Healthcare Perfectionistas

Social determinants of health (SDOH) are defined as the conditions in which persons are born, grow, live, work, worship (Frank et al., 2017). Social and economic factors represent 40% of health determinants in the Robert Wood Johnson model. Socioeconomic status and location can be a main determinant in the health and quality of life of an individual (Ainsworth, slide 7).

Socioeconomic status of Native American’s can be used to explain the higher rates of diabetes in their community. The place you live will determine your diet and access to food. Unfortunately, 41% of Native American’s are living below the poverty line (Arguello & Artiga, 2013). In most cases, healthier food tends to be more expensive. With many Native American’s living below poverty that means many of them do not have access to reliable transportation and access to healthier food is almost impossible. They can only rely on convenience stores, like Family Dollar or quick marts, that don’t offer the same quality food options.

Since there are a variety of different health factors that constitute an overall sense of health, it is not surprising that health behaviors would have one of the higher percentages of the other factors. According to the Robert Wood Johnson County Health Rankings, health behaviors makeup 30% to an individual’s health outcomes (Ainsworth, slide 7). This is the second largest ranking following social and economic factors. While Native Americans had a history of healthy diets, it all changed as the government placed them on reservations and given non nutrient rich foods.

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The article, State of the Science: A Cultural View of Native Americans and Diabetes Prevention writes that “On many reservations, malnutrition and nutritional deficiencies were endemic. Despite recommendations to improve Native American diets, food aid provided to the tribes was usually insufficient and low quality” (Divers, 2009). The Native Americans were forced to change their dietary and other health behaviors due to the influence of unavoidable factors. They had to cultivate new dietary behaviors to stay fed because food insecurity was a prominent threat to their health as well.

In recent trends, Native Americans suffer higher rates of diabetes than any other racial/ethnic groups. According to Cho et al., “​the rates of diabetes as an underlying cause of death and a multiple cause of death have remained 2.5 to 3.5 times higher for Native Americans than for whites of all ages 20 and older, for every Indian Health Service (IHS) region except Alaska” (2014). Note, that the underlying cause of death due to diabetes is twice and triple times higher in IHS regions. This raises the question as to why there is an increase in the rate of diabetes among Native American population despite living in proximity to an IHS facility. Shouldn’t the morbidity rate of diabetes among Native Americans gradually decrease over time due to IHS available in these regions?

According to Robert Wood Johnson’s foundation model of population health, 20% of clinical care, such as limited access to care and the quality of care, are two major factors that contribute to the increase rates of diabetes among the Native American population as a whole (Ainsworth, slide 7). Although there are several, physically available IHS locations in these districts, not all Native American have access to the care and quality of care of these IHS agencies because many of them are ineligible and uninsured to receive these services.

Many low income individuals and people of color are at risk of being uninsured, lacking access to care, and experiencing worse health outcomes. The status of “American Indians/Alaskan Natives and low income individuals ​are more likely to be uninsured relative to Whites and those with higher incomes [and] also face increased barriers to accessing care/receiving poorer quality of care” (Orgera & Artiga, 1). ​Without proper access and quality of care, Native Americans find themselves vulnerable to health inequity and lack the preventative tools that may potentially inhibit rates of diabetes mellitus from increasing.

Despite restricted clinical/insured care as a leading contributor to the higher rates of diabetes in Native Americans than other racial/ethnic groups, the role of environmental factors is of undoubted importance in explaining the dramatic increase in the morbidity rates of diabetes among this specific Native American population. The physical environment in which an individual lives along with many elements of the physical environment, such as sanitation, climate, air/water quality, and housing/transit may affect overall health (Ainsworth, slide 7). Native Americans living in remote and isolated locations that exposes its residents to polluted air, water, stress, lack of physical activity, and an unhealthy diet are potentially environmental determinants that contribute to the diabtetical rates skyrocketing.

In one particular study involving Native Pima Indians, researchers have discovered an association involving high calorie diet intake and the development of diabetes mellitus amongst this tribal population. ​The traditional Pima diet, derived from local agricultural produce, was once high in fiber and low in fat, have changed during this century and is now similar to the diet in the rest of the United States. The fat content of Indian diets “has increased dramatically—from 17 percent of total calories in the pre-European contact diet, to 28 percent in the reservation diet, to 38 percent in the current diet” (Jackson, 1994).

These statistical comparisons stretching from three distinct periods in history emphasizes the inevitable continuous affect poor diet has on the increasing development of chronic diseases, such as diabetes mellitus, on Native Americans. The increase in current fat content in their unhealthy diet also increases the percentage of developing obesity, leading to a sedentary lifestyle as well. These environmental determinants are a chain reaction of contributors directly affecting higher rates of diabetes in the Native American population.

A good healthcare manager ​should be​ concerned with the healthcare disparities and populations they serve to provide excellent healthcare services to their communities and “As the population grows, shrinks, and changes in age and ethnic diversity, the epidemiology of disease changes and the HCO must respond” (​White & Griffith, 2010​). Any concerned healthcare manager will be working for one of these excellent healthcare organizations that will primarily focus on addressing the concerns (treating and diagnosing) of their patients. To accomplish this, healthcare disparities must be considered because they affect public health and relate to social inequalities in population health.

Healthcare disparities “​are not just a problem for the persons experiencing them but also a concern for the entire population in the society. Take the U.S. as an example, there are large health status gaps between racial groups, and the health of the racial minorities in the U.S. will negatively impact the overall health of the nation. Health disparities are also costly and particularly burdensome to the U.S. health-care system.” (Xin, 2017).

For ethnic minorities in the United States today, health disparities target their groups and take on many forms such as the higher rates of diabetes that Native Americans suffer from. As the United States becomes more and more diverse each day, it is important that our health care managers are making sure that the quality of care that minorities receive is no less than those who are any other race/ ethnicity beyond caucasian. Similar to a puzzle that needs the last piece to become complete, healthcare managers can be the last piece a healthcare organization might need to excel and distinguish excellence from other HCOs because they are willing to address the many healthcare disparities present in our society today.

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