Burden of a Chronic Condition

This document discusses the burden of chronic conditions, specifically focusing on diabetes, both globally and in Australia. It explores the public health significance of diabetes as a chronic condition and discusses the determinants and individual risk factors associated with chronic conditions. Additionally, it provides an overview of the framework utilized for the prevention and management of chronic conditions.

Assignment 1 – Burden of a Chronic Condition
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Table of Contents
Rationale for consideration of diabetes as a chronic condition..................................................3
Burden of chronic condition both globally and in Australia......................................................3
Public health significance..........................................................................................................6
Determinants of chronic condition.............................................................................................7
Individual risk factors for condition...........................................................................................8
Framework utilized for prevention or management.................................................................10
Critical analysis of framework.................................................................................................12
References................................................................................................................................13
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Rationale for consideration of diabetes as a chronic condition
Chronic conditions cover the chronic diseases, illnesses and disabilities, however, some
communicable diseases such as HIV/AIDS are also included in the category of chronic
conditions. Chronic conditions exist for long duration and are rarely treated completelyand
they are complex in nature. Some of the chronic conditions contribute highly to premature
death or disability in the patients. Usually, chronic conditions originate due to life
experiences and exposures to social and environmental factors, which enhance the risk to
unhealthy behaviours afterwards in life. The health risk behaviours give rise to chronic health
conditions such as diabetes, high cholesterol, cardiovascular diseases, which can lead to
impairment, disability and even death of people (Remington, Brownson, & Wegner, 2016).
National Health Priority Area (NHPA) initiative has identified Diabetes Mellitus as national
health priorities since 1997. The number of individuals having diabetes is increasing
graduallyand it becomes a major reasonbehind occurrence oflower limb amputation, loss of
sight, kidney failure, heart attacks and stroke.In 2016, diabetes led to 1.6 million deaths. It
was also one of the top 10 causes of death in the same year (World Health Organization,
2018). That is why, Diabetes has been considered to be as a chronic condition for the purpose
of this research.
Burden of chronic condition both globally and in Australia
The “Global Burden of Disease” (GBD) can be measured with the use of “Disability-
Adjusted Life Years” (DALY). In these time-based measuring criteria, “Years of Life Lost”
(YLL) because of premature deathsand years of life suffered due to unhealthy conditions or
disability (YLD). With the use of DALY, diabetes could be measured on the basis ofsum of
years of life lost due to premature death (YLL) and “Years Lost due to Disability”(YLD).
The increasing rate of death due to diabetes mellitus had been around 1.28 million, which is
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around 2.4% all over the world (Lozano, et al., 2012). The global trends in disability reveal
that disability due to metabolic conditions such as Type 2 diabetes has increased all over the
world as well as across all the levels of development (Institute for Health Metrics and
Evaluation, 2018). The ranking of leading cause of disability due to diabetes have been
changed drastically for all the age groups. In 1990, diabetes was the ninth major reason
behind disability all over the world, which has reached fourth position in the year 2017.
Image Source: (Institute for Health Metrics and Evaluation, 2013)
Similarly, diabetes ranked as thefifteenth major cause of early death in 2016 globally, and it
is also expected that it will certainly occupy seventh position till 2040.
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Image Source: (Institute for Health Metrics and Evaluation, 2018)
In Australia, the life expectancy and death rates are increasing specifically and the “burden of
Type 2 Diabetes”is growingdrastically and it is anticipatedthat it will become a major cause
of disease burden in the next few years. Furthermore, the main cause of increasing rate of
end-stage kidney disease has been found to be diabetes. As per the “Australian Burden of
Disease Study” (ABDS) conducted by “Australian Institute of Health and Welfare” (AIHW),
the burden of lower limb amputations because of diabetes in the country include four
complicated conditions related to diabetes, which are lower limb amputation, diabetic
neuropathy, foot ulcers, as well as vision impairment. It has been estimated in 2011 that
around 730000 Australians were diagnosed with diabetes, 1.7% among whom had lower limb
amputation. The loss of health directly related to diabetesin the form of lower limb
amputation included around 1% of the overall non-fatal burden estimated for diabetes in that
year. The ABDS report also quantified the effect of diabetes on the burden of various other
diseases, which proved causal association for estimation of indirect burden due to diabetes. It
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revealed that indirect burden due to linked diseases for diabetes was 1.9 times as high as its
direct burden (AIHW, 2017).
Public health significance
Diabetes has been developed as a major public health issue all over the world. As per the
current global estimates, it will mark 415 million people and will escalate to 642
milliontillthe year 2040 globally. Furthermore, millions of people remain undiagnosed
usuallydue to mild symptoms of the condition at initial stages, particularly in cases of Type 2
diabetes (Al-Lawati, 2017). This chronic disease occurs due tofailureto develop or reduce
sensitivity to hormone insulin.Long-term impact of diabetes includesloss of sight, renal
failure, neuropathy and many more health deteriorations.It also reduces the life expectancy of
patients by around 20 years due to Type 1 diabetes and around 10 years due to Type 2
diabetes. The common complications associated with diabetes include macro-vascular
complications and cardiovascular diseases asmajor deaths of people with diabetes is caused
by cardiovascular disease. The diabetic people have double the risk of death due to heart
diseasesas compared to others and there is a high probability of stroke. The micro-vascular
complications associated with diabetes include nerves related issues as, around 60 to 70% of
diabetic people are prone. The warning signsof the nerve issues include itchiness, pain,
burning, and numbness and the probability of limb amputation and foot ulcers along with
other conditions such as erectile dysfunction. The major reasonof loss of sightamong working
aged population is diabetes and it also results inlongstandingdamage to the blood vessels in
the retinal region (Sherringham, 2010). Around 2% of the people suffering from diabetes for
a prolonged period of more than 15 years and around 10% develop severe visual impairment.
Similarly, renal failure affects 30% of the people having diabetes (Sherringham, 2010).
Considering all these points, it is essential that public should be made aware of the harms
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caused due to diabetes and significant actions should be considered to reduce the rate of
diabetes all over the world. In order to achieve it, it is essential that the public is aware of the
causal reasons behind diabetes so that they could take necessary measures to get prevented
from diabetes.
Determinants of chronic condition
The social determinants of health are also known as socio-ecological factors having greater
influence on health. The overall framework is developed by the people, their social
connections, and cultural as well as environmental conditions. The environmental and socio-
ecological factors create influences upon the individuals, which include culture, environment,
working conditions, education, and access to medical care as well as community
infrastructure. The major specific socio-ecological factors associated with diabetes are
building environment or public infrastructure, economic constancy, education, healthcare or
admission to medical care, and cultural or social and community support.
The components of physical situation comprise variety of influences such as safety, healthy
food, transportation and such others. When barriers to such factors affect individuals with
diabetes, insufficient admission to the possessions magnifies the effects. For example,
restricted transport facilities in rural region limit the access of rural community to have access
to healthcare providers or to healthy diet. Similarly, transportation barriers in front of urban
people include the lack of footpaths on the roads also dismays individuals from walking,
which is considered as an effectivephysical exercise. The improved health outcomes are also
associated with healthy diet and there are certain food items that provide health benefits for
reducing the progression of diabetes. However, access to healthy food and socio-economic
status are also considered as strong analyst for obesity among people detected with diabetes.
Similarly, education level, employment as well as family income disturbs the socio-economic
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status and thus, affects the health of people. As greater educational achievements have been
associated with better-quality health outcomes because it increases probability of socio-
economic stability after increasing the opportunities for better employment (Institute for
Health Metrics and Evaluation, 2013). The individuals with high education most probably
contribute in precautionary healthcare, which include healthydiet andto become physically
active to avoid obesity.
The accessibility of healthcare resources such as admission to medical care on the basis of
aspects such as socio-economic standing, residential location, race or background, and culture
creates disparity in availing medical care. The socio-economic factors include level of
education influences health insurance status and remote rural regions which lack basic as well
as speciality healthcare providers reduces the availability to healthcare for populations
suffering from chronic diseases like diabetes. The lack of inadequate care might result in
deteriorating the long-term impact effects of chronic diseases. Furthermore, in the process of
working towards improving the health outcomes, social support is also essential. The better
social support is associated with better self-management consequences, while negative or
decreased levels of social care increases the risk of self-management behaviours in the
process of improving health outcomes (Clark & Utz, 2014).
Individual risk factors for condition
Three types of diabetes are Type 1, Type 2 and gestational diabetes. In all the types of
diabetes, the production of the insulin hormone is reduced and resistance of tissues to the
impact of insulin also reduces. Usually, the majority of people are not aware that they have
diabetes due to mild symptoms of specifically Type 2 diabetes. However, the affect of the
disease over the body depends individually (NIH, 2019).
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Type 1 Diabetes is usually diagnosed during childhood when pancreases stop making insulin
and it exists throughout life. The major reasons associated with Type 1 are generally genetic
history, pancreatic diseases or infection or illnesses. When an individual has close relatives
with diabetes, the probability becomes higher. The capability of the pancreas to produce
insulin get affected due to pancreatic diseases.
Type 2 Diabetes reduces the efficiency of the body to make or use insulin as it is known as
insulin resistance. Type 2 usually marks adults and can occur at any stage of life. The major
things leading to Type 2 diabetes are overweightness, diminished glucose intolerance, insulin
resistance, ethnic background, gestational diabetes, inactive lifestyle, family history,
“Polycystic Ovary Syndrome” (PCOS), age and various other factors. Due to increasing
obesity among people, the probability of Type 2 Diabetes increases. Prediabetes is considered
as milder form of Type 2 Disease. Usually, at initial phase, the cells start getting resistant to
insulin, which requiresthe pancreas to function more to produce sufficient insulin to satisfy
the insulin need of body. Similarly, the females who had or have diabetes during their
pregnancy have high probability of gestational diabetes. It also increases the probabilities of
getting Type 2 Diabetes in later stages of life. Another major reason behind increasing
probability of diabetes is the sedentary lifestyle of people. Furthermore, the people with
diabetes in their family history have huge probability to have diabetes Type 2. The females
with Polycystic Ovary syndrome also have high probability of getting diabetes. The age
factors are also associated with diabetes as people above the age of 45 years and obese, the
chances of getting diabetic increases.
Gestational diabetes is triggered by the hormones formed by placenta or due to less amount
of insulin (WebMD, 2019). In addition, high level of blood sugar in mother increases blood
sugar level of baby also, which results in growth and development issues of baby if left
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untreated. The gestational diabetes generally occurs due to obesity, glucose intolerance,
family history, age and ethnic backgrounds.
Therefore, risk factors associated with diabetes vary from person to person. It depends on the
social life, personal life, family history, diet and such other factors of individuals.
Framework utilized for prevention or management
WHO has developed “Innovative Care for Chronic Conditions (ICCC)” model in response to
increasing dominance of chronic conditions in various countries. The model has been taken
from “Chronic Care Model (CCM)” for the purpose of providing long-term healthcare
management to the people suffering from chronic diseases. The aim of the ICCC is to create
positive environment in the policy that promote consistent financing and development of
workforce and human resources required for providing chronic care. The framework includes
fundamental components at patient level (micro), organizational level (meso) and policy
levels (macro) to be utilized for the purpose of creating or redesigning healthcare system in
order to effectively manage long-term chronic health conditions.
At macro level, the government should take effective measures in developing and
implementing policies for the purpose of preventing and managing chronic conditions. In this
context, fragmented financing of the projects should be avoided and monitoring and
regulations should be improved. As per the “WHO Global status report” regarding non-
communicable diseases, variety of ‘best buy’ interventions has been identified for the
purpose of preventing chronic condition like diabetes. ‘Best buy’ are the actions that need to
be commenced instantly in order to achieve quick results in the form of lives protected and
diseases prevented (World Health Organization, 2015). On a population-wide basis, ‘best
buy’ to prevent chronic condition include shielding people from smoking tobacco by
outlawing tobacco smoking publicly. The government should make strict policies to ensure
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healthier dietary habits by people and should ban unhealthy practices. In this context, the
population should be warned about the dangers associated with tobacco smoke and bans
should be enforced on tobacco advertisements and sponsorships. Similarly, increasing taxes
on alcohol and other such products can reduce its consumption (Australian Health Ministers'
Advisory Council, 2017). The replacement of trans-fat in food with the polyunsaturated fat
can contribute a lot to increasing healthy consumption by people. The broader government
initiatives in this context include effective public health education or reformulation of food
products to reduce excessive salt or sugar content.
Meso level includes systems for the purpose of managing care, which comprises educating
health professionals, guidelines, prevention strategies and association with the community
resources. The interventions for the purpose of addressing modifiable risk factors for this
chronic disease include behavioural changes such as physical activity or improving the diets.
The medical interventions in this context include prescribing blood pressure control
medications. As in Australia specifically, lack of proper diet is the main issue due to which
people become more prone to various chronic diseases which include diabetes also. So,
control measures are required to be taken by the government such as encouraging public
awareness regarding the food regime to be followed and importance of physical activity
through various social media platforms (Lawn & Schoo, 2010). In addition to it, there are a
number of profitable and reasonable interventions for the purpose of reducing risk factors
such as restriction on advertising of food items and beverages high in fats, sugars and salt
particularly to kids and increasing taxes on such food items to promote healthy diets.
Similarly, creating healthy and nutritional environments in schools; providing nutritious diet
related information and counselling in healthcare; developing nation-wide physical activity
guidelines; school-based physical activities for children; community programs to increase
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physical activities and promoting healthy food regimes; and designing the environment to
promote physical activities (Warsi, Wang, LaValley, Avorn, & Solomon, 2014).
At micro level, the role of the patients and their family members is enhanced in associating
with communities and healthcare organizations. To achieve the purpose, specific skills need
to be developed among the individuals themselves so that they could easily manage their
chronic health conditions. The individuals having diabetic conditions should be educated
about their health requirements and how to manage their health conditions. The people
suffering from diabetes should maintain their healthy routines and perform physical exercises
to keep their metabolism effective. They should also be educated to have their medicines on
tine to prevent ill-effect of diabetes on health.
Critical analysis of framework
Diabetes might substantially affect the quality of life and enhancesthe risk of grave health
issues. That is why, it is essential to prevent people from getting diabetic and government and
local authorities are making every possible effort to reduce the rate of diabetes. However, it is
impossible to avoid Type 1 diabetes easily but, Type 2 Diabetes could be controlled through
tackling some of the risk factors causing diabetes (Australian Health Ministers' Advisory
Council, 2017). It is essential to control Type 2 Diabetes among people because its severity
increases the possibility of various other health issues and results in death as well. Through
lifestyle improvement, it is possible to prevent people from getting diabetic easily. Proper
physical exercise, healthy diet and sufficient education regarding symptoms of diabetes can
reduce the probability and can prevent the people from this chronic disease (Goris, Komaric,
Guandalini, Francis, & Hawes, 2012).
The management of diabetes can be done effectively by following proper routine and diet
chart and through physical exercise. The medications should be taken properly to reduce the
severity of disease. The healthcare professionals should be consulted from time to time and
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blood tests should be conducted timely to check the frequency of blood sugar level changes
(McDermott, Baldwin, Bryant, & DeBate, 2010). It is a chronic condition and could be
managed easily with proper medications, healthy diet and through healthy routine if not
practised in some cases.
References
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Al-Lawati, J. A. (2017). Diabetes mellitus: a local and global public health emergency. Oman
medical journal, 32(3), 177-179.
Australian Health Ministers' Advisory Council. (2017). National Strategic Framework for
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http://www.health.gov.au/internet/main/publishing.nsf/content/nsfcc
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Lawn, S., & Schoo, A. (2010). Supporting self-management of chronic health conditions:
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%20older%20had%20diabetes.
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