Australian National Diabetes Strategy: An Equity SPA Analysis

This article analyzes the Australian National Diabetes Strategy using the EQUITY SPA methodology. It discusses the program's objectives, strategies, and activities, as well as its impact on the Aboriginal and Torres Strait Islander communities. The article also provides recommendations for improving equity in diabetes prevention and management.

RUNNING HEAD: HEALTHCARE MANAGEMENT
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Name of Student
Name of University
Author note

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Part 1: Introduction, Overview of Health Program, Project or Service and Population it
serves
There are various health programs that are run across the globe by the joint collaboration of
United Nations and the World Health Organisation. These international programs are highly
targeted at certain populations that suffer from a certain health condition (Crossland et al.
2016). This health condition can be genetic, nutritional, metabolic or systemic and it has
affected the population for many number of years and is still ongoing. In these scenarios,
where the national government is unable to develop the right health programs targeted at the
population, it collaborates with the World Health organisation to develop their health projects
more drastically that can have immensely health benefits out of the target population (Speight
2016). In order to deliver the international health program, the international body at first
collaborates its resources with the resources of the national government and the state
regulatory body to deliver the health care program at an exceedingly fluent rate. In order to
do this, the strategy, programs and activities (SPA) of the chosen population targeted health
program has to be determined so as to plan the right interventions that is required to deliver
the chosen health program. The methodology followed to determine SPA parameters of the
chosen program – the social determinants of health and the structural determinants needs to
be understood before the strategies are planned and the interventions are executed.
The Australian National Diabetes Strategy is a major nutritional health program in
Australia that is supported by World Health Organisation that is a 4 year project from 2016 to
2020. Diabetes mellitus has affected the Australian community people that is the Aboriginal
and the Torres Strait Islander people, for many decades now. Even with emergence of cutting
edge medical technology and with development of more advanced pharmacological along
with non -pharmacological therapies – the Diabetes Mellitus prevalence with the Aboriginal
and the Torres Strait Islander community of Australia was not coped with evenly. There

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continued to be increased rates of type 2 diabetes mellitus amongst the members of these
population and the Australian government along with support from World health
Organisation came up with the Australian National Diabetes Strategy (Jones 2016). Type 2
diabetes mellitus which is associated with hereditary condition and metabolic issues related to
lifestyle habits and addictions as well. In the aboriginal population and the Torres Strait
Islander population, the smoking, alcohol and substance abuse habits amongst the community
members has shown to deteriorate the already present pathophysiological effects of Type 2
and Type 1 Diabetes mellitus in the body. The lifestyle and habits of these Australian
community living people led to the causation of Diabetes Mellitus and worsening of the
effects of Diabetes. The main reasons for development and prevalence of Diabetes Mellitus in
the Aboriginal and the Torres strait community living people is malnutrition and poor diet
(MacDonald et al. 2016), insufficient physical activity, tobacco and substance abuse and most
importantly hereditary serves as a very important role in increasing the incidences of
Diabetes in the Australian community living people. Improper education of the Aboriginal
people regarding lifestyle habits and disease prevention also played a very cardinal part in
prevalence of Type 2 diabetes mellitus in the aboriginal people. Lack of apt health programs
and lack of public awareness amongst the community living Aboriginal and Torres Strait
islander people has led to more elevated rates of Diabetes Mellitus amongst the community
population. Hence, the Australian National Diabetes Strategy has been targeted by the
Australian government along with the supportive framework of World Health Organisation to
treat the target population from Diabetes Mellitus, therefore decreasing the rates of type 2
Diabetes Mellitus amongst the Aboriginal people and Torres Strait islander people of
Australia.
The Australian National Diabetes Strategy program develop by the government of
Australia in the year of 2016 as a four year strategy in order to reform the public awareness

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about Diabetes mellitus amongst the local community population. The objective of the
National Diabetes strategy is to equip the primary health care network also known as PPNs
with high quality and high functioning advanced medicines, high technology devices and
stocking of the quality resources for the prevention of Diabetes Mellitus amongst the
Aboriginal and the Torres Strait Islander People. The program is planned to deliver public
awareness amongst the Aboriginal and Torres Strait Aboriginal people, regarding the
controllable factors of the disease – Type 2 Diabetes Mellitus. The vision of the program is
to strengthen all the sectors relating health care in development, implementation and
evaluation of a coordinated and integration of a multidisciplinary approach for the reduction
of human, economic and social impact of type 1 Diabetes Mellitus and Type 2 Diabetes
Mellitus in Australia.
Part 2: Analysis of program, project or service using the EQUITY SPA methodology.
The methodological guide to the incorporation of EQUITY into the health care Strategy,
Program and Activities (SPA) takes into consideration the social determinants of health such
as the governance, social and the public policies associated with the health care program. It
also take into account the socio-economic position, the social stratification and class
hierarchy in delivery of the health care program. In these social strategies that are
implemented as a part of the health program - the behavioural and the psychosocial factors
along the overall resources available and the resources that can be possibly developed should
be identified and determined prior to implementation of the whole project. The Diabetes
National Diabetes Strategy, in overall, takes into consideration - the psychosocial factors and
the socio economic factors as barriers, enhancers and facilitators in delivery of the health
program to the target population. The other vital factors such as education, gender, ethnicity
and income in relation to the community of Aboriginal and Torres Strait Islander people is
also encompassed by the policymakers of the Australian National Diabetes Strategy. The

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health program’s primary motive is to raise the awareness of the Aboriginal and Torres Strait
islander people about the prevention and control Diabetes mellitus (Webster et al. 2015). This
approach of the Diabetes Prevention Strategy is based on the psychosocial empowerment of
the Aboriginal and Torres Strait islander people by transferring the disease and healthy
lifestyle based knowledge. According to EQUITY SPA, methodology – the health program
focusses on creating awareness about the proper diet and nutrition as an important preventive
strategy through collaboration, information (by providing the knowledge about diabetes
prevention and diabetes control strategies to the community people), encouraging
participation of the community people and the community social workers by consultation and
empowerment.
Analysis of Strategy, Program and Activities (SPA) of the Australian National Diabetes
Strategy program using the EQUITY framework
E Examine  The program’s main strategy is to promote health
awareness about Diabetes Mellitus amongst
different sections of Australian community
especially in the socially vulnerable Aboriginal and
Torres Strait Islander people. The Australian
National Diabetes Prevention program’s other
important strategy is to empower the cultural and
psychosocial framework of the Aboriginal and
Torres Strait Islander community members for the
delivery of the diabetes prevention and diabetes
control strategies.
 While the social determinants of health that

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underlies the SPA theory play a very important role
in delivery services – in this case the Australian
National Diabetes Strategy focusses on
strengthening the socio economic determinants of
health by empowering the local community of
Aboriginal people with knowledge and jobs. This
promotes equity as well.
 The social workers from the aboriginal community
itself and the traditional heath care embedded in the
community system for many centuries are
empowered through delivery of the knowledge and
awareness about diabetes control and diabetes
prevention strategies. This is to promote equity
(Schembri et al. 2016).
 Moreover, to enhance the quality of psychosocial
and psychosocial determinant in order to eliminate
the diabetes prevalence amongst the community
people – collaborative efforts are taken by the
program’s service providers ( such as the nurses,
doctors, psychologists, dieticians, cardiovascular
specialists, physical and occupational therapists ) in
order to provide a complete and specialist trans-
disciplinary (multidisciplinary) care for
management of diabetes mellitus amongst the local
community of Australia.

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 The high quality medicine and the high technology
medical diagnoses are delivered by the program at
an affordable rate.
 The clinical assessments, workshops and awareness
campaigns are run by the Diabetes Prevention
Program in order to manage the diabetes mellitus
amongst the younger and elderly Aboriginal people.
Q Question  The aboriginal people accesses the services of
Australian National Diabetes Strategy.
 The Torres Strait Islander people accesses the
service of program.
 The Torres Strait Islander people and Aboriginal
people has been analysed and reported to have been
suffering from the social inequality in terms of
economy, culture and access to health care services.
This has led to prevalence of metabolic disorders
like diabetes mellitus amongst the local community
and low socio economic condition and lack of
access to the quality health care facility increased
the prevalence of Diabetes Mellitus amongst these
people.
 In the first stage (information) – the program assists
the Aboriginal people with awareness of the disease
Diabetes and lifestyle changes are advised. Proper
nutritional habits are taught as well. The social

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workers, the community health nurses play a very
important part. The preventive strategies are
educated.
 Second stage (cooperation) – the program service
providers assess the health status of the aboriginal
and the Torres Strait islander community with the
use of culturally competent language. Gaining the
trust of the community people is an important
strategy. The indigenous social workers play an
important role in the collaboration (Baba et al.
2015).
 Stage 3 ( coordination ) – the coordination of the
healthcare professionals and the social workers in
the framework of the National Diabetes Prevention
strategies has been elucidate in the policies
associated with the program. The coordination of
the government policy makers and non-
governmental organisations working towards the
interest of the Aboriginal people is mandatory
under the program policies – to extend the
nutritional change program in prevention of
Diabetes (Zhang et al., 2017).
 Stage 4 (Integration) – finally, the health care and
nutritional program also strives to integrate the
primary health care networks and the local health

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care system in order to deliver a collaborative,
community empowered health care, nutritional
improvement and health awareness service
(Australia, 2019).
U Understanding Barriers to the health equity – lack of education and low
socio economic status, limited or lack of access to health
care, lack of heath awareness regarding metabolic disorders
(diabetes mellitus). Other barriers are smoking, alcohol and
substance abuse (Ogloff et al. 2017).
Facilitators to the health equity – the natural and
indigenous workforce present in the community. The
existent traditional health care system.
 In some areas though, lack of communication from
the health care professional’s side with the
Aboriginal people has led to continuity in inequality
of health during delivery of the health care
program.
Knowledge based education, awareness raising and training
of Aboriginal people (Culturally and Linguistically Diverse
(CALD) or other vulnerable community) about nutrition,
lifestyle, medications and interventions in diabetes mellitus
(Schembri 2016).

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I Interrelating The healthcare equity promotional strategies employed by
the Australian National Diabetes Strategy such as
collaboration with the indigenous workforce in order to
empower them with occupation, income and education is a
very important step. The health and nutrition program
strives to promote knowledge and intersectoral
collaboration along with the assistance from the socio-
political framework.
T Thinking
Y Your design
Part 3: Identification the aims and priorities for improving equity and
recommendations for action
The redesigned goals and priorities of the Australian National Diabetes prevention program
are as follows: -
 More collaboration between the community living people in Australia and the socio-
political framework has to be fostered.
 More dietetics, nutritionists and community health nurses have to be enrolled in this
diabetes prevention program - so to assess, empower and raise awareness regarding
diabetes.
 More holistic training and education based framework should be incorporated in the
sociocultural system of local community.
 The food and nutrition policies must be strengthened as the part of the chosen
program’s operational policy

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 Continuous audit of the food (nutritional) intake by the Aboriginal people should be
included in the program for improving equity.
 The non-governmental organisations working with Aboriginal people must strengthen
their socio-political connection with the government under the framework of the
health and program.
 The chosen health program must manage diabetes mediated health disorders of the
Aboriginal people on a priority basis by incorporating proper diet and nutrition,
pharmacological management (Helson et al. 2017). This diabetes management
process should include parallel operation of health awareness programs and
counselling programs where the healthcare professionals and social extend both
knowledge and training to aboriginal people to develop self-management strategies in
prevention of Type 2 Diabetes Mellitus amongst the local community people.
Part 4: Conclusion and Lessoned Learned
The National Diabetes Prevention Strategy program has a lot of promising diabetes
prevention and management strategies and it is been in the health care framework of
Australia for three years now. Although it has been certainly helpful in strengthening the
health care and nutritional in take policies concerning the Aboriginal and Torres Strait
population of Australia. The high quality medicines, technology advances along with
evidence based practice medical and nursing interventions has been an integral component of
the Australian Diabetes Prevention program and there has been many reports that has
elucidated the lack of culturally competent communication and culturally competent
interaction with the local community (Flyvbjerg and Goldstein, 2017). This in turn has
deteriorated the quality of service provided by the Australian National Health Service

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Program. The health care professional working in the framework of Diabetes prevention
program needs to be trained more on the usage of cultural competence and the appropriate
ways of informing the indigenous people about the prevention of diabetes and effective
management of the diabetes mellitus. The community nurses working in the program’s
framework must be educated and more trained about the importance of pharmacological and
non-pharmacological management to be delivered to the local community. More experienced
nurse needs to be recruited under the project and nurses with actual experiences of working
with the Aboriginal people needs to be recruited for elevating the level of quality service
delivered in the community health systems. It is very important that the food and nutritional
policies, although in use in the health care delivery, must be made more effective in relation
to the Australian National Diabetes Strategy framework. I have learned from the analysis that
the executional part of the food and nutritional policies has to be strengthened as the strategic
part is quite holistic and tactical by all means. In order to do these – as mentioned before
more dieticians, nutritionists and community nurses should be included in the program’s
framework to enhance the health assessment quality of the community living people. The
clinical aspects and the psychosocial aspects of the chosen health and nutritional
improvement program has to be strengthened further with socio- political and administrative
legislations. I also learned, it is also very important for the clinicians, health service
providers, allied health professionals, and the social workers to work within a closed loop
where they can send continuous feedback about the challenges with implementation of
nutritional policies in prevention of diabetes mellitus and the interventions in management of
the same. There should be more collaborative approach from individuals of different
disciplines in order to foster a proper clinical and psychosocial care in prevention of diabetes
Mellitus 2 amongst the Aboriginals and Torres Strait islander people.

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References
Australia, H., 2019. Type 1 diabetes.

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Baba, M., Davis, W.A., Norman, P.E. and Davis, T.M., 2015. Temporal changes in the
prevalence and associates of diabetes-related lower extremity amputations in patients with
type 2 diabetes: the Fremantle Diabetes Study. Cardiovascular diabetology, 14(1), p.152.
Crossland, L., Askew, D., Ware, R., Cranstoun, P., Mitchell, P., Bryett, A. and Jackson, C.,
2016. Diabetic retinopathy screening and monitoring of early stage disease in Australian
general practice: tackling preventable blindness within a chronic care model. Journal of
diabetes research, 2016.
Helson, C., Walker, R., Palermo, C., Rounsefell, K., Aron, Y., MacDonald, C., Atkinson, P.
and Browne, J., 2017. Is Aboriginal† nutrition a priority for local government? A policy
analysis. Public health nutrition, 20(16), pp.3019-3028.
Jones, A., Magnusson, R., Swinburn, B., Webster, J., Wood, A., Sacks, G. and Neal, B.,
2016. Designing a healthy food partnership: Lessons from the Australian food and health
dialogue. BMC public health, 16(1), p.651.
MacDonald, C., Genat, B., Thorpe, S. and Browne, J., 2016. Establishing health-promoting
workplaces in Aboriginal community organisations: healthy eating policies. Australian
journal of primary health, 22(3), pp.239-243.
Ogloff, J.R., Pfeifer, J.E., Shepherd, S.M. and Ciorciari, J., 2017. Assessing the mental
health, substance abuse, cognitive functioning, and social/emotional well-being needs of
aboriginal prisoners in Australia. Journal of Correctional Health Care, 23(4), pp.398-411.
Schembri, L., Curran, J., Collins, L., Pelinovskaia, M., Bell, H., Richardson, C., & Palermo,
C. (2016). The effect of nutrition education on nutrition‐related health outcomes of
Aboriginal and Torres Strait Islander people: a systematic review. Australian and New
Zealand journal of public health, 40(S1), S42-S47.

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Speight, J. 2016. Behavioural innovation is key to improving the health of one million
Australians living with type 2 diabetes. Medical journal of Australia, 205(4), 149-151.
R.I., Cockram, C., Flyvbjerg, A. and Goldstein, B.J. eds., 2017. Textbook of diabetes. John
Wiley & Sons.
Webster, J., Trieu, K., Dunford, E., Nowson, C., Jolly, K.A., Greenland, R., Reimers, J. and
Bolam, B., 2015. Salt reduction in Australia: from advocacy to action. Cardiovascular
diagnosis and therapy, 5(3), p.207.
Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D. and Bi, Y., 2017. Global epidemiology of
diabetic foot ulceration: a systematic review and meta-analysis. Annals of medicine, 49(2),
pp.106-116.