Diabetes in Australia and Saudi Arabia

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Introduction

The global prevalence of diabetes mellitus continues to rise at alarming rate. Accordingly, Eckel et al. (2004, p. 2971) underscore that this trend is instilling fear among governments due to its implications on healthcare budgets. Additionally, this chronic condition has equally been blamed for high levels of morbidity and mortality (Eckel et al., 2004, p. 2972). As a matter of fact, diabetes has been termed as a lifestyle disease and its rapid spread has triggered the need for public awareness campaigns aimed at educating vulnerable populations on the risk factors associated with the condition (Australian Institute of Health and Welfare, 2006, p. 12). Moreover, the situation has also triggered intense and extensive research as experts seek knowledge about anti-diabetes solutions owing to the fact that recognition of preventive measures will go a long way towards containing the disease (Alqurashi, Aljabri & Bokhari, 2011, p. 20). As epitomized above, diabetes epidemic is widespread around the world. However, this essay is limited in scope and will only analyze its prevalence in Australia and Middle East with an aim of exposing both similarities and differences. Furthermore, this essay also aims at an analyzing the condition from a sociological point of view whereby the views of sociologists like Karl max, Goffman, Foucauldian ,Durkheim as well as Feminism concept will be integrated in this analysis. Most importantly, the essay begins with a background analysis of diabetes prevalence in Australia and Middle East as well as the Pathophysiology of the disease.

Background information

According to Eckel et al. (2004, p. 2968), the year 2000 world statistics stood at heartbreaking figure of 171 million patients. Experts warn that this figure might reach 366 million patients by 2030. Statistics in Australia from a research conducted between 2004 and 2005 estimated that around 700,000 Australians had diabetes mellitus type 2 (Australian Institute of Health and Welfare, 2006, p. 12). In addition, it has been regarded as a leading chronic condition and during the same period it was the cause of most hospital admissions in South West region of Australia (AIHW, 2006, p. 12). Prevalence cuts across all segments of the population ranging from old to young people regardless of gender or social class owing to the increasing habits of unhealthy consumption of foods as well as reduced physical activity among (Alqurashi, Aljabri & Bokhari, 2011, 20).On the other hand, owing to rapid industrialization in Saudi Arabia, people’s lifestyles have changed. This has exposed individuals to numerous lifestyles diseases like diabetes (Eckel et al., 2004, p. 2971). Since late 1980s, intensive studies have been carried out among populations to expose diabetes prevalence statistics. Conclusive results indicate an increasing trend (Eckel et al., 2004, p. 2972). The major risk factor that has been blamed for rising diabetes prevalence in Saudi Arabia is obesity. The latter has also increased cases of hypertension and coronary heart diseases (Alqurashi, Aljabri & Bokhari, 2011, 19).

Diabetes is an endocrine disorder characterized by chronic hyperglycemia syndrome, which is a consequence of inadequate production or action of insulin. This leads to a violation of all types of metabolism related to vascular lesions (angiopathy) and nervous system (neuropathy) (Eckel et al., 2004, p. 2968). Since the onset of the 21^st century, diabetes has acquired an epidemic character, being one of the most frequent causes of disability and mortality. It is within the first triad in the structure of the most common adult diseases: cancer, sclerosis, and diabetes. Among the chronic diseases in children, diabetes is also ranked third, behind the palm of bronchial asthma and infantile cerebral palsy (Eckel et al., 2004, p. 2971). The main causes of this increased morbidity are “urbanization, sedentary lifestyle, and defects in food, stress as well as the aging” population (Eckel et al., 2004, p. 2972).

Moreover, in order to understand the devastating effects of diabetes to the infected individuals as well as shed light on why the condition leads to high rate of mortality, it imperative to expose the pathophysology process of the disease as outlined below.

Pathophysiology of diabetes

The absolute lack of insulin decreases insulin levels due to violations of its synthesis or secretion of beta-cells of Langerhans cells (Ferri, 2009, p. 44). Relative insulin deficiency may result from decreased activity of insulin due to its high protein binding, enhanced destruction of liver enzymes and predominance of the effects of hormonal and non-hormonal antagonists of and changes in insulin sensitivity of tissues to insulin (Ferri, 2009, p. 55). This lack of insulin leads to disruption of carbohydrate, fat and protein metabolism and often accompanied by polyuria and polydipsia (Ferri, 2009, p. 54). Reduced formation and increased breakdown of fats increases ketone bodies in the blood such as acetoacetic, beta-hydroxybutyric and acetoacetic acid condensation product – acetone. Such occurrences may lead to shift in acid-base balance towards acidosis which contributes to increased excretion of potassium, sodium and magnesium in the urine. It also interferes with working of the kidney (Australian Institute of Health and Welfare, 2006).

These facts are vital in terms of setting objectives, identifying strategies and implementing those within the areas selected. Despite the extraordinary scientific and practical advances in medicine diabetes mellitus (DM) continue to be a widespread and serious illness, presenting severe health and social problem among affected individuals (Ferri, 2009, p. 52).

Epidemiology of diabetes in Australia and Saudi Arabia

The number of registered patients with diabetes in Australia is approaching 700 000 mark (12% of them are patients with type 1 diabetes). This represents approximately 3.5% of the total population (Australian Institute of Health and Welfare, 2006, p. 16). However, as evident from results of the epidemiological studies, the actual number of such patients is at least two times larger. Currently in Australia, diabetes affects about 1.5 million people (including those with latent and other forms of this disease), representing 5% of the total population (Australian Institute of Health and Welfare, 1999, p.12). As at 2003, one in four Australians over the age of 25 years were among groups of individual with diabetes or at risk of illness from this disease due to metabolic disorders. Diabetes is diagnosed in every 5^th Australian resident over the age of 65 years and approximately 70% of people aged over 50 are at risk (Australian Institute of Health and Welfare, 2006, p. 12). The number of patients with diabetes in Australia is increasing by 25-26 thousand annually. This high incidence is due not only to well-known risk factors but also demographic features of this multicultural country. In Australia, about 25% were born in other countries (Australian Institute of Health and Welfare, 2006, p. 26).

Approximately 30% of the population consists of immigrants and their children in the first generation. The Australian-born share of patients with diabetes is 3.0%, while among Australian residents born in the South, Central and South-East Asia, the figure ranges from 6.6 to 9.0% (Australian Institute of Health and Welfare, 2006, p. 46). Meanwhile, immigrants are becoming Australian permanent residents from these countries as well as other regions where the prevalence of diabetes reaches 7-8% or more (Australian Institute of Health and Welfare, 2006p. 22). For example, migrants from Southeast Asia, India, Bangladesh, Pakistan, Sri Lanka and others exceed 10-15% of the total Australian migrant population.

Other population groups at high-risk of diabetes are indigenous Australians. Among this group are adults (aged over 25). The Australian Aborigines who are more than 40% of the population suffer from diabetes.

There has been increasing cases of type 2 diabetes of late, not only among the elderly. Young adults and children are equally affected. The number of hospitalized patients with diabetes and its complications in 2004 was 1334per 100 000 sample of of vulnerable ppeople, which is three times higher than during the 1993-1994 period (Australian Institute of Health and Welfare, 2006p. 12). The major share of hospitalized patients with diabetes consists of individuals with heart and vascular diseases (40%), kidneys (30%), feet, etc. DM absorbs a significant portion of national spending on medicine, the average sum per patient ranged from $2500 to $4000, in general, reaching $ 3 billion per year (12% of health spending). The cost of servicing patients with diabetes in Australia on average is about 2 times higher than similar charges in the same populations of persons not suffering from this disease. There is evidence that the total cost per patient with complicated diabetes may reach 15 000 dollars a year or more. For the treatment of patients with DM with concomitant cardiovascular and other diseases the hospital spends 40-50% more than in the treatment of patients with similar diseases, but not suffering from diabetes (Australian Institute of Health and Welfare, 2006, p. 32).

One of the capacious expenses is procurement of insulin and other medicines. For example, 5 bottles of insulin with 10 ml each, depending on the brand manufacturer, was costing 50-90 dollars some five years ago (Australian Institute of Health and Welfare, 2006p. 23). Through the various subsidies of the Pharmaceutical Benefits Scheme (PBS), a prescription will cost no more than $33.30, and retired or concession card holder pays $5.40 with the PBS pays more than 80% of market value of the drug. It is predicted that this ratio will remain by 2025(Australian Institute of Health and Welfare, 2006, p. 23). In 1996, Australia has developed multi-faceted federal program for the National Diabetes Strategy (NDS), one of five national priority programs in the health care field. Particular attention in this program is devoted to the quality and availability of treatment of patients with DM. As in most other countries, such treatment is comprehensive and is based on generally accepted principles of modern treatment: a balanced diet, adequate physical activity, personal hygiene and healthy lifestyles, use of hypoglycemic medications, regular medical and self-control, early diagnosis and treatment of opportunistic diseases and complications (Ferri, 2009, p. 55).

For drug therapy in patients with type 2 diabetes (more than 85% of all diabetic patients) sulfa drugs are used of the second and (most) of the third generation, biguanides (metformin, etc.), derivatives of benzoic acid, etc (Ferri, 2009, p. 58). However in recent years a new class of drugs thiazolidinediones (glitazones, etc.) is used increasingly. The main advantage is their ability in a relatively small daily doses (6-10 mg) effectively increases the sensitivity of tissue receptors to endogenous insulin enhance its production by β-cells, to optimize the lipid metabolism. If necessary, thiazolidinediones may be combined with taking sulfonamides and insulin (Ferri, 2009, p. 52).

Nearly 24% of the population of Saudi Arabia suffers from diabetes, according to Saudi newspaper Al-Riyadh, citing data from the Ministry of Health of the Kingdom. The main reasons for this high level of morbidity are, according to experts, poor diet and sedentary lifestyle. As a result, approximately half of Saudi women and about a quarter of men suffer from obesity, frequent companions of which are diabetes and cardiovascular disease (Alqurashi, Aljabri & Bokhari, 2011, 19). The fight against diabetes in Saudi Arabia is placed on a nationwide scale. Only during the 2007 the country opened nine specialized medical centers eleven more were commissioned in 2008 (Eckel et al., 2004, p. 2968). Simultaneously, a national program to combat chronic illnesses government of the kingdom has been a widespread awareness among the population aimed at prevention and prevention of diabetes, cardiovascular diseases and cancer (Alqurashi, Aljabri & Bokhari, 2011, 19).

As outlined above, diabetes is to a greater percentage a lifestyle disease and statistics indicate that high levels of new infections are attributable to social factors than biological predisposition. Against this consideration, the disparities as well as similarities in epidemiology of diabetes in Australia and Saudi Arabia can be critically analyzed through the wider window of social theories which include; feminism,. Goffman view on stigmatization, Marxists and Foucauldian Social Theories and Durkheim’s view on religion.

The link between Social Theories and Diabetes

Feminism and diabetes

Generally, the concept of feminism was conceived amidst widespread outcry to liberate women from matriarchal perception that viewed women as lesser beings (Harkess, 2000, p. 153). Since its inception numerous feminists’ movements around the world have been established in an attempt to fight for equal treatments among men and women (Harkess, 2000, p. 153). Although, the rise of feminism has attracted much criticism especially in societies where patriarchal systems are deeply observed, its successful role cannot be overemphasized. Nonetheless, although the initial movements were rooted in political ideas, recent day movements encompass all aspects of women’s life and more importantly in health matters since healthy women would translate to a healthy world owing to the fact that women play a vital role in families and society as a whole (Harkess, 2000, p. 155). According to Harkess (2000, p. 160) women continue to be at risk of preventable diseases because of high level of illiteracy, poverty, unemployment and restrictive cultural practices. The above notion justifies the significant role of feminism movements to liberate women from practices that put a risk to their health. Harkess (2000, p. 162) further elucidate that though heath matters should be a concern of every member of the society, the feminist element of women health should not be overlooked because some biological elements of being a women puts them at a greatest risk to some disease prevalence as compared to men.

Apparently, diabetes prevalence has been associated with obesity. Moreover, more often than not obesity is a lifestyle condition that is linked to consumption of higher-fat diets and lack of physical exercises (Eckel et al., 2004, p. 2968). The lack of physical inactivity especially among women is more aggravated in Saudi Arabia owing to cultural and social practices that limit the opportunities for women to exercise (Eckel et al., 2004, p. 2970). However, it is imperative to mention that empirical researches indicate generally women are more inactive than women in terms of physical activity regardless of whether they reside in developing countries like Saudi Arabia or developed like Australia. According to Eckel et al. (2004, p. 2972) regular exercise has been attributed to myriad health benefits ranging from mental, emotional and physical well being. On the same note, regular exercise can go along way in preventing obesity and as a result eliminate or reduce risk factors of diabetes.

Contrastingly, the uptake of physical exercises to reduce diabetes prevalence among women in Australia may be facilitated with ease as compared to Saudi Arabia (Alqurashi, Aljabri & Bokhari, 2011, 19). In Australia, women are more liberated than in Saudi Arabia and all that is needed might be as simple as creating media campaign to promote physical exercise (Eckel et al., 2004, p. 2973).On the other hand, media campaign might do little in Saudi Arabia where women are still being oppressed by the patriarchal and religious perceptions of women. Walker (2009, p.6) underscores that in Saudi Arabia women shy away from physical exercises since it is forbidden in fatwa, though covertly. This controversial fatwa which is deeply embedded in Islamic religion forbids women from physical exercises since it requires women to stay at home and look after their children. Moreover, women are treated as a home jewel and unless it is very necessary their husbands run the households errands; thus even the least opportunity to engage in physical exercise such is walking is most of the times unavailable (Harkess, 2000, p. 152). The above situation calls for deliberate and aggressive measures to promote the uptake of physical exercises among women in Saudi Arabia. As epitomized above, feminism seeks to empower women so that they can be in charge of all aspects of their life. According to Harkess (2000, p. 155) empowerment of women through feminist movements in US to promote sports and subsequent self esteem have yielded positive results. Similarly, the same strategy can be adapted in Saudi Arabia owing to the fact in recent year’s diabetes prevalence among women in Saudi Arabia have exceeded that of men.

Walker (2009, pp.2-17) also supports this notion that physical exercise is the way to go if the epidemic of diabetes in the world is to be controlled from further incapacitating the population. He quotes a recent study that indicated that physical exercise and the resultant weight loss could reduce the incidence of diabetes by approximately 58 percent. To revisit the issue of feminism and women heath issues it is imperative to mention women generated and led campaigns are likely to succeed in promoting physical exercises among women both in Saudi Arabia and Australia.

On the same note, whereas there are established network like Australian Women’s Health Network in Australia to promote health issues among women, such incentives are lacking in Saudi Arabia (Eckel et al., 2004, p. 2970). This further exposes the need for introduction of feminist ideas in Saudi Arabia to liberate their women from patriarchal and religious oppression. As epitomized elsewhere in the paper, consistent care for diabetic patients is necessary to promote positive living. However, most women in Saudi Arabia are unable to access health care due to the fact that they have to obtain permission from the men in their lives of which it is not always granted (Walker, 2009, p.2). Furthermore, these men also have to give consent incase women are to be admitted in hospital as well as to medical procedures (Walker, 2009, p.2). It is obvious that some cases of diabetes sometimes require urgent medical attention and the above social and cultural puts a woman’s health at risk. Therefore, the few feminist movements in Saudi Arabia should incorporate health matters in their agenda to promote physical exercises and curb practices that hinder access to medical care (Harkess, 2000, p. 152).

Goffman view on stigmatization its implications to diabetes prevention

Empirical researches have indicated obesity predisposes an individual to diabetes mellitus and other types of lifestyles diseases. The prevalence of obesity is more prominent in developed than developing countries although the situation is changing as world economies improve (Eckel et al., 2004, p. 2968). Statistics indicate that obesity prevalence has been on the rise in Australia for the last 20years and this trend will continue if appropriate measures are not adopted. Currently the figure stands at 20.5 % with men leading at 67.4% and women at 52% (Australian Institute of Health and Welfare, 2006, p. 22). The above statistics is alarming and the government should be prepared to dig deeper in healthcare allocation if timely measures are not implemented to reverse the situation. According to Eckel et al. (2004, p. 2968) treatment of obesity in most worldwide healthcare settings is greatly hindered by lack of prioritization of obesity as a health risk condition. Physicians are sluggish in identification and treatment of obesity partly because of lack of adequate and efficient tool. The gravity of the matter is the stigma associated with obesity whereby such individuals are blamed for their situation owing to the fact that societies associate the condition with overeating (Rochon, 2008, p. 8).

On this note, stigmatization of obese patients can be linked to the social and cultural setting of the society. For instance, in ancient Greek society an individual was stigmatized by society if at all they exhibited any usual portray of health complication (Rochon, 2008, p. 8). Goffman a 19^th century sociologist expounded on the concept of stigmatization and highlighted that it arose depending on the social expectations embedded in a particular culture. This implies that the negative perception about obese individuals by some physicians arises due to the same perceptions within the society. Goffman further expounds that society tend to stigmatize individuals if their behavior and appearance falls short of the expected standards (Rochon, 2008, p. 10). On the same note, obese people tend to be isolated because the stereotypical view in the society that obesity is due to overeating exposes them to stigmatization. According to Eckel et al. (2004, p. 2971) prevention of obesity should begin at societal level whereby members are required to adjust their socio-cultural towards healthier lifestyles. However, the above strategy might prove to be impossible if obesity continue to be a concept of stigmatization (Rochon, 2008, p. 13). Besides, adequate campaigns to change the mindset that an individual is to blame for his or her illness are the way to go in creating acceptance that obesity is a disease that calls for effective preventive and curative measures (Rochon, 2008, p. 11).

Durkheim’s view on religion; implications to diabetes prevalence among women in Saudi Arabia

As highlighted elsewhere type 2 diabetes is the recent epidemic in the world and Saudi Arabia is not spared from this catastrophe and apparently it has been associated with high mortality rates (Alqurashi, Aljabri & Bokhari, 2011, 20) in this region. Diabetes prevalence in relation to age, social class and gender varies from country to country due to lifestyle differences that are informed by culture. However, it is imperative to mention that diabetes prevalence in relation to gender in Saudi Arabia indicates a different pattern in comparison to other countries like Australia (Alqurashi, Aljabri & Bokhari, 2011, 21). Whereas diabetes mellitus prevalence among men in Australia as well as in most countries surpasses that of women, the situation in Saudi Arabia is slowly changing whereby recent research statistics as shown below indicate that women more prevalent than men to diabetes mellitus epidemic (Alqurashi, Aljabri & Bokhari, 2011, 22). As indicated elsewhere, diabetes mellitus is more of a lifestyle disease whereby factors such as obesity and physical inactivity predispose individuals to the disease. However, society has a role to play in this new discovery since patriarchal and religious perceptions of women roles puts them at a risk (Walker, 2009, p.2).

Figure: Male/Female distribution (%) of Diabetes Prevalence (IDF, 2010).

According to Harkess (2000, p. 158).) women health orientation is shaped by societal perceptions and as explained above fatwa confines Saudi Arabian women to their homes without any leeway to get access to physical fitness programs or access to medical care for those who are already affected (Walker, 2009, p. 12). The fact that Islamic religion seems to yield oppressive results among Saudi Arabian women as compared to their fellow counterparts in Australia undermines Durkheim view that religion reinforces societal values (Walker, 2009, p. 12). Durkheim viewed religion as a unifying factor that directed society to observe sacred practices and beliefs. Moreover, he believed that religion provided significant guidelines for fruitful social life. Nonetheless, whereas this view was significant in creating and maintaining a harmonious society it has no place in modern society since numerous changes calls for diversified and flexible religious view ( Alqurashi, Aljabri & Bokhari, 2011,p. 20).Walker(2009, p. 8 ) underscores that although the role of religion in society should not be despised, oppressive religious practices have no place in modern society. As a matter of fact, Durkheim observation was based on Australian aborigines, but the practice by these society is not comparable to Islamic practices in Saudi Arabia that views women as lesser and voiceless beings. This negative view of religion is also accentuated by feminists who perceive religion as a foundation upon which oppressive patriarchal ideologies are executed (Harkess, 2000, p. 156). Therefore, measures that are aimed at reducing diabetes mellitus prevalence among women in Saudi Arabia should first address these religious shortcomings.

Marxists Social Theory

Social development, according to Marx (Paolucci, 2008, p.352), is in accordance with certain laws, by which he means the “internal and necessary connection” between events. Marx believed in the existence of universal and immutable historical laws that underlie the development of humankind. He believed that the contradictions, the struggle of opposites are the sources of the driving force for development. The ascent from the abstract to the concrete he is considered as a general scientific method of cognition (Paolucci, 2008, p.354).

Theory of classes and class struggle is central to the teachings of Marx. In his work, he does not define the class, although the definition of the reconstructed on the basis of his works there. Classes, according to Marx are social groups that are disadvantaged and struggling with each other, but in a narrower sense, it is social groups that differ in relation to property, especially to the means of production (Paolucci, 2008, p.355)

Marx saw class in terms of ownership of capital and means of production, dividing the population into property owners and the poor, the capitalist class and the proletariat. He acknowledged the existence of groups that do not fit into this framework (such as farmers or small proprietors), but argued that they represent the remnants of pre-capitalist economy, which will disappear as the maturation of the capitalist system (Owen & Powell, 2006, p.112). Category class for Marx means something more than a simple means of describing the economic positions of different social groups – classes, he considered as a real community and real social forces that can change society (Paolucci, 2008, p.379)

Marxist theory can be applied to the epidemiological data to explain the variations in presentation in the population who are diabetic because the concept of spheres of public life captures the social being as a one that characterizes all of the relevant phenomena of social life in its entirety, and in this meaning serves as an important independent category of historical materialism. Spheres of public life:

Economic is characterized by unity of productive forces and production relations and processes of production, distribution, exchange and consumption of material means of subsistence, etc. Serves primarily as the foundation of society and all other spheres, as the leading cause of the condition and background of the historical process, for people to “make history” should live, to have the material means of life. It represents the highest manifestation of the need and at the same freedom in society, becoming a kind of vector for all other spheres of public life, the matrix, the benchmark, on the model which they construct (Paolucci, 2008, p.365).
Social Network. Human society is a complex collection of different groups, their relationships and interactions, i.e, it is socially structured. Stable social ties between certain people are reflected in the features of lifestyle of this social group, in the unity of the needs, interests and value orientations, behavioral and other characteristics of public individuals. Certain aspects of basic and superstructural phenomena are “synthesized” into a single entity – a real community of people who have, along with economic and depending on them and other features of their social image (Paolucci, 2008, p.366).
Political. Politics is the first ideologically organized social force. Setting in motion classes and the masses, it becomes a means of resolving the pressing social contradictions, including the contradictions of the economic sphere. The policy sets dependent on political decisions and actions, the way how to implement their demands, accelerating, delaying or speeding up in one plan, and in another delaying economic development. In a class society, economic relations cannot exist without state-legal services (Paolucci, 2008, p.358).
Spiritual – purposefully organized society, the spiritual life. It is divided into subsystems: the ideological, scientific, artistic and aesthetic life, education, education. Important role in the spiritual realm is a religion (Saudi Arabia). Each of the subsystems of the sphere covers a certain fragments of the public consciousness. However, these subsystems are not limited to public consciousness. They presented in activities of the productive side of the spiritual life, ie, the very activity of production, distribution, circulation and consumption of spiritual values. It is institutionalized, i.e, organized in the form of certain social institutions. This area grows from literally all aspects of social life. Synthesizing the most common measure of all entities of the spiritual sphere is that in each of consciousness is a kind of center around which they unite with each other. Consciousness is the result of certain activities (it is), and the product (it is consumed) and means (it is – then, by what we get new spiritual values), and the immediate goal (for the sake of it are academic institutions, education, art, Church, etc.) (Paolucci, 2008, p.371).

To study the functioning and development of major areas of public life, which is based on the allocation of the most important and generally homogeneous social processes, it is essential to the characterization and analysis of society as a social organism. The division of social life on these areas allows people to study society as it is structural integrity, to identify the contents and features of the functioning of these spheres, their objective relationship and mutual dependence. Based on the scientific understanding of the nature of their interaction can consciously influence on the development of society. The problem of the scientific management of society is one of the central problems in Marxist sociology, although it has not been effectively solved in practice (Paolucci, 2008, p.369).

Foucauldian Social Theory

Foucault has updated the methodology of the research of the society (Owen & Powell, 2006, p.118). He believed that the traditional analysis of state institutions does not exhaust the field of functioning of government. Open question remains: who has the power and where? According to Foucault, the nature of power can be understood only in the context of historically defined social practices. Archaeological findings of the Foucault offers us a history of bodies: psychic, erotic, and the condemned prisoners, obedient and rebellious, or rather not so much the same body as the history of a certain type of bodily practices. According to Foucault, European “identity” would be impossible without various technologies of supervision, training, education, exams (surveillance) (Owen & Powell, 2006, p.118).

Individual, of course, is imagined as an atom of “ideological” picture of society, but also, it is present in a reality and set up for action – the specific technology of power, called “discipline”. By definition of Foucault, “discipline” cannot be identified either with some kind of institution, or with some device; discipline is a type and art of power, how its implementation is linked with a whole set of tools, methods and techniques. Not that kind of disciplinary authorities replaced the rest of varieties – it just could cultivate in them and at the same time made it possible to prove the influence of authority up to the most remote, least important elements of the society (Owen & Powell, 2006, p.112).

Disciplinary (control) society makes the individual carefully, following the tactics of the required forces and bodies. The disciplinary authority finds its own power largely through organizing objects. Therefore, those on whom it operates, seeking to individualize louder – through supervision, observation, comparative measures as a starting point rules “norm” (Owen & Powell, 2006, p.115). At the end of the classical era normalization power standards was one of the great instruments of power. In a sense, “norm” makes for uniformity, but it also can individualize, allowing measurement of the indentation, to determine the level specialization register and use differences. “Norm” was confirmed together with the introduction of standardized education and establishing educational institutions, established a rate of adjusting production processes. Government standards combined with other types of power (power law, power words, tradition), forcing them to new era of command (Owen & Powell, 2006, p.117).

The principle behind the schedule time, in traditional form, is inherently negative. This is a principle of avoiding idleness: forbidden to waste time that it dismissed by the Lord of time and routine is to prevent dangerous waste – moral issues and economic dishonesty. Instead, discipline make positive economics, in theory puts forward the principle of increasingly better use of time. This means that the attempt to intensify the use of the slightest moment, as though as a detailed internal arrangement can attain the ideal point where the maximum speed combined with maximum efficiency.

Exams are normative control, supervision, allowing qualified to classify and to punish. In all disciplinary institutions exams are much ritualized, they are combined with the ceremony of power, manifestation and detection power of truth (Owen & Powell, 2006, p.111).

Training was characterized by individual and complete dependence with the aim of mastering constant length of study. Moreover, it contained family aspects. Discipleship in this tradition is an ending challenge – a “masterpiece” which reaffirmed the already carried out the transfer of knowledge, but this test did not meet certain program.

Exams radically change the visibility of the exercise of power. Traditionally, government – is that visible that show and those on whom power operates, may remain in the dark, they can illuminate and perhaps share power, they retreat, or instant glare effect that makes them the power. Instead, disciplinary power operates, while remaining invisible, but they raised their obnoxious principle of compulsory visibility. Exam was the mechanism, using which the government catches and drives to subjects in the mechanism of objectification (Owen & Powell, 2006, p.116).

In Foucauldian theory, regardless of the patient visiting a specialist endocrinologist GPs continues to regularly monitor patients, in case it is necessary to forward the patient to other relevant specialists for other diagnostic tests. Based on the results of laboratory and other studies, patients can learn about their condition from their GPs. If desired (this makes a remark of GPs in the appropriate blanks on the direction of analysis) the patient can quickly get an analysis on home fax or mail. (Owen & Powell, 2006, p.114)

Due to the Marxists social production theory – healthy food costs more and this is why diabetes is over represented in low SES communities (Owen & Powell, 2006, p.116). Relating food with diabetic patients is an important element of their therapeutic and prophylactic treatment. An extensive range of commercially available variety in composition and cooking properties of foods and products allows knowledgeable patients to buy those that are recommended for consumption among diabetes mellitus patients (Owen & Powell, 2006, p.116). Patients with diabetes are recommended that the ratio of the major energy-consuming nutrients is as follows: carbohydrates – 45-60% (including the share of sugar – no more than 10%), protein – 12-15% (in Japan – 15-20 %), fat – less than 35% (including saturated – up to 10%).Widely exhibited and well-known in Australia is the “food pyramid” with a list of foods according to their biological value and usefulness, which includes three grades: acceptable in small quantities or even excluded from the daily diet foods (animal fats, sugar, fatty meats, etc.); moderate consumption of foods (fish, chicken, eggs, dairy, etc.), healthy foods (fruits, vegetables, whole meal bread, etc.) (Australian Institute of Health and Welfare, 2006, p. 28). In order to maintain the familiar taste of foods and products some of them added by various sweeteners, often aspartame, sucralose, saccharin, acesulfame potassium, isomalt. DM patients have available popular literature and reference books with recommendations on diet for diabetes (Owen & Powell, 2006, p.117).

Conclusion

In a nutshell, it is imperative to note that diabetes epidemic may gradually transcend into one of the worst killer if appropriate measures are not taken to contain further spread. On the same note, early diagnosis of diabetic patients is necessary in order to contain its devastating effects. However, this might prove to be difficult in low income countries such as Saudi Arabia largely due to financial constraints among most of the population. From the essay, it is evident that the possibility of early diagnosis of diabetes among Australian population is higher than Saudi Arabia due to improved health measures courtesy of the Queensland government. Correspondingly, the negative effect of financial constraints on population’s health as highlighted in the essay should be viewed from the wider scope of Marxists and Foucauldian social theory.

On the same note, it is evident that both Australia and Saudi Arabia are afflicted by this epidemic although the latter is hard hit owing to the rapid rate of new diagnosis. As evident in the above analysis, the emerging prevalence of diabetes among Saudis can be attributed to unhealthy eating habits. The above notion can also be analyzed under Marxists social theory due to the fact that most of the inflicted population is unable to afford healthy meals; thus accelerating diabetes epidemiology in this region. Additionally, diabetes prevalence among women is higher in Saudi Arabia than Australia and this situation can be attributed to negative religious practices that discourage women from taking part in outdoor activities. The negative impacts of religion on women’s health in Saudi Arabia emphasize that Durkheim’s view on the unifying element of religion has no place in modern society. Similarly, the increasing diabetes prevalence among women in Saudi Arabia implies that feminism movements are highly significant in Saudi Arabia in order to liberate women from religious and societal oppressive practices that tend to accelerate their prevalence to diabetes. Finally, Goffman’s view on stigmatization can be used to capture societal and practitioners’ stereotypical perception that obesity is a self inflicted condition. Perhaps, by eliminating this negative view, both the society and practitioners will commence positive journey towards the reduction of incidents of obesity among affected populations and by so doing, reduce prevalence of diabetes.

References

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