Multiple programs aim to cater for primary, secondary as well as tertiary care in children with diabetes, diabetes-related diseases, and disabilities. There are government-based programs that run through the department of health and human services. These include the programs running under the National Institute of Health (NIH), as well as the centers for disease control and prevention. Programs in place which are nonfederal government based usually are university based and/ or health professional organizations /voluntary organization based.
NIH supports the National diabetes education program which is a federally supported program focused on diagnosis as well as secondary and tertiary prevention i.e. diagnosis, treatment, and management as well as prevention of disability and mortality from the disease.
The center for disease control and prevention is one of the major organizations which are at the government’s disposal to control diseases. It comprises eight divisions, three of which cater to diabetes, nutrition, and physical activity, and adolescent and school health. “Division of Adolescent and School Health (DASH) sponsors state-based school health programs on nutrition and physical activity and develops school health program guidelines, school health strategies, planning guides, and related resources and tools.
The School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide enables schools to identify the strengths and weaknesses of their physical activity and nutrition programs, develop action plans for improving student health, and involve teachers, parents, students, and the community in improving school services. Other online resources include status reports, school and community guidelines, and brochures for parents, teachers, and principals promoting increased physical activity among youth.”(Diabetes in children and adolescents [ No date] ).
There are universities-based as well as voluntary programs as well which try to reduce the disease burden. The University of Colorado with the collaboration of the Department of Health and human resources a plan called the ‘Colorado on the Move’ program. It is a program that encourages people to walk at least two thousand steps more than they previously used to. The extra exercise is intended to prevent obesity and decrease the risk of developing diabetes. This program also involves a 5-day healthy eating campaign. This program aims to encourage healthy dietary habits as well as exercise in the community with the hope that the practices will eventually catch on and become part of the population’s daily routine.
In Washington, the state is promoting a ‘Kids Walk to School Day’.
The aim is to encourage exercise through daily walking as well as raising awareness of the importance of walking to school. Local communities are encouraged to take part in these initiatives as well as start initiatives of their own to promote healthy living and prevention of risk factors that are precursors for diabetes (Prevention programs in action, 2003).
Barriers towards quality and access to health care Mexican /American communities in the US make a large proportion of the minority groups. They have many difficulties in terms of getting access to health care. These barriers include financial barriers, structural as well as institutional barriers.
Financial barriers present in this community usually are in the form of the absence of healthcare insurance. More than seven million Latinos residing in the US do not have health insurance. The majority of the Latin population is in the low and low/middle-class segment of the society. Therefore without health insurance, the accessibility of health care in this segment of society becomes limited.
This leads to poor secondary as well as tertiary care in the case of patients suffering from diabetes. Lack of financial resources amongst the population leads to non-affordability of clinic fees, travel expenses. People cannot afford the gas and drive to the health care center by Mexican people. Even if the people can afford the financial burden, they usually work two jobs to make ends meet. Parents who arrive home late in the night have to approach the midnight free clinics. Hence no amount of quality care gets provided to them.
Each community has unique and specific health needs and the organizations which have been set up to cater to the community’s health needs often do not look into those needs. The structural and delivery systems of these organizations therefore cannot fulfill the social and cultural needs of the community. Institutional barriers often are present in the form of the government’s policies going against the migrant population. The government focuses on policies that favor the insurance companies and /or favor tertiary care hospitals. (Valdez R B,1993.}
A large segment of the Mexican population is illegally residing in the US. This is an additional barrier as they are hesitant to approach hospitals for fear of being caught and deported.
- Language presents another barrier as some in the Mexican community especially men and recent immigrants cannot speak English. Therefore they are reluctant to approach the doctors or primary care providers with their medical illnesses. There is a lack of healthcare providers that can speak the Spanish language. This along with the reluctance of the Mexican population to learn English tends to be a barrier for them (Sobralske M C, 2006).
- Policies and programs that are still needed to improve the quality of their care
To cater to the Mexican community and the health needs especially when it comes to adolescents and the problem of diabetes, the triple mode action plan should be initiated and programs should be created while keeping in mind the social, cultural, and linguistic needs of the community.
Firstly programs that can enable and enforce primary prevention in the community should be started. Risk factors for diabetes primarily include obesity, sedentary lifestyle, and familial links. Programs that can focus on encouraging healthy eating, regular exercise, or sports activities along with early diagnosis and detection programs should be initiated. Government should make it mandatory for the public as well as private schools to carry highly nutritious foods for lunch.
The meals should be a mixture of leafy vegetables with fruits and a small portion of meat. Efforts should be undertaken to ban high energy or carbonated drinks from schools. Government, as well as private schools, should be encouraged to incorporate sporting activities in their curriculum regularly. Keeping in mind that Mexican American adolescents are usually of the poor socioeconomic group, the government should fund the communities to create recreational centers for physical activities in the city. This will enable and encourage children to participate in physical activities at home as well as at school.
Another important aspect of primary prevention is early diagnosis. It is especially important in children and adolescents. School programs should make it possible for children who are at a high risk for diabetes to be screened at school.
It could be done that a bi-monthly physical checkup should be made mandatory for the children and the overweight and obese students, or those with a family history of diabetes be checked for hyperglycemia and diabetes. This health facility should be provided free of cost keeping in mind that the Mexican community usually cannot afford the extra financial burden.
Secondary prevention includes managing the disease. Diabetes is a manageable disease and programs should be initiated to allow children of the stated community to have access to free hypoglycemic drugs/and or insulin. All the children diagnosed as diabetics in schools could be asked to report to school clinics that would be equipped with competent staff and drugs. The staff would be maintaining charts and administering the drugs. Every month, a doctor could be required to come and evaluate the diabetic control of the students and alter the drug doses accordingly. The funds required to run such a program could come from charitable foundations or communities themselves.
The tertiary care system calls for limiting disability from the disease. Programs involving free Mobile health clinics should be initiated. Staffed with clinicians and nurses either from the community itself or comprising of people who speak the Spanish language could be tasked to visit communities every month. They would be tasked with the job of monitoring the progression of the disease by doing routine examinations. They could also refill the prescriptions of the people affected with diabetes etc.
Overall these programs will ensure that children of this much-neglected community are provided with foolproof healthcare including primary, secondary as well as tertiary care. School programs will encourage healthy eating habits and exercise will become part of the daily routine. These programs if enforced these changes will lead to a healthy community and a healthy future generation.
References
Diabetes in children and adolescents; National diabetes education program. Web.
Prevention programs in action (2003); US department of health and human services. Web.
Sobralske M C (2006); Community-based strategies to improve the health of Mexican American men, International Journal of Men’s Health. Web.
Valdez R B, Giachello A, Rodriguez-Trias H, Gomez P, and De la Rocha C (1993), Improving access to health care in Latino communities. Public Health, 108(5): 534–539.