Health Equity Regarding Type 2 Diabetes

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Table of Contents

Introduction
Health Equity’s Role in the Global Distribution of T2D
Cultural Humility, Inclusion, and Community-Based Participatory Research (CBPR)
T2D: Research Progress, Humility/Equity, and Community’s Role
Inclusion/Equity Strategies for the U.S.
Cultural Biases in Global Health Research
Conclusion
References

Introduction

Promoting equitable and inclusive healthcare informs the global community’s attempts to strengthen links between actual diversity and services. In research and program planning endeavors, maintaining other-oriented interpersonal stances and openness to cultural heterogeneity support universal access to health. Using type 2 diabetes (T2D) as an example, this paper examines the ideas of cultural humility, equitable care and research, inclusion, cultural bias, and community partnerships in health studies.

Health Equity’s Role in the Global Distribution of T2D

Globally, the absence of ethnically, culturally, and economically dissimilar populations’ equal opportunity to attain their full health potential does not play a major role in T2D’s distribution. Contrary to other disorders with an inverse relationship between prevalence and the nation’s GDP, T2D is widespread in relatively wealthy countries, such as the United Kingdom, the U.S., Switzerland, the Netherlands, Sweden, and Taiwan (Khan et al., 2020). America ranks first in terms of both prevalence rates and the daily burden of suffering, whereas Africa has the lowest rates despite being the most economically disadvantaged region (Khan et al., 2020). Deficiencies in health equity are, therefore, more pronounced at the regional and national levels.

Cultural Humility, Inclusion, and Community-Based Participatory Research (CBPR)

Inclusion, humility, and CBPR are essential concepts in pursuing health equity. Inclusion and cultural humility, which is a three-tenet attitude to serving ethnically heterogeneous populations, are crucially important in health research as open-mindedness with regard to sample collection and recruitment produces truly generalizable findings to inform evidence-based practice. Such research creates the conditions for just resource planning and allocation decisions by ensuring the presence of complete data on inter-group differences and minority populations’ need profiles (Rajaram & Bockrath, 2014). Being an equitable approach to research based on community inputs and integrating community-specific knowledge into policy decisions, CBPR increases the recognition of local populations as stakeholders in research by including them in equitable partnerships (Ward et al., 2018). CBPR engages local populations in cyclical multi-stage processes, ranging from quality improvement projects to patient teaching campaigns. With that in mind, all three concepts are inextricably connected to addressing gaps in resource distribution.

T2D: Research Progress, Humility/Equity, and Community’s Role

T2D research has recently seen progress toward greater equity and culture-related humility, which is evident from ethnic and sexual minorities’ greater representation as research subjects. According to Tajkarimi (2018), the number of research reports focusing on T2D’s prevalence and characteristics in underserved minorities in the U.S., especially American Indians, Asian Americans, and African Americans, has increased since 2010, indicating the research community’s gradual adoption of humility and equitable research as priority areas. Recent advancements in promoting equitable T2D management are also seen in the increasing popularity of cultural humility-based patient teaching frameworks for LGBTQ+ populations diagnosed with T2D/prediabetes (Savin & Garnero, 2022). However, this progress does not eliminate disparities in the disorder’s prevalence.

The community’s role in promoting equity and humility also deserves attention. T2D-related CBPR interventions, including the methods of shared leadership and outreach, have become prevalent in the last decade and promote statistically significant post-intervention improvements in A1C levels, blood pressure, and lipid profiles (Campbell et al., 2020). In the U.S., recent community-based projects have focused on promoting these outcomes in diabetic and prediabetic minority populations, including African Americans, Marshallese people, American Indians, Bangladeshi people, and East Asian immigrants (Campbell et al., 2020). Thus, the community’s and the CBPR approach’s contributions to equitable care and the practice of cultural humility with regard to T2D prevention and management have been tremendous, but the room for improvement still persists.

Inclusion/Equity Strategies for the U.S.

Two strategies can be proposed to increase equity and inclusion within the frame of the National Diabetes Prevention Program (NDPP) and the U.S. public health system’s program for American Indians. The first strategy seeks to reduce the imbalance between urban and rural residents’ access to T2D prevention services by expanding the number of NDPP partnership sites in rural counties and establishing the institution of diabetes peer coaches in underserved rural areas (Ariel-Donges et al., 2020). Adapting the program’s toolkits to rural Americans’ eating and self-management habits could also be instrumental in seeking cultural responsiveness and humility. The second strategy pertains to the Special Diabetes Program for Indians and involves reconsidering the approach to anti-T2D lifestyle interventions in neighborhoods with extremely high concentrations of American Indians (Jiang et al., 2018). This could be achieved by including such communities’ eating cultures and access to healthier food or places for physical activity in analytical efforts.

Cultural Biases in Global Health Research

Cultural biases can affect global health research by causing the most widespread group’s inclination toward underestimating cultural minorities’ systematic struggles. The Equal Earth map projection method proposed by Šavrič et al. (2019) seeks to represent the planet’s surface in a visually pleasing way while maintaining various continents’ true relative sizes. Similar to exploring global patterns in health research, preserving the planet’s features without any distortions is not possible, and those involved in decision-making will still have the chance to select the “angle” that makes their “location” fully visible while leaving the other areas distant from the center of attention. Therefore, the cultural affinity bias and the risk of producing oversimplified causal explanations that do not consider smaller groups’ internal heterogeneity and variability can be challenging to eliminate in health research.

Conclusion

Finally, cultural responsiveness and inclusive research and services should still be promoted when it comes to T2D. Culture-related humility and minority groups’ representation in T2D prevention and treatment endeavors feature some room for improvement, including disease prevention strategies that would address rural Americans’ and low-income ethnic minorities’ lifestyles. However, the existence of biases pertaining to culture might further strengthen ongoing barriers to health equity and inclusion.

References

Ariel-Donges, A. H., Gordon, E. L., Dixon, B. N., Eastman, A. J., Bauman, V., Ross, K. M., & Perri, M. G. (2020). Rural/urban disparities in access to the National Diabetes Prevention Program.Translational Behavioral Medicine, 10(6), 1554-1558. Web.

Campbell, J. A., Yan, A., & Egede, L. E. (2020). Community-based participatory research interventions to improve diabetes outcomes: A systematic review.The Diabetes Educator, 46(6), 527-539. Web.

Jiang, L., Chang, J., Beals, J., Bullock, A., & Manson, S. M. (2018). Neighborhood characteristics and lifestyle intervention outcomes: Results from the Special Diabetes Program for Indians. Preventive Medicine, 111, 216-224.

Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of type 2 diabetes: Global burden of disease and forecasted trends. Journal of Epidemiology and Global Health, 10(1), 107-111.

Rajaram, S. S., & Bockrath, S. (2014). Cultural competence: New conceptual insights into its limits and potential for addressing health disparities. Journal of Health Disparities Research and Practice, 7(5), 82-89. Web.

Savin, K., & Garnero, T. (2022). Know thyself: A cultural humility framework for diabetes education for LGBTQ individuals.ADCES in Practice, 10(2), 8-12. Web.

Šavrič, B., Patterson, T., & Jenny, B. (2019). The equal Earth map projection. International Journal of Geographical Information Science, 33(3), 454-465.

Tajkarimi, A. (2018). An overview of minority-based research on diabetes type II in the US between 2012–2017. The FASEB Journal, 32(1), S547.

Ward, M., Schulz, A. J., Israel, B. A., Rice, K., Martenies, S. E., & Markarian, E. (2018). A conceptual framework for evaluating health equity promotion within community-based participatory research partnerships.Evaluation and Program Planning, 70, 25-34. Web.

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