A disparate burden pg. 5
Putting the brakes on escalating diabetes incidence in disadvantaged and minority populations will not be easy, but most agree that the greatest impact will come from education, both at a local community level and on a broader national scale.
“Certainly, community outreach and intervention is critical to the control of this problem,” says Satcher, who is now director of the Center of Excellence on Health Disparities at Morehouse School of Medicine. “There isn’t any substitute for it, really. It’s going to get more people into care early. It’s going to, in some cases, prevent onset in people who are at high risk. And when people get into care…it will help them stay in care.”
Community outreach has been the goal of the Nashville REACH 2010 project (Racial and Ethnic Approaches to Community Health), part of a national initiative aimed at eliminating health disparities in more than 30 urban and rural communities. The project’s target group: African-Americans in north Nashville who are particularly hard-hit by diabetes and heart disease when compared to Caucasians in the same area, and when compared to African Americans in other parts of the country.
During the past seven years, REACH volunteers have worked with hospitals, community groups and other providers, including the Matthew Walker Comprehensive Health Center, to screen for undiagnosed diabetes, hypertension and high cholesterol, increase access to quality health care, decrease tobacco use and teach the benefits of nutrition and physical activity.
Far too many Hispanics and African Americans don’t have a medical home, says Satcher. “A lot of them go to emergency rooms for their care,” he says, where cultural issues, such as language barriers or racial stereotyping, often make for a less than satisfactory experience.
Satcher points to a 2002 Institute of Medicine report on racial and ethnic bias in health care—Unequal Treatment—as “pivotal in increasing sensitivity” among providers, especially in its potential to affect training of future physicians and nurses. “There is, for example, a program here at Morehouse School of Medicine that attracts people from around the country to a course on cultural competence.”
Increased cultural sensitivity in providers is a major feature of the National Diabetes Education Program, according to Gavin. The NDEP has a special populations work group, he says, that is “heavily invested in looking at approaches to help bridge the cultural chasms that make it difficult for some of these cross-cultural encounters to be successful.”
As to raising consciousness about the disease within minority populations, Gavin believes that the success of diabetes education efforts will hinge on repetition of message, not just isolated, one-hit attempts.
“There has been this tendency to think that…as long as content is accurate and the message is compelling, it shouldn’t take much exposure to drive the point home,” he says. “I think consistency of message will be required, and that means often and it means early.”
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