Diabetes Type 2 in Manchester City: Factors, Challenges, and Health Inequalities

This essay discusses the health condition (diabetes type 2) of the Manchester City people along with the factors affecting the health and wellbeing of the people. It also covers a few challenges related to the health improvement of the people, role of nurses in improving health and health inequalities.

Running head: DIABETES TYPE 2 IN MANCHESTER CITY
Diabetes type 2 in Manchester City
Name of the Student
Name of the University
Author Note

1DIABETES TYPE 2 IN MANCHESTER CITY
Introduction
The issue of diabetes is one of the most common problems among the people around
the different countries of the world. In this context, it can be stated that in most of the cases,
diabetes type 2 is more common among the individuals. In case of UK, the scenario is not at
all different and it is estimated that since 1996 to 2019 almost 3.5 million of people are
diagnosed with the problem of diabetes type 2 in the country. Moreover, while considering
the people undiagnosed diabetes, it can be stated that the number is almost 4 million.
Therefore, it is estimated that by the end of 2025, almost 5 million will face the problem of
diabetes. This data represents that almost 1 out of 6 people in the country is suffering from
this issues. In UK, the overall data suggested that the among all the diabetes cases 90 per cent
of the cases are type 2 diabetes mellitus (Gov.uk 2020). While reviewing the data of the
Manchester City, it is observed that almost 2.8 million of people are residing in this city and
it is expected that the population may face a growth of 3 per cent along with an aging
population group in the city. Moreover, the overall employment rate of Manchester is lower
than that of the whole country. In case of England, the employment rate is almost 74 per cent
and in case of Manchester this rate is almost 70.5 per cent (GMCA 2018). In terms of
smoking behaviour, the rate of smoking among the people of the city is higher than that of the
overall rate in the country. In various studies, it is stated that the issue of smoking and
unemployment are closely related to the onset of diabetes type 2 and poor quality of life
among the people of the city. The high number of aged population (70 years or above) is a
serious threat for the health system of the city as it is observed that a huge number of aged
people are suffering from diabetes type 2 in Manchester City (GMCA 2018). In Greater
Manchester City, almost 160,000 people have the issue of diabetes and among them only
11,000 has diabetes type 1. At CCG level, in the year of 2015/ 16, the average prevalence of
diabetes type 2 in North Manchester was 7 per cent, in case of Central Manchester the rate is

2DIABETES TYPE 2 IN MANCHESTER CITY
almost 6 per cent and in case of South Manchester the rate is almost 5.9 per cent. From the
data, it is reported that the rate of Manchester City diabetes type 2 prevalence is higher than
that of the overall rate of England and it is estimated that with the advancement of time the
rate of diabetes type 2 is enhancing. Therefore, in order to improve the overall health and
wellbeing of the individuals it is very important to improve the employment rate and health
literacy rate so that the overall health conditions of the people can be improved (GMCA
2018).
In this essay, the health condition (diabetes type 2) of the Manchester City people is
discussed along with the factors affecting the health and wellbeing of the people. Along with
this, a few challenges related to the health improvement of the people, role of nurses in
improving health and health inequalities are also discussed in the later part of the essay.
Impact of Health Literacy on Disease Condition
The impact of health literacy rate, social influence and behaviours of the individuals is
highly correlated with the condition of the disease condition of the city. In this context, it can
be stated that a higher level of health literacy rate among the people of the society can help
them to understand the bad impact of the disease. According to the study of Brach, Dreyer
and Schillinger (2014), it is stated that the improvement in the health literacy rate in the
society will help the people to improve their own conditions. From the report of Manchester
City, it is reported that structured education programme can improve the health conditions of
the people as well. In this study it was reported that concept of health knowledge or health
education refers to the knowledge and understanding people have about health-related issues
and as a result overall health and wellbeing of the individuals will also be improved. This
study also reported that the improved health literacy rate among the people will also help to
improve the mental health conditions of the people as well. In this regard, it can be stated that

3DIABETES TYPE 2 IN MANCHESTER CITY
along with improvement in the health literacy rate of the individuals, social influence is also
very crucial for maintain the health and wellbeing of the society. The study findings of Lynch
and Franklin (2019) stated that a various range of social factors such as socioeconomic status,
gender, race or ethnicity can affect the conditions of the people in the society. Therefore issue
of poverty and deprivation, poor social support to the people suffering from diseased
condition can make the condition worse for them. In terms of overall wellbeing of the people
of the society, it can be stated that behaviours of the social people is also associated with the
development of the disease. Therefore the social support must be provided irrespective of
race and gender. So, in order to promote the health and wellbeing of the society, it is very
important to maintain the health literacy, positive social influence and proper social support
to the people and it will help them to be well (Edwards et al. 2015).
Social Determinants of Health and Challenges to Improve Health Outcome
The issue of health and wellbeing of the people of the society is closely associated
with social determinants of the health. In this regard, it can be stated that the cultural aspect
can greatly impact the social determinants of health present in the society. In this context, it
can be stated that the income and social status is one of the social determinants of health that
is correlated with the health related outcome of the individuals (Corin 2017). According to
the study of Collins (2016), it is stated that the issue of poverty is associated with the poor
health related outcomes among the individuals. In this study it was stated that the due to the
poverty issues, people are not having enough amount of money in their hands and so they are
unable to access all type of health care services to protect themselves from all type of disease
conditions. In the study of Humphreys, McLeod and Ruseski (2014), it is observed that the
patient factors such as physical activity level and diet of the individuals and health system
factors such as insurance status, health service accessibility are related to the health
outcomes. In this context, it can be stated that the issue of diabetes type 2 in the Manchester

4DIABETES TYPE 2 IN MANCHESTER CITY
City, is closely related to these factors. From the data, it was observed that the employment
rate of the city is lower than that of the national level and so it is quite impossible to access
all the health care services as they have not enough amount of money in their hand. Another
crucial social determinant of health that is associated with the poor health related outcome is
environment. In this context, it can be stated that environmental disadvantage can cause poor
health related outcome among the people of the society. In the study finding of Baar et al.
(2016) stated that the environmental disadvantage was cross-sectional connected with poor
health outcomes of the people of the society. In this study, the researchers assessed almost
14,261 persons; however only the head of the households were asked for their insights of the
environment, and their responses were coded for the whole household. So, the researchers
were only able to use only data of only 7430 households. For assessing the physical
environment, the researchers used a self-perceived environmental disadvantage from the year
2004. Along with this, the participants were inquired about air pollution, noise pollution and
lack of accessible green spaces in their society. The study result reported that environmental
disadvantage was associated with the health irrespective of age, sex, and income of the
individuals. Therefore, the study the concluded that, poor environmental facilities are
associated with the adverse health related outcomes among the individuals. Along with this,
lack of support from the society also causes poor health related outcomes among the
individuals (McManus et al. 2016). Hence, it can be stated that a proper societal support to
the community people can improve the overall health and wellbeing of the society. Therefore,
it is the duty of the people residing in the society to provide equal amount of support to the
lower socioeconomic people of the society. As a part of the challenges of faced by the people
in the society, it can be stated that the people who are engaged in the process of providing
health literacy and health related educational program, it may possible that the people of the
society are not at all ready to accept that as they have different cultural beliefs. Therefore,

5DIABETES TYPE 2 IN MANCHESTER CITY
such orthodox cultural belief can restrict them to accept the new knowledge regarding their
health condition (Kim and Lee 2016). Another crucial challenge that can restrict the health
and wellbeing of the individuals of the society is the smoking practice and dietary habits of
the people. So, it is quite obvious that during the health literacy program, due to the lower
level of education and wealth, the people will not be understand about the importance of
dietary practices in preventing or managing diabetes type 2. Along with this, lower
socioeconomic condition will also restrict them to access healthy dietary habits (Powers et al.
2017).
Factors associated with Health Inequalities
The issue of health inequalities is one of the most common issues faced by the people
of the society due to few reasons. In various studies, it is observed that there are a few
reasons that can contribute to the health related inequalities in the society. These inequalities
in the society include income levels of individuals, their educational attainment and
unemployment levels, and along with this, a variety of neighbourhood socioeconomic and
environmental factors are also contribute to the health related inequalities. In this context, it
can be stated that racial discrimination is one of the factors that can contribute to the health
inequalities. According to the study of Veenstra and Patterson (2016), racial discrimination
can cause health related inequalities in the society. In this study, black women and men were
assessed and the study reported that the rate of reporting about hypertension and diabetes
among the black men and women was higher than that of their white counterpart. On the
contrary, in case of cancer and mental health condition, the rate of reporting is higher among
the white women than that of the black women and in case of heart disease, black men were
less likely to report the disease condition than that of the black men. Therefore, the study
reported that the higher amount of diabetes and hypertension among the black Canadian male
may be due to their race. In case of the Manchester City population, this health related

6DIABETES TYPE 2 IN MANCHESTER CITY
inequality may also con tribute to the situation. Another health related inequality is smoking
behaviour of the people in the society as it is reported that due to the lower socioeconomic
condition of the people has not have proper level of education and thus they are unable to
understand the correlation of the smoking and diabetes. According to the study of Hu et al.
(2018), it is reported that there is a direct correlation in between the smoking practices and
onset of diabetes and so it is very important to assess this problem to reduce the inequalities
in the society. In this context, it is also very crucial to identify that lower level of education is
associated with the unhealthy practices among the individuals. According to the study of
Patoli et al. (2015), it is stated that lower socioeconomic status (SES) is associated with the
tobacco consumption among the people. Apart from that, the study also stated that the lower
socioeconomic condition can also cause psychological distress and psychological distress is
associated with the onset of diabetes and different types of other chronic diseases. So, it can
be stated that from the findings of another study that improvement in the economic condition
of the people of the society will also help to reduce the health related inequalities in the
society (Bonevski et al. 2014).
Role of Nurses in Health Promotion
While discussing the ways of improving the health of the individuals in the society in
terms of physical and mental health conditions, it can be stated that the role of nurses is very
crucial as they are one of the primary care givers to the patients. In this regard, it can be
stated that, nurses can play a crucial role in improving the overall health condition and
wellbeing of the patients. Hence, it can be reported that the nurse can take part in the
awareness program so that the patients’ health literacy can be improved. Therefore, it can be
reported that the improved level of health literacy can contribute to the overall health and
wellbeing of the people (Hollis, Glaister and Anne Lapsley 2014). Along with this, the
nurses can take proper initiatives to improve the smoking behaviours of the people and it will

7DIABETES TYPE 2 IN MANCHESTER CITY
help to improve the physical health of the people. According to the study of Baum and Fisher
(2014), it is stated that smoking is associated with poor health related outcomes such as
cancer, cardiovascular diseases. Therefore, changing smoking practices of the people in the
society will reduce the chances of developing cancer and other chronic illness. So, it can be
stated that if the nurses can enhance the level of knowledge among the people, then it may
possible that the health condition of the people will be improved. For improving the mental
health condition of the people the nurses can initiate proper communication process with the
mental health patients and they should show empathy to the patients. Hence, the proper
communication and application of proper communication strategy can improve the mental
health conditions of the people (Pehrson et al. 2016).
Conclusion
Hence, it can be concluded, that issue of diabetes type 2 is one of the crucial issues for
the residents of the Manchester City as it has become a serious area of threat for the residents
of the city. The rate of Manchester City diabetes type 2 prevalence is higher than that of the
overall rate of England. The impact of health literacy rate, social influence and behaviours of
the individuals is highly correlated with the condition of the disease condition of the city. A
higher level of health literacy rate among the people of the society can help them to
understand the bad impact of the disease. A various range of social factors such as
socioeconomic status, gender, race or ethnicity can affect the conditions of the people in the
society. The income and social status is one of the social determinants of health that is
correlated with the health related outcome of the individuals. Lack of support from the
society also causes poor health related outcomes among the individuals. Smoking practice
and dietary habits of the people can cause health related inequalities among the people of the
society. Racial discrimination can cause health related inequalities in the society. However, it

8DIABETES TYPE 2 IN MANCHESTER CITY
is also stated that in order to improve the mental and physical health wellbeing of the people
the community nurses can play crucial role.

9DIABETES TYPE 2 IN MANCHESTER CITY
References
Baum, F. and Fisher, M., 2014. Why behavioural health promotion endures despite its failure
to reduce health inequities. Sociology of health & illness, 36(2), pp.213-225.
Bonevski, B., Regan, T., Paul, C., Baker, A.L. and Bisquera, A., 2014. Associations between
alcohol, smoking, socioeconomic status and comorbidities: Evidence from the 45 and U p S
tudy. Drug and alcohol review, 33(2), pp.169-176.
Brach, C., Dreyer, B.P. and Schillinger, D., 2014. Physicians’ roles in creating health literate
organizations: a call to action. Journal of general internal medicine, 29(2), pp.273-275.
Collins, S.E., 2016. Associations between socioeconomic factors and alcohol
outcomes. Alcohol research: current reviews, 38(1), p.83.
Corin, E., 2017. The social and cultural matrix of health and disease. In Why are some people
healthy and others not? (pp. 93-132). Routledge.
Edwards, M., Wood, F., Davies, M. and Edwards, A., 2015. ‘Distributed health literacy’:
longitudinal qualitative analysis of the roles of health literacy mediators and social networks
of people living with a long‐term health condition. Health Expectations, 18(5), pp.1180-
1193.
GMCA, 2018. Diabetes Clinical Best Practices Strategy 2018-2023. Greater Manchester
Combined Authority. Retrieved from-
https://www.gmhsc.org.uk/wp-content/uploads/2018/05/Diabetes-Clinical-Strategy-2018-
2023-11.05.18.pdf [Accessed on 20th March 2020]

10DIABETES TYPE 2 IN MANCHESTER CITY
Gov.uk, 2020. 3.8 million people in England now have diabetes. Public Health England.
Retrieved from- https://www.gov.uk/government/news/38-million-people-in-england-now-
have-diabetes [Accessed on 20th March 2020]
Hollis, M., Glaister, K. and Anne Lapsley, J., 2014. Do practice nurses have the knowledge to
provide diabetes self-management education?. Contemporary nurse, 46(2), pp.234-241.
Hu, Y., Zong, G., Liu, G., Wang, M., Rosner, B., Pan, A., Willett, W.C., Manson, J.E., Hu,
F.B. and Sun, Q., 2018. Smoking cessation, weight change, type 2 diabetes, and
mortality. New England Journal of Medicine.
Humphreys, B.R., McLeod, L. and Ruseski, J.E., 2014. Physical activity and health
outcomes: evidence from Canada. Health economics, 23(1), pp.33-54.
Kim, S.H. and Lee, A., 2016. Health‐literacy‐sensitive diabetes self‐management
interventions: a systematic review and meta‐analysis. Worldviews on Evidence
‐Based
Nursing, 13(4), pp.324-333.
Lynch, M.A.M. and Franklin, G.V., 2019. Health Literacy: An Intervention to Improve
Health Outcomes. In Strategies to Reduce Hospital Mortality in Lower and Middle Income
Countries (LMICs) and Resource-Limited Settings. IntechOpen.
McManus, S., Bebbington, P., Jenkins, R. and Brugha, T., 2016. Mental health and wellbeing
in England: Adult Psychiatric Morbidity Survey 2014. A survey carried out for NHS Digital
by NatCen Social Research and the Department of Health Sciences, University of Leicester.
Patoli, S., Jabeen, N., Masood, R.T. and Butt, A.I., 2015. Socioeconomic status and
smokeless tobacco consumption in fishermen community of a coastal area of Karachi. Annals
Abbasi Shaheed Hospital Karachi Medical Dental College, 20, pp.34-39.

11DIABETES TYPE 2 IN MANCHESTER CITY
Pehrson, C., Banerjee, S.C., Manna, R., Shen, M.J., Hammonds, S., Coyle, N., Krueger, C.A.,
Maloney, E., Zaider, T. and Bylund, C.L., 2016. Responding empathically to patients:
Development, implementation, and evaluation of a communication skills training module for
oncology nurses. Patient education and counseling, 99(4), pp.610-616.
Powers, M.A., Bardsley, J., Cypress, M., Duker, P., Funnell, M.M., Fischl, A.H., Maryniuk,
M.D., Siminerio, L. and Vivian, E., 2017. Diabetes self-management education and support
in type 2 diabetes: a joint position statement of the American Diabetes Association, the
American Association of Diabetes Educators, and the Academy of Nutrition and
Dietetics. The Diabetes Educator, 43(1), pp.40-53.
Veenstra, G. and Patterson, A.C., 2016. Black–white health inequalities in Canada. Journal of
immigrant and minority health, 18(1), pp.51-57.

12DIABETES TYPE 2 IN MANCHESTER CITY

13DIABETES TYPE 2 IN MANCHESTER CITY