Intervention

The intervention I plan on implementing is requiring physical education and health classes throughout all schools.  In order to implement this intervention, first the school board and curriculum organizers must be contacted.  They must agree to make these classes required for all ages from first to 12th grade. Curriculum organizers must put together these classes and determine what is to be taught.  The physical education classes should have at least 30 minutes of class time in which the students participate in a fairly rigorous exercise activity.  The health classes should be designed to include nutrition education and also education on how to maintain a healthy lifestyle and the consequences of not being healthy.

For this strategy there are not a lot of barriers.  Cost is always a factor because more teachers would need to be hired and instructed for these classes and various learning tools will be needed to supply these classes adequately.  The school will have to look at their budget and cut costs on things that seem unnecessary in order to fuel this project.  Another barrier could be designing the class structure and what is going to be done in the class time.  The curriculum organizers can meet with nutritionists and doctors in order to come up with a proper education plan.

A key stakeholder that would need to be communicated with is the children's parents.  The school can send home letters and email the parents informing them on the cirriculum change.  The health classes can email the parents once a week to briefly let the parents know what was covered in class and could potentially create healthy habits at home.  The physical education class could encourage the parents to help their child get another 30 minutes of exercise each day.

To evaluate the intervention, we would need to take health screenings of the kids before the program and then take health screenings of the kids after the program.  By tracking their progress in a years time, we can evaluate if it was effective or not.  My expected outcomes for this intervention is moderate.  I believe that it could help change the life styles of some of the younger students, but the older students tend to be more apathetic.

Intervention

Once a problem has been defined, public health officials then strategize different interventions that could be implemented to prevent or treat the problem at hand.  In the case of my topic, type 2 diabetes in children, there are not many interventions in place because it is still fairly rare, but yet a growing issue.  Most interventions aim to prevent or treat obesity, which is believed to be linked to type 2 diabetes occurring in children.

         CARDIAC Kids in Tennessee is an intervention program aimed at changing the eating and exercise behaviors of elementary school children.  The program also aims to involve families of overweight/obese kids to learn about better eating habits and activity levels.  The first part of this program is nutritional intervention.  The children learn about different foods and how they affect their diet.  The second part is physical activity intervention where the kids engage in physical activity for 60 minutes.  The final part is parental/family participation in the activities.  KEY DETERMINANTS!!!!

         There are three different classifications of interventions: primary, secondary, and tertiary.  Primary intervention is a prevention strategy to help a group of people before they get into a situation that would need aid.  Secondary intervention is providing services to the at-risk group.  Tertiary intervention is helping the at-risk group after the fact.

         A possible intervention strategy for this topic can be health screenings for children aged 10-19.  These health screenings should test for blood sugar levels, blood pressure levels, and BMI.  All these things indicate a potential for being diagnosed with diabetes.  If any of the results show that they are at risk, the doctor will educate them on how to avoid becoming type 2 diabetic through nutritional education and lifestyle education.  The stakeholders for this would be the children and doctors.  The key determinants this intervention will address would be biological.  This would be mostly a primary strategy, but the follow up with the doctor would make it partly secondary because of the educational aspect.

         Another possible intervention could take place in schools.  Local governments could pass a law pertaining to dining options in school cafeterias.  School dining halls could be required to offer healthier food options and meals.  There could also be a restriction on fatty foods being sold in the cafeteria; or the unhealthy food could be eliminated all together.  This would be classified as a secondary strategy.  There is actual physical intervention being made.  The key determinants this would address would be environmental and economical.  Stakeholders for this would be the children, dining hall staff, local government, school board, and food supply companies. 

         A third intervention could be an educational program in schools.  Schools can require their students to participate in physical education classes and take health and nutrition classes. Students would get at least 30 minutes of physical activity a day.  They will also learn about their health and how to create a healthier life style for themselves.  The key determinant this addresses is environmental and social.  This strategy is educational and physical so it would be partly primary and partly secondary.  The stakeholders involved would be the children, health and physical education teachers, school board, and local governments.

         Although studies show educational programs are not always the most successful, I feel that the third intervention involving education and gym in schools will be the most successful.  This strategy requires the kids to be active for part of the day.  They are able to get physical activity in school in case they don’t get any at home.  Here, they are also able to learn about healthy lifestyles and eating habits.  I feel like once kids become educated on their health, they will be able to make conscious good decisions regarding it.

Stakeholders

            In public health, once a problem has been identified, intervention strategies are hypothesized.  When thinking of potential interventions, one must think of the people or things that will be affected by each intervention.  These are called stakeholders.  Stakeholders are people, organizations, or other groups who share a stake in the issue at hand.  These people may be directly affected by the problem or solution to the problem.  Stakeholders can also have something to gain or lose by an intended intervention or solution on a topic.

            For my public health problem, the major stakeholder would be children ages 10-19 with and without type 2 diabetes.  Other potential stakeholders would include the parents of children ages 10-19, local/state officials, local governments, school physical education programs, school dining programs, medical clinics, nutritionists, hospitals, and potentially many more depending on the intervention at hand.

            The stakeholders that would need to be negotiated with would be parents, governments, school physical education programs, and school dining programs.  Health care providers may need to discuss with parents of these children healthier eating and exercise habits and lifestyles.  Government can go hand in hand with the schools depending on the specific intervention.  Government can pass certain laws requiring schools to have physical education and health classes so students will be able to get exercise and learn how to take care of their bodies.  Government could also potentially pass laws pertaining to the school’s cafeteria options.  They can require the school’s to have healthier options available and plenty of them.  They also can restrict how much fatty foods are for sale. 

            The children may also have to be negotiated with.  They might need to be persuaded to accept healthier options and participate fully in their physical education classes.

            Interventions to consider could be educational programs.  Schools can implement health classes to educate children on correct eating habits and ways to lead a healthy lifestyle.  Also implementing physical education classes in school can be helpful.  Making sure kids get exercise everyday can improve their health.  Schools could also prohibit fatty foods from their dining halls so kids cannot purchase them.  In alternative, the dining halls can be supplied with healthier food options.  Those who are at risk for type 2 diabetes and those with type 2 diabetes can meet with nutritionists to give them dieting tips and meals they can make in order to keep a healthy eating habit.

            Stakeholders that would be opposed to this could be manufacturers of unhealthy food products.  They would lose business if all schools implemented the intervention of no unhealthy food.  To address their concerns, they could create a healthier alternative to their food that could be sold in the dining halls.  For example, how Lays started manufacturing “baked” chips.

Key Determinants

Emergence of Type II Diabetes Among Children Ages 10 to 19 in the United States Over The Last 15 Years

           Biological determinants refer to the anatomic, physical, or medical/clinical reason that a problem might exist.  Pertaining to my problem definition, a biological determinant of type 2 diabetes in children would be obesity.  Being overweight or diagnosed with diabetes.  In a report, Chronic Disease—Diabetes At A Glance (2011), published by the CDC discussing diabetes, it stated, “Type 2 diabetes accounts for 90-95% of diabetes cases and is usually associated with…obesity and physical inactivity, family history of type 2 diabetes…”  Type 2 diabetes is caused by obesity and in the American Heart Association’s most recent report (2013) states “23.9 million children ages 2 to 19 are overweight or obese”.  This high and rising rate of obesity prevalence among children will eventually lead to type 2 diabetes development.  Another biological determinant is the child’s family medical history.  Children are more susceptible to getting diabetes if someone in their family has previously been diagnosed with diabetes.  Parents also have a huge influence in their child’s weight.  Michelle L. Brandt (2004) reports from the Stanford Report that “the factor that puts children at greatest risk of being overweight is having obese parents.”

            Social and cultural determinant include social class, social environment, peer influences, religion, ethnicity, norm of a particular group of people.  The American Diabetes Association writes that there are certain factors that make a person susceptible to type to diabetes that a person cannot change about their self.  One of these things is race.  “African Americans, Mexican Americans, American Indians, Native Hawaiians, Pacific Islanders, and Asian Americans have a higher risk for (diabetes)”. 

            Environmental determinants might include weather conditions, geography, air quality, levels of pollution, urban living vs suburban living, and so forth.  In the past few years a new term has emerged, “food deserts”.  The Johns Hopkins Center for a Livable Future states that a food desert is an area that does not have easy access to healthy foods, typically in the form of a supermarket.  People living location can affect their access to certain foods and could potentially affect their diet.  In these food deserts, healthy food is virtually unattainable and fast food is more easily accessible.  Another environmental determinant could be the safety of one’s living environment and ability to exercise outside or at a local rec center.

            Economic determinants refers to issues related to money, but can be thought of both from an individual level, but also as a community level.  In the situation with diabetes, economical and environmental determinants go hand in hand.  The people living in the food deserts are typically ones of lower socioeconomic classes.  These people do not have access to healthy foods, but even if they did, the costs of those food would be too high.  Poorer people don’t always have the best nutrition because they cannot afford the healthy foods that contribute to a balanced diet.  The CDC’s data report called Obesity and Overweight for Professionals: Childhood (2013), that “1 of 7 low-income children is obese.”  When low-income people are diagnosed with diabetes, it is extremely detrimental.  Andrea Janus (2010) reports on the relationship between poverty and type 2 diabetes.  “What we know about type 2 diabetes is not only are low-income and poor people more likely to get it, but they’re also the ones that, once they get it, are much more likely to suffer complications.” 

            Political determinant are usually though of as the factors that occur because of the executive, legislative, or judicial decisions, or behaviors that exist during a particular time period.  There are not necessarily any specific political determinants that directly affect the cause of type 2 diabetes among children and adolescents.  One that could possibly fall under this category is government funding for health insurance.  If children are being raised in low-income families, then the typically won’t get quality medical care or any medical care at all.  Medical care is important because health professionals can educated the patients on diet and exercise and can track a obesity problem in children and treat it before diabetes results.

Work Cited:

"Age, Race, Gender & Family History - American Diabetes Association." American Diabetes Association Home Page - American Diabetes Association. N.p., n.d. Web. 6 Apr. 2013. <http://www.diabetes.org/diabetes-basics/prevention/checkup-america/nonmodifiables.html#Race>.\Brandt, Michelle. "Obese parents increase kids' risk of being overweight." Stanford News. N.p., n.d. Web. 6 Apr. 2013. <http://news.stanford.edu/news/2004/july21/med-obesity-721.html>."CDC - Chronic Disease - Diabetes - At A Glance." Centers for Disease Control and Prevention. N.p., n.d. Web. 6 Apr. 2013. <http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm>."Obesity and Overweight for Professionals: Childhood: Data | DNPAO | CDC." Centers for Disease Control and Prevention. N.p., n.d. Web. 6 Apr. 2013. <http://www.cdc.gov/obesity/data/childhood.html>. "Overweight & Obesity Statistical Fact Sheet 2013 Update." American Heart Association 1 (2013): n. pag. American Heart Association. Web. 4 Apr. 2013.

Magnitude and Indicators

Emergence of Type II Diabetes Among Children Ages 10 to 19 in the United States Over the Last 15 Years

            Type 2 diabetes was primarily known as adult-onset diabetes diagnosed to overweight patients in their late 40s and older.  However, over the last two decades or so, pediatricians have seen an alarming increase of this disease being diagnosed in children.  Diabetes is one of the most common chronic diseases in children and adolescents.

            Type 2 diabetes has been described as a new epidemic affecting the American pediatric population.  In 1992, it was rare to see a case of type two diabetes in children.  Pediatric centers reported 2-4% of patients were diagnosed with type two diabetes.  In a two-year time span, this percentage jumped to 16%.  In the past decade, this number has increased to an astonishing 33% and is continuing to increase at a rapid rate.  We see from this data how much this epidemic is growing.  In a matter of two decades this disease went from extremely rare or nonexistent to becoming a national epidemic.  If this disease isn’t controlled, prevented, and treated, a third of all children born in the year 2000 will be diagnosed with type 2 diabetes.    

            In response to this growing epidemic, the CDC partnered with the National Institutes of Health in 2000 to fund the SEARCH for diabetes in youth.  In 2001, SEARCH observed 3.5 million children under 20 years of age under active surveillance to estimate how many children had diabetes.  They observed that 154,000 kids had diabetes and type 2 diabetes was a rare occurrence.  SEARCH continued their surveillance from 2002 to 2003 but of 5.5 million children less than 20 years of age.  They estimated that the overall incidence of diabetes is estimated to be 24.3 per 100,000 per year.  Fifteen thousand youths are diagnosed with type 1 diabetes in a year.  Three thousand, seven hundred are diagnosed with type 2 diabetes a year.  The rate of new cases for individual’s under the age of 20 is 5.3 per 100,000 per year for type 2 diabetes. 

            The number of children aged 10-19 in the United States with type 2 diabetes would be a direct indicator.  There are currently 154,000 children in the United States diagnosed with this disease.  The percentage of children with diabetes that have type 2 diabetes, 30-40%, is also significant.  Blood pressure and blood sugar levels of children can also be an indicator of type 2 diabetes.  Also the percentage of children who have the potential to become diagnosed with type two diabetes would be a direct indicator. 

            Indirect indicators for type 2 diabetes would be rising obesity rates in children.  Eighty percent of all children who develop type 2 diabetes are either overweight or obese.  This statistic would be reliable because it is calculating a child’s BMI and not subject to any bias.  Another indirect indicator would be inactivity in children.  When children aren’t active, they tend to gain more weight, which can also be a cause of diabetes.  Children spend more time inside watching TV and playing on electronic devices rather than going outside and getting active.  You could look into the statistics of how many children aged 10-19 are active regularly.  Genetics could also be a indirect indicator.  The statistics of kids who have parents that are overweight or have diabetes is significant.

            For the direct indicators such a the number and percentage of kids with diabetes can be very accurate and inexpensive.  The data for this can be collected through surveillance by reports from pediatricians.  However, it might be subject to a little bias because not all children go to the doctors office.  For children inactivity, the results will not be completely reliable.  These results are based solely off of the information that children report.  There is no telling whether or not these children were truthful in the survey.  Also genetics can be reliable but also have the potential of being unreliable.  If the researchers access the parents’ medical records they would be reliable data.  However, this can be considered an invasion of privacy.  Avoiding the invasion of privacy, researchers would have to rely on the parents reporting their data.  Which these results can also be skewed based off the honesty of the parents and the parents who are willing to fill out the survey. 

Work Cited:

http://diabetes.niddk.nih.gov/dm/pubs/statistics/#ddY20

http://www.cdc.gov/diabetes/projects/diab_children.htm

http://www.cdc.gov/diabetes/projects/cda2.htm

http://care.diabetesjournals.org/content/23/3/381.full.pdf

Emergence of Type II Diabetes Among Children Ages 10 to 19 in the United States Over The Last 15 Years

Emergence of Type II Diabetes Among Children Ages 10 to 19 in the United States Over The Last 15 Years

            Just a few years ago, it was rare to diagnose a child with type II diabetes.  But over the last few years it has become more and more common.  Diabetes is one of the most common chronic diseases in children and adolescents.  About 151,000 people below the age of 20 years old have diabetes.  Type I, or commonly referred to as juvenile diabetes, is typically the type of diabetes seen in children.  This type occurs because the patient’s own immune system mistakenly destroys the cells in the pancreas that makes insulin, a hormone needed to control blood sugar levels.  Type II diabetes is thought to be brought on by obesity and inactivity in people who have a genetic predisposition to develop the disease when they gain weight.  Their pancreas still produces insulin, just not enough and the body does not use it properly.  Type II diabetes was typically seen in overweight to obese people aged 40 years or older.  However, starting in the 2000s, it started becoming a childhood problem.

            Diabetes among children is a new and emerging disease.  So new that doctors are still conducting research on the disease.  Scientists are coming up with new ways to try and treat diabetes in children.  Diabetes is a serious disease.  With it comes many other health problems.  Children now how have to live their lives with these health problems lingering over their lives.  Type II diabetes is hard to detect in children because it can go undiagnosed for a long time. 

            I found this topic interesting because there is so much talk today in the public health world about obesity.  This topic is a direct affect of it.  It shows people that obesity is actually causing harmful problems.  A disease that was uncommon for children is now emerging is such high rates.  It’s project emergence for the future is also scary.  It is such a rapidly growing disease.  This topic interested me because it is a preventable disease.  It is also a disease that can go away through certain measures.  I am interested in how the CDC plans to take action against this disease and what programs they will implement to help prevent and treat it.

            This disease is socially relevant because of the high rates of obesity this country is experiencing now.  This disease is a direct result of the rates of overweight people.  People talk about obesity and how harmful it can be to your health.  Finally, the emergence of diabetes in children at such high rates directly shows how harmful obesity can be to children’s health.

"Contagion"

            This week, I watched the movie Contagion, which follows the path of a deadly airborne virus as it makes its way around the world.  The movie depicts how highly contagious viruses are spread and how easily they are contracted through simple everyday motions one would not even think about second-guessing.  As the disease spreads rapidly and its toll on the population greatens, public health organizations desperately work to contain the disease while working with scientists work to create and then distribute a vaccine to stop this epidemic.  Watching this movie for the first time, I was struck with paranoia.  Every time I heard someone cough, I would tense up.  I applied hand sanitizer on my hands more than I ever had in my whole lifetime.  I particularly enjoyed the last scene of the movie, in which the origin of the disease is shown and how it transfers to its first victim.  It shows how easy a disease can be started and how careful we should be with our hygiene practices.  With public health knowledge, I was able to see how public health officials reacted in such a desperate situation. They worked with epidemiologists and scientists to create a vaccine to cure the disease.  They also went through extensive measures to prevent the disease from spreading further.

            An outbreak is an occurrence of a disease in more cases than expected within a specific place or group of people over a given period of time—a sudden increase in the incidence of a disease.  The movie’s plot is driven by the outbreak of the deadly disease.  We can see the outbreak as the virus transfers from animals and then human-to-human.  When pandemonium hits the public health organizations, the rising number of cases seems much higher than expected or hoped for.  Outbreak investigations are done by epidemiologists and public health officials to help identify the source of an ongoing outbreak and prevent additional cases from occurring.  In the movie, we see public health officials working to try to find a place of origin of the disease, how it was transmitted, and how to create a vaccine to cure it.  Isolation and quarantine are public health practices used to stop or limit the spread of disease.  Isolation is used to separate those who have been infected with the disease from a society where people are healthy.  In the movie, the people who had the disease were taken into medical institutions in order to prevent greater spread of the disease.  Quarantine is when people who have been exposed to the disease are separated from society.  Doctors then observe them to see if they become ill with the disease as well.  After his wife and son died from the disease, Mr. Emhoff was placed in quarantine due to his exposure to the disease from his close family.

            A major sector of public health is preparedness.  In the movie, the public health agencies were unprepared in their immediate response to the outbreak.  The hospitals were not prepared for such a large-scaled disease.  They filled beds up so quickly and patients were kept too close.  This further allowed the disease to be transmitted easily.  There was also a lack of hospital staffing.  Doctors and nurses treated the ill and put themselves in risk of contracting the disease as well.  Once they did develop the disease, there were less health officials to help the sick patients.  The CDC should have made sure those people were better protected against the disease or given the vaccine first so they could still help others.  Lastly, the public health organizations withheld the severity of the disease outbreak too long.  They should have immediately notified the public and told them what they should do to protect themselves.  This could have limited the spread and the overall severity of the disease.

U.S. Health Care: The Good News

            This week, I watched a PBS video called “U.S. Health Care: The Good News”.   This documentary visited multiple cities and health clinics with innovative practices that help cut the cost of health care spending.

            Dartmouth University started studying millions of health care billing records.    They published their finding in a report called the Dartmouth Atlas Project.  They studied bills from different towns across the nations.  They found huge differences in treatments and cots in different communities.  

            I think that health care is a right for all human beings.  Looking at countries across the globe, most governments have a universal health care for all their citizens.  The United States is one of the few, if not only, developed nation in the world that does not guarantee health coverage for its citizens.  I feel that it is the government’s responsibility to care for and protect its citizens.  The Declaration of Independence states that all Americans have the unalienable right to “life”.  This includes a right to health care to help preserve life.  In the preamble of the US Constitution it states it purpose to “promote the general welfare”.  Health care is a human right.  The United Nations Universal Declaration of Human Rights states that “everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family including…medical care”.  Many legal documents signed by our country and many countries around the world state that citizens should have a right to health care; the government should provide health care to everyone.

            In Grand Junction, Colorado, the health care system has an agreement with their physicians.  They have a system where they withhold a portion of a doctor’s payment.  The doctor’s willingly put money into the pool.  At the end of the year, the hospital evaluates the cost and quality measures.  These determine how much money the physician will get back or will not get back from the withheld pool.

            In Seattle, Washington, there is something called Group Health.  The doctor would spend a lot of time with their patients.  Each patient get at least 30 minutes of face time with their physician.  The patients are very welcomed with the medical staff.  The patients are encouraged to email the physician with any illness or health problems they’re having.  And almost instantly, they will get a response from a health care provider.  This system of health care actually saves money and lives.  By talking regularly or for a long period of time, physicians are able to help prevent illnesses from developing into anything serious.  This saved money by avoiding surgeries and hospital visits.

            In Everett Washington, there is a clinic, Everett Clinic, which uses a lot of modern technology to help cut health care costs.  Their main way of cutting costs is by eliminating unneeded, expensive procedures, and controlling blood transfusions.

            Usually, the doctor looks at the patient’s disease and suggests surgery.  And a surgeon who is viewed by the patient as the one who knows all should have the right decision.  At the Hitchcock Medical Center in Dartmouth allow the patients to make the decision for their treatment.  There is center for shared decision-making where the patient is educated on their treatment options and from there, they are able to make their treatment decision.

I do believe that the way medical care is practiced in the shown cities can be duplicated in the area I’m from and cities across the nation.  However, to obtain these health care systems big changes will have to be mad.  Not just decisions concerning physical changes, but people’s morals will have to be changed.  Doctors will have to be willing to take lower salaries in the name of successful patient outcomes.  This practice is doable.  Medical practices need to be willing to use new technology and new delivery models so they can spend more time with patients.  Doctors, hospitals, and insurance companies need to work together to keep track of costs and hold them down.  Doctors have to be willing to give their patients real voice in treatment decisions.  Big steps need to be taken in order to implement these health care practices nationally.  But yes, this way of medicine is possible to achieve.