ARHI_T2DM in Appalachia.ppt

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

• [email protected]

• www.diabetesfamily.net

• www.diabetesappalachia.net