Introduction
Public health is described by various scholars and authors as the art and science of preventing diseases, prolonging life as well as sensitizing members of the public on ways to make informed choices with regard to their health (Bullard 2004, p. 44). Modern public health practices involve the coordination of efforts made by various stakeholders in the health sector. This has been achieved through the introduction of preventive and curative measures such as vaccinations and the provision of antibiotics. The World Health Organisation (herein referred to as WHO) has been at the forefront in the provision and championing of such services. The training of various stakeholders in the health sector such as the medical practitioners has also been vital in the promotion of public health (Freudenberg 2008). Public health practices aim at addressing the needs of all members of society rather than focusing on individuals. Individuals in society are regarded as patients.
Indigenous Australians account for about 2.6 percent of the total Australian population. Indigenous Australians unlike European Australians are mostly black. It is estimated that the prevalence of Type 2 Diabetes Mellitus among this population ranges between 21 to 35 percent of the total population with most victims aged over 35 years of age (Schulz & Krieger 2002). Research points out that Aboriginal Australians have a lighter body build as compared to European Australians. This implies that Aboriginal Australians cannot handle a heavy body mass. This is thought to be the major reason why they are most affected by this condition as opposed to the other members of the population.
Failure by members of society to control their dietary intake has also led to a massive increase in body weight among individuals leading to obesity. Previously, Type 2 Diabetes had been associated with adults but recent studies have shown an alarming shift with the disease affecting adolescents and children.
This paper seeks to address Type 2 Diabetes Mellitus and its relationship to the Indigenous Australian inhabitants. The disease is chronic and it is characterized by a rise in the levels of glucose as a result of insulin resistance (Galea & Vlahov 2005). Variation in susceptibility between the indigenous Australian population and the non-indigenous Australian population has been an issue of concern eliciting debate within public health circles. The author of this paper will discuss some of the contributing factors to this health status imbalance.
Methods
Narrative Review
Type 2 Diabetes Mellitus is one of the most prevalent chronic diseases in the world today. This trend has made analysts and public health experts consider this disease as an epidemic. This prevalence has also given the condition worldwide recognition, especially in the health sector. Indigenous Australians have however been noted to be more susceptible to the disease than any other group of people in the world today with the prevalence rate ranging between 21 to 35 percent of the total population (Adler & Newman 2002). Traditionally the disease had been associated with old age but this has changed in the recent past. Recent public health statistics have listed adolescents and children as potential victims of the disease. A positive correlation between obesity and Type 2 Diabetes Mellitus has also been established. Both conditions are mainly associated with indigenous Australians.
Disparities between the indigenous Australian’s body structure and that of European Australians are viewed as the major factor behind the differences in the prevalence of Type 2 Diabetes Mellitus among the two groups with more cases reported among the Indigenous population. According to historians, Indigenous Australians were predominantly hunters and gatherers. Their body structure thus entailed long legs with short and narrow-body trunks which were an adaptation to their hunting activities (Link & Phelan 2005). With rising modernization in Australia, this trend has changed over the years with researchers reporting an alarming rate of general body weight gain leading to obesity. This situation has been blamed on a change in lifestyle, improper diet as well as lack of the necessary education on both lifestyles as well as diet. To this end, it is noted that the hunters and gatherers who used to be slim are now obese. This change is brought about by the change in lifestyle that accompanied modernization. The diet of the Indigenous Australians has now changed from that of a hunter and gatherer (composed of meat, roots, fruits and tubers) to that of an urbanite (composed of processed foods).
In this paper, the writer also seeks to exhibit the co-relation between type 2 Diabetes Mellitus and obesity. Logical conclusions are made to the effect that physical fitness and dietary interventions are vital in the development of sound public health practices and strategies.
Themes Discussed
Lifestyle Change as a Factor in Type 2 Diabetes Mellitus
The high prevalence rate of Type 2 Diabetes Mellitus among indigenous Australians has been associated with their natural light bodyweight as already indicated. Change in lifestyle has however seen a change in their body structure with most Indigenous Australians gaining weight creating an imbalance between their body weight and their height. This has subsequently led to obesity and other lifestyle conditions such as high blood pressure and diabetes.
The status quo also determines the susceptibility of individuals to Type 2 Diabetes Mellitus. High employment rates have seen individuals switch from an active to a sedentary lifestyle normally associated with poor feeding habits as well as lack of physical body activity (Kawachi & Berkman 2003). A steady flow of income guarantees the population a simplified and rather mechanized life. Lack of exercise coupled with improper diet leads to obesity which is a condition that increases susceptibility to Type 2 Diabetes Mellitus. Upholding general body fitness is considered a major milestone in the development of feasible public health practices (Vlahov & Galea 2002)
Researchers have it that obesity is the major cause of type 2 Diabetes Mellitus (Israel & Schulz 2008). Being traditional hunters and gatherers, indigenous Australians exhibits a general light body mass which was a natural adaptation to their hunting activities. The gradual change in their cultural practices as a result of urbanization and change in lifestyle has seen indigenous Australians discard their traditions. This has made them prone to weight gain that in extreme cases leads to obesity. Mild glucose and cholesterol levels associated with obesity lead to diabetes if left unattended (Israel & Schulz 2003). Without timely interventions, this condition deteriorates leading to more complications with the patients being potential victims of other ailments such as cardiac failure and high blood pressure. This situation is a major setback in the development of viable public health practices.
Type 2 Diabetes Mellitus as already indicated is a lifestyle-related condition. Lifestyle modification is in a way likely to reduce the risks associated with impaired glucose tolerance. This is thus considered to be the most effective means of reducing the prevalence of Type 2 Diabetes Mellitus among Indigenous Australians (Schulz & Israel 2008). These interventions should however be sustained to prevent retrogression as a result of individuals moving back to their old habits and leading unhealthy lifestyles.
The development of individual personal skills will also be vital in an attempt to control the prevalence of Type 2 Diabetes Mellitus among Indigenous Australians (Metzler & Higgins 2003). Championing favourable life skills will be vital in the prevention of the disease. Interventions would include increased physical activity as well as sensitization on healthy practices such as improved feeding habits that would help the individuals counter their susceptibility to the disease. Life skills would not only be beneficial to those seeking to protect themselves from contracting the disease but also to those already suffering from the condition. Their incorporation into therapy will help those affected by the disease to cope with their condition through the application of treatment procedures such as insulin injections. Physical body exercise will also help an individual reduce the likelihood of facing more complications such as those related to cardiac and high blood pressure (Alexander & Weiner 2003). Individuals eventually get used to suitable lifestyles and adapt to them with time. It becomes part and parcel of their everyday life. This can be encouraged among the indigenous Australian communities to cope with the high rates of Type 2 Diabetes Mellitus.
Diet as a Factor in Type 2 Diabetes Mellitus
Poor feeding habits has seen increased death rates among indigenous Australians as a result of a rise in cases of Type 2 Diabetes Mellitus. This has risen close to 17 times that recorded among the non-indigenous population. This has created the need to formulate and implement sound public health policies and practices to help address these alarming statistics (House & Williams 2000). Urbanization has also greatly impacted the change of diet among the indigenous Australians as well as the change in culture with many exhibiting reduced physical activity. Despite these logical conclusions, one wonders why the disease is more prevalent among Indigenous Australians than it is among other groups in the country. This is especially so considering the fact that statistics show that fairly a large number of non-indigenous Australians have also adopted the urbanization culture. A great proportion of the world’s population today also inhabits urban areas yet they are less susceptible to the disease.
Dietary interventions are vital in reducing the prevalence of Type 2 Diabetes Mellitus. Healthy feeding helps in the maintenance of body weight as well as maintaining a balance between general body weight and body mass (Dekoning & Martins 2006). The dietary intervention also involves the reduction in junk food intake in a bid to prevent the accumulation of cholesterol and glucose in the body. This will not only guard against Type 2 Diabetes Mellitus but also against other similar conditions such as high blood pressure and heart conditions. Individuals should be advised on ways to maintain favourable body weight to reduce their susceptibility to chronic ailments such as Type 2 Diabetes Mellitus. Farmers should also be encouraged to cultivate healthy foods to meet the growing demand for healthy foods in society (Galea 2001). Eating plans should also be devised to ensure that only the right quantity and right quality of food is consumed at regulated intervals. Recipes should also be made available to the Indigenous Australians to encourage the consumption of the right quantities as well as the right qualities of food to maintain a balanced diet.
Proper diet is the most effective means of preventing the occurrence of Type 2 Diabetes Mellitus (Minkler & Wallerstein 2003). The need to keep fit has received worldwide recognition and support with many private stakeholders and governments venturing into the public health sector in a bid to guarantee healthy living in the society. The education sector has also come in handy to promote awareness in proper feeding habits with the introduction of courses such as Food Sciences and Nutrition. Increased awareness among the global population would be vital in ensuring that favourable international public health practices are achieved and sustained (Israel & Parker 2005). The world population should be encouraged to incorporate food supplements such as food and vegetables that are considered nutritious and healthy as compared to other processed foods.
Education Levels as a Factor in Type 2 Diabetes Mellitus
level of education has been identified as one of the major factors influencing the prevalence of Type 2 Diabetes Mellitus. Poor feeding habits can be attributed to a lack of insight among indigenous Australians (Kaplan 2009). Stakeholders in the health sector (and especially those involved in public health) should strive to provide both formal and informal education to the population in order to raise awareness regarding possible strategies that can be adopted to prevent and control Type 2 Diabetes Mellitus. Such possible strategies may include upholding practices such as a healthy diet and physical body exercise. Research shows that members of the Indigenous Australian community have been generally left out in health matters with only a few individuals taking part in the provision of health care. Education would be vital in empowering groups of people since they would gain access to knowledge regarding Type 2 Diabetes Mellitus. Such knowledge or information is likely to increase their ability to cater to their own health needs without necessarily having to depend on health service-providing agencies (Marmot 2006).
Rurality which is associated with most indigenous Australians has been identified as a major hindrance to the provision of health care in the community. Most indigenous Australians are to be found in rural areas. The large distance between the community and the health and urban centres has been a major hindrance as far as access to quality health care among the indigenous Australians is considered (Williams & Collins 2005). Over half of the indigenous Australian population has to travel for over 50 kilometres to access quality health care. Many indigenous Australians hold a view that Aboriginal Australians should also be involved in the provision of health care services (Green & George 2005). This factor is however not vivid enough in explaining the correlation between indigenous Australians and the high prevalence of Type 2 Diabetes Mellitus among them due to the fact that fairly a large number of non-indigenous Australians live in the countryside yet they are less susceptible to the disease.
Failure to educate the Indigenous Australian population has seen them lag behind their non-indigenous counterparts in health matters. This has crippled their ability to deal with their personal health matters such as the maintenance of a healthy diet. The indigenous Australians have also adopted modernized lifestyles which makes them more vulnerable to Type 2 Diabetes Mellitus (Kaplan 2009).
Improving health care services in rural areas would be a major milestone in the attempt to enhance the provision of health education among indigenous Australians. During such forums, indigenous Australians will be sensitized to Type 2 Diabetes Mellitus. Individuals would learn that the disease is related to their lifestyle and that it is only through modifying their lifestyle that they can survive the disorder (Kaplan 2009). Each and every individual is entitled to health care services despite their location.
Health Education Promotion Plan
A favourable health education promotion plan would entail the collaboration of all the stakeholders in the health sector in the provision of health care services. Local as well as national leaders would also play an important role in the promotion of such activities since they are known to command respect from the general public. Reducing the prevalence of Type 2 Diabetes Mellitus among the indigenous Australians would therefore entail bringing together leaders as well as other stakeholders in the public health sector to sensitize locals on healthy living practices such as preparing healthy foods (Kaplan 2009). Education programs are most effective when carried out using the native language. Mass media would also be of great assistance in the provision of health incentives because of its wide coverage.
It is evident that the government and public health service providers cannot be solely entrusted with the responsibility of providing public health care services (Freudenberg 2001). Collaboration with welfare groups such as Non-Governmental Organisations (NGOs) and local leaders is vital in ensuring maximum penetration into the local communities. This has however not been the case among indigenous Australians. Lack of alliances and collaboration in the provision of public health care is largely to blame for the prevalence of Type 2 Diabetes Mellitus among Indigenous Australians (Green & Daniel 2001). Leaders have failed in their duty to sensitize the population on key practices and activities that would provide a basis for Type 2 Diabetes Mellitus prevention and treatment. To create international awareness, public health practices should become a topic in all social and political forums. International leaders must include favourable health incentives in their manifestos to safeguard the lives of their subjects.
As a result of failure among stakeholders to collaborate in creating awareness among Indigenous Australians, cases of chronic diseases have been on the rise top among them being Type 2 Diabetes Mellitus (Lantz & Viruell 2005). Lifestyle should be top on the list of key issues to be taught in society. A positive change of lifestyle would be beneficial to society since it aims at preventing rather than treating Type 2 Diabetes Mellitus. The practice would also be cost-effective since the funds spent on treating type 2 Diabetes Mellitus will be reduced. Would-be victims of the disease are also able to cut costs related to the treatment of the ailment. However, these awareness initiatives have not been popular among Indigenous Australians with such campaigns only targeting those inhabiting urban centres. With some Indigenous Australians living up to 50 kilometres away from urban centres, they remain ignorant thus the high prevalence of Type 2 Diabetes Mellitus among them (Schensul 2009). Services aimed at helping Indigenous Australians deal with lifestyle issues are also urban-based leaving out those people living in the rural areas. These are for example the services that are provided by entities such as NGOs and faith-based organisations and in some cases the government through the public hospitals.
Considerations for Health Education Promotion Plan
Health promotion is the process of empowering people to increase their control over their health as well as improving it (Best & Stokols 2003). Inspiration is thus vital in the process of helping people to achieve full physical, psychological and social well-being. To achieve this, people are expected to devise mechanisms that will enable them to fully cope with the environment as well as other factors surrounding them. Social and personal resources must therefore be fully mobilized to achieve a healthy living among members of the society. Positive public health concepts must also be emphasized to promote responsibility in the public health sector. Individual health responsibility provides the basis for international health promotion (Gomez & Greenberg 2006). Policies should also be put in place to promote equality in the public health sector to ensure the delivery of service to all.
Public health promotion should be put into consideration when formulating international health policies and agendas. Decision-making, as well as the implementation of public health practices, should be in line with laid down policies and practices governing the health sector (Williams & Labonte 2005). Long and arduous processes such as legislation, taxation as well as other organisational changes have in the past crippled the process of public health promotion. Penetration of the Indigenous Australian population in a bid to coordinate public health activities relating to Type 2 Diabetes Mellitus will require those spearheading the process to seek and satisfy this obligation thus delaying the commencement of service delivery (Bracht & Finnegan 2004). For example, the NGOs providing public health services to members of the indigenous community have to adhere to these legal regulations which may at times hurt their efforts in helping the community. Public health analysts should take into consideration these hurdles before making an entry into the sector.
Environmental aspects should also be an important consideration in the promotion of public health care. Those spearheading public health promotion processes should ensure that the environmental conditions in their target region are in line with their policies for them to be fully workable (Evashwick & Ory 2003). The Australian government has a responsibility to ensure that the prevailing conditions among the Indigenous Australians promote and support the implementation of public health policies and development activities. An enabling environment would be crucial in the devising of mechanisms likely to best suit preventive and curative measures employed to control the prevalence of Type 2 Diabetes Mellitus in the community (Goodman & Steckler 2009). Proper understanding of the environment will also aid in the discovery of natural means of controlling the disease’s prevalence among Indigenous Australian individuals.
Cultural practices among the target group are important factors that should be taken into consideration in the public health promotion plan (Jacksons & Fortmann 2004). It is a culture that defines the way of life of a particular group or community. Indigenous Australian communities are characterized by diverse cultural practices. An efficient and workable promotion plan should put into consideration these different cultures represented by indigenous Australian communities. Proper understanding of a subject’s culture is vital in ensuring understanding and peaceful co-existence between the participating parties (Shediac & Bone 2006). An individual with a proper understanding of the community’s culture will be in a better position to coexist peacefully with the target group thus amounting to the success of the plan.
A subject’s language is also an important factor to put into consideration as it determines the success (or lack of it thereof) of a public health promotion plan. A promotion plan will be successful only if a person has a working understanding of the native language used by the subject (Higgins & Metzler 2001). Understanding the native language will promote communication among the concerned parties. The public health promotion campaigner having an understanding of the Indigenous Australian’s native language will be able to communicate effectively with the natives in an attempt to explain his or her policies as well as educate the community on Type 2 Diabetes Mellitus. Proper understanding will facilitate an easy and effective educative process among the locals. Locals are also able to express themselves with a lot of ease.
The target group is also an important factor to consider while conducting a public health promotion campaign. This understanding varies with the age of the individual, their preferences as well as their attitude towards the ideas being promoted (Keleher & MacDougall 2009). This understanding is aimed at devising ways to best deal with the subject as well as the selection of techniques to be used by the public health practice promoter. This consideration will help the Indigenous Australians have a sense of belonging and own the whole process as well as create a forum favourable for the exchange of ideas. The Indigenous Australians will thus be part of the process in Type 2 Diabetes Mellitus education and ideas generated will be owned by all the parties involved.
Limitations Facing Public Health Education Promotion Plans among the Indigenous Communities in Australia
Numerous public health policies which form part of public health development practices have become major hurdles in the promotion of public health (Dwyer & Silburn 2004). Organisations seeking to engage in the provision of public health services are required to undertake numerous legislation processes that are often tedious and as a result, lengthen the whole process. The operation of these groups is also limited to the policies governing the provision of public health care services. These time-consuming processes lock out potential health promotion organizations. These long processes also delay the service delivery process. These legislations should be reduced or streamlined to hasten public health promotion processes. This will be vital in timely control of Type 2 Diabetes Mellitus among the Indigenous Australian population as well as in encouraging and promoting international health practices.
Resource and financial constraints have also been a major hindrance to public health promotion practices. Fiscal issues facing organisation such as taxation can be a hindrance to the organization’s involvement and participation in the health sector. These practices adopted in the health sector have seen many potential organisations being locked out of the public health care service provision industry. This is especially so for non-profit organisations such as NGOs and faith-based organisations. The Australian government should scrap off some of these requirements to encourage more organisations to participate in the sector. Some of the requirements can also be merged in a bid to streamline them. Government control over the public health sector has crippled the operation of interested organisations thus greatly impacting the control of Type 2 Diabetes Mellitus among Indigenous Australians. Lack of independence has thus not only negatively impacted health service delivery in Australia but has also negatively affected the promotion of health services in the entire world.
Resistance to change among members of society has also been a major blow to public health care promotion campaigns. Many communities have resorted to traditional health care practices with total disregard for modern practices. These practices have left the communities susceptible to many chronic disorders among them Type 2 Diabetes Mellitus (Hurley & Baum 2010). Indigenous Australian communities have been known to have a rich culture and traditions which many of them have maintained to date. This aspect has seen them seek traditional health care options such as the use of herbs and in some cases witchcraft. Modern public health promotion however discourages such practices since they are often not standardised and are offered by individuals who have little or no insight into public health. This is especially so considering the fact that it is not viable to address modern-day ailments and conditions (or health problems) using traditional practices that may be outdated in some cases. Traditional health practitioners would however be incorporated into the healthcare sector to supplement health service delivery after intense training. This is considering that they have indigenous knowledge which may be useful in tackling public health issues.
Conclusion
Effective and competent public health practices should be a collective responsibility among all stakeholders in the public health sector. This means that provision of quality public health care services should not be left solely in the hands of the governments. Private organisations should be encouraged to venture into the public health sector through most of the legislations that have been put in place have barred the participation of these organisations in the sector (Donoghue 2009). Members of the Indigenous Australian population should be empowered to deal with as well as control their susceptibility to Type 2 Diabetes Mellitus. This can be achieved through the provision of civic education on topics such as nutrition as well as how to maintain physical fitness.
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