-respect, moderation You are a sacred being- take care of yourself