Determinants of health are an array of factors that impact the health status of a given population. The elements comprise of social, political and economic and they differ in different stages of life. What is more, the factors do not exist in isolation, but instead, they are interrelating. For the African American community, the predisposing factors to the risk of prediabetes include education, income, and race. Studies have been conducted to analyze each of these factors independently, and this paper presents a thorough analysis of the interconnectedness that exists in these factors as far as prediabetes is concerned for African Americans.
It is promulgate that almost 30 million American adults are diagnosed with diabetes. Additionally, another 8 million Americans are afflicted with diabetes but is unaware. Controversy, another 86 million American adults have been diagnosed with prediabetes. Of note, Diabetes Care (2017) reported an annual growth of 700,000 newly diagnosed diabetic patient between 2012 – 2015. It is projected that this number will continue to grow exponentially. Subsequently, diabetes is considered one of the top leading causes of mortality accounting for over 200 annual deaths annually.
In 2012 the economic burden of diabetes was approximately $245 with $69 million allocated to loss of productivity (Watson 2017; Diabetes Care 2017). This represents a 41% increase of medical expenditure totaling approximately $174 billion from 2007 (Diabetes Care, 2017). Inpatient hospitalization accounts for almost 43% of the $176 billion spent treating diabetes. On average diabetic patients spend twice as much on healthcare expenses compared to a non-diabetic patient. On the other hand, in a news feed disseminated by the American Diabetes Association (2014), over a five years span indicated that the financial burden associated with pre diabetes has risen to 74%. Interestingly, African Americans have the highest incidence of prediabetes and are prone to develop type 2 diabetes. The purpose of this paper is shed light on the social epidemiology aggregates that cause the proliferation of prediabetes among African Americans.
The term prediabetes also known as impaired plasma glucose metabolism was coined in 1979. According to CMS.gov (2017), Prediabetes is a condition where one has high levels of glucose but not high enough to be diagnosed with diabetes. Prediabetes is defined as “plasma glucose concentration 7.8 – 11.1 mmo1/L (140-200 mg/dL) two hours after 75g glucose load (Yudkin & Montori, 2014). Furthermore, Diabetic Care (2013) classifies HbA1c of 5.7% as prediabetes.
The prevalence of prediabetes is steadily on the rise. More than 33% of U.S. adults were diagnosed with prediabetes. Of that number almost half were over age 65 years old. According to National Diabetes Statistic Report (2017) more men than women are diagnosed with prediabetes. Of note African Americans have the highest incidence HbA1c and subsequently the highest rate of prediabetes. The predisposing factors mentioned might not all negatively impact the health status of an African American, but there exists some interconnectedness among them thus necessitating the discussion of how they correlate.
Many researchers have discussed education as a determinant of prediabetes. According to Goldman & Smith (2011) increase in education reduces the prevalence of diabetes. The study conducted by the authors also revealed that education is vital in preventing prediabetes to progressing diabetes. Olshansky et al. (2012) also assert that those with low levels of education have lower life expectancies than those who have attained more than 12 years of education which is a typical feature of African Americans. The author, however, asserts that the trend is still the same as 1950s thus there needs to be a policy adjustments to rule out education from determining the health status of African Americans or at least to narrow the gap between the health status of the educated and the uneducated.
A race is also another determinant of health for the African Americans in the US. According to Braveman et al., (2010) blacks are disadvantaged regarding health and fail to enjoy similar health benefits as their white counterparts regardless of their levels of income or their educational background. The same case applies to the Hispanics, but they are better off than the African Americans. Blacks are also more likely to live in the disadvantaged neighborhoods that do not expose them to health benefits that the more wealthy neighborhoods receive. The research, therefore, shows that the whites receive the most health benefits in the US and race or ethnic category for the African Americans has a lot to do with determining their health status of chronic illnesses such as diabetes. American Diabetes Association (2016) reveals that African Americans are less inclined to seek medical attention when needed. American Diabetes Association (2016) further reveals that minority races are less informed about prediabetes and few of them know that Medicare provides free testing and education to those who wish to know their diabetes status.
Finally, income is also a health determinant of prediabetes cases for African Americans in the US. Income determines the kind of insurance that Americans have and their frequency of seeking healthcare attention. Income levels also determine the type of preventative measures that the people take to prevent prediabetes from advancing and becoming diabetes. Low income is also associated with neighborhoods that lack access to healthy foods further predisposing the African Americans who are the majority in these regions to lower health status (Spanakis & Golden, 2013). Furthermore obesity and physical inactivity is a major risk factor for prediabetes (Watson, 2017).
Interrelation between the determinants of Health
Income and education reveal some interconnection because the least educated are also the least insured according to sentiments expressed by Goldman & Smith (2011). As the number of uninsured increases in America, it is more widespread in the less educated compared to those who have gone above high school levels of education. African Americans are among the races that are less educated and most of them earn considerably low income compared to the whites thus they opt cheap or no insurance plans. Braveman et al., (2010) reveals the relationship between the two elements whereby the author emphasizes when health status is analyzed in relations with education and the levels of income, blacks in the US ranked poorly in both.
The other interrelation is revealed by Braveman et al., (2010) who discuss the relationship between socioeconomic status and education concerning the health status of the African Americans. Socioeconomic status combines both social and economic factors of a given population. The study result showed that African Americans, whose economic gains and levels of education were lower, also had lower health status compared to their educated and higher earning counterparts. The researchers conclude that less healthy people characterize low socioeconomic status while intermediate socioeconomic status is characterized by healthier individuals but not as healthy as those with high socioeconomic status.
Olshansky et al. (2012) reveal the interconnection between race and education concerning the health status of the Americans. According to the author, whites are generally more educated than the blacks and the whites with over 16 years of education have higher life expectancies than black Americans with less than 12 years of education. The author further asserts that the gap in health disparity for the white American men versus the black American ones is wider than the difference in the women from the two races. Life expectancy for black American men is 14.2 years less than white men, and the same for the black women is 10.3 years less than that of white women with more education. Goldman & Smith (2011) is also in support of this idea whereby he asserts that African Americans are also the majority concerning those who did not advance in education and their health outcomes are considerably lower. Clearly, race and education are interconnected and greatly determines the health status of the African Americans.
Education and income levels also show some interrelation in that more education acquisition means increasing the possibilities for higher incomes in the future. Education, therefore, exposes African Americans to the risk of Prediabetes by directly affecting their future income levels (Goldman & Smith, 2011). Goldman & Smith (2011) also bring about the interconnection between incomes, education, and race whereby a combination of low income, less educated minority group in the US experiences the worst health status while the more educated, white and wealthy American experiences the best health status.
To conclude, the number of Americans with Prediabetes is 50%, but these figures are distributed unequally among the population due to the impacts of education, race and economic status whereby minorities, the less educated and those earning lower incomes, who are majorly the African Americans, are more affected by the condition. The solutions to this phenomena point to the policymakers to make reforms such that all Americans are exposed to similar income levels, and education and that race may not be a factor for determining the health status of a population. Conclusively, Social, health, and biological factors all contribute significantly to global health issues. Prevention of race disparity in the health sector across the United States needs a multi-level intervention. Most useful of all is to target health care systems, patients and health policies. By addressing and eliminating the disparities that exist, this will ultimately improve the country’s health sector.?