Transcript
Today’s Picture of Type 2 Diabetes
in the Appalachian Region
Sharon A. Denham, DSN, RNProfessor Emerita, Ohio University School of NursingProgram Director, Strengthening Communities to Prevent Diabetes in Rural Appalachia
Objectives
1. Review surveillance data linked with type 2 diabetes in the Appalachian region.
2. Describe social determinants of health associated with diabetes risks for residents of Appalachia.
3. Explain ways cultural sensitivity is important for reducing incidence of type 2 diabetes and its complications.
Diabetes from 1980 to 2010
Diabetes: A Global Problem
Over 346 million people worldwide
25.8 million in USA
8.2% national average
79 million pre-diabetes in USA (35% of adults over 20 years have it; 50% of those over 65 years; only 7% know)
Cost $218 billion (2007)
Leading cause of serious complications
Appalachian Regional Commission
Low incomeLow income
High povertyHigh poverty
Limited educationLimited education
Poor living standardsPoor living standards
Job deficitsJob deficits
High unemploymentHigh unemployment
Out-migrationOut-migration
StagnationStagnation
Geography of Appalachia
Appalachian Regional Appalachian Regional Development: Development:
11 states (360 counties)11 states (360 counties)
1967: 13 states/393 1967: 13 states/393 countiescounties
1991: 399 counties1991: 399 counties
1998: 402 counties1998: 402 counties
2002: 410 counties2002: 410 counties
2008: 420 counties2008: 420 counties
Diversity in Appalachia
Not all mountains
Limited urbanization
Rural areas lag behind rural mainstream America
Distressed versus
Non-distressed
Largely populated by Caucasian people
Myths about Appalachia
Dilapidated and crowded housing.
Lack plumbing and clean running water.
Lack access to public utilities.
Geographic isolation due to transportation systems.
Poor communication abilities
Percentage of Homes with Complete Plumbing (1960 to 2000)
“A Hidden America: Children of the Mountains:
ABC’S 20/20
DIANE SAWYER
* Mt. Dew Mouth * Oxycotin and Substance
Abuse * Undervalue of Education * Poor Parenting Skills
Positives:
Two Appalachias Some focus on the dignity
of the people Challenges in breaking the
cycle of poverty Help needed is non-
materialistic
Appalachian Stereotypes
The “Real Appalachia” Not Monolithic Most raise children properly & have well-kept
homes One-sided exploitation (need to tell the whole
story) “Difference between being poor and being ‘Sorry’”
Social Determinants of Health
• Generational poverty versus situational poverty
• Literacy and low health literacy
• History of extraction of natural resources
• High risk employment
• Local environments
• Social influences on lifestyles
FY 2006FY 2005
Economic Status
FY 2012FY 2011
Economic Status
FY 2013
Economic Status
Poverty Rates 2006-2010
Appalachian VoicesThis map shows the relationship between coal surface mining and poverty. The red Xs are mined areas. The darker blue counties are those with the highest rates of poverty.
Unemployment Rates (2010)
High School Completion Rates
20001990
Diabetes by Education (1980-2010)
Where is Time Spent???
• 24/7/365 = 8,760 hours/year
• 1-2 hours a year doctor’s care
• Leaves 8,758 hours
Family Economics
• Median family income lower
• Limited employment opportunities
• Uninsured & underinsured
• Larger Medicaid & Medicare populations
• Greater numbers of older persons
Appalachian TraitsKind, Helpful, & HospitableKind, Helpful, & Hospitable
Outgoing & OpenheartedOutgoing & Openhearted
HelpfulHelpful
Strong faith valuesStrong faith values
Family highly prizedFamily highly prized
Strong moral valuesStrong moral values
Attachment to placeAttachment to place
Commitment & dedication to Commitment & dedication to workwork
PridePride
Maintain some older traditionsMaintain some older traditions
AppalachiaFamily
Place
Physical Activity
Should have 30 minutes of moderate activity at least 5 days a week
Only 35.6% of those in Appalachia reported no exercise in the last month
One in 3 adults not getting exercise
Percent Obese in U.S. Adults
Overweight
BMI of 25 or higher (includes those that are obese)
70.1% of those in Appalachia
7 in 10 adults
Obese
Defined as a BMI of 30.0 or higher
Appalachia rate 34.6% or more than 1 in 3 adults
2009-2011 County Obesity Prevalence Among Low-Income ChildrenAged 2 to 4 Years
Diabetes (2009)
Diabetes
13.3% of those in Appalachia have been told that they have diabetes
1 in 8 persons
Steadily risen: was 9.9% in 2003
Kentucky
Virginia
Mississippi
West Virginia
Pennysylvania
Ohio
2009
Diabetes Belt
In 2009, 81% of Appalachia counties had high rates of diabetes and obesity
Three-quarters of counties in the Southeast have similar rates
Highest concentrated diabetes rates in those counties with high percentages of African Americans.
These increases in obesity and diabetes partially reflect the cultural shifts that are affecting all of us,but we see them most in regions where there is more poverty and where educational levels are lower.
Contact Information
• denham@ohio.edu
• www.diabetesfamily.net
• www.diabetesappalachia.net
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