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Public health policy often excludes access to essential medicines. Drawing on an in-depth case study examining access to essential medicines in the context of the HIV/AIDS pandemic in South Africa, and more briefly, making reference to the U.S. diabetes epidemic, we highlight the relationship between the need for essential medicines in world populations, and the role of groups external to government in promoting access to essential medicines in public health policy. We consider how, in the context of health stratification, the activities of patient advocacy groups, and “third way” social policies of the pharmaceutical industry generate “social capital,” creating enhanced access to essential medicines for a few, and promoting the ideal of the right to access for all. The implications for the development of public health policy inclusive of essential medicines are discussed.

This study uses ethnographic data from two diabetes clinics to examine how some organizational features of medical settings are connected to the daily cognitive and interactional work of medical providers – specifically, the process of assessing patient adherence and using such assessments to make treatment decisions. I address continuity of care, scheduling and time constraints, team management, provider interaction, and medical recordkeeping as organizational-level issues that impact individual-level providers’ work. More than a top-down model of how “macro” influences “micro,” this study highlights how organizational influences are accounted for in terms of variation in patients’ behavior.

Purpose – To examine potential sex differences among American Indian and Alaska Native peoples (AIANs) in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs within the Indian Health Services (IHS).

Methodology/Approach – Data were drawn from the IHS Improving Healthcare Delivery Data Project with 437,608 persons in our analytical sample. We described sex and age differences in diabetes, comorbidities, healthcare utilization, and treatment costs among the adults with diabetes. We evaluated the statistical differences between men and women using confidence intervals calculated at the 95% level, with nonoverlapping confidence intervals indicating statistical significance.

Findings – The prevalence of diabetes among females was somewhat higher than that of males (10.82 vs 9.16%, respectively, p < 0.05). Among adults with diabetes, males had statistically higher prevalence of hypertension, cardiovascular disease, and substance use disorders and fewer mental health disorders compared to females. Although males had overall lower average cost of services than females, males had higher utilization for hospital inpatient services than females, and females used more outpatient services.

Research limitations/implications – We are limited to one fiscal year of data and thus cannot predict the influence of healthcare utilization patterns on the overall health of this population. Although a large sample, the findings are only generalizable to the active users of the participating IHS Service Units.

Originality/Value of Paper – This study fills a major gap in our knowledge of sex differences in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs among AIANs. Differences in the comorbidities that characterized the AIAN adult males and females with diabetes in this sample have important implications for mortality and cost of care. Diabetes management that addresses such gender-specific comorbidities, particularly substance use disorders among men and mental health disorders among women, promises to reduce these comorbidities and related complications.

Research on Asian Americans’ health behavior has often cited socioeconomic status, race, language, cultural beliefs, acculturation, etc. as barriers to seeking health care services. Less is known about Southeast Asians refugees’ help-seeking process. In this exploratory study, we examine the illness experiences of Southeast Asian refugees with a Type 2 diabetes diagnosis, and consider the factors that contribute to their understanding and management of diabetes.

We used Pescosolido’s network episode model to frame our understanding of the ways in which Southeast Asians maneuver through their social support networks, face barriers in accessing health care services, and manage their diabetes. We interviewed a convenience sample of 16 adults. All interviews were digitally recorded, transcribed, and coded. Analysis was guided by the grounded theory approach.

Our findings revealed that Southeast Asians’ definition, acceptance, and management of their diabetes was largely influenced by various factors including: trauma and PTSD from their refugee experience, challenges of acculturation, illness experience, mental health, and access and barriers to health care services. The network episode model provides a blueprint for understanding the social and cultural challenges that Southeast Asian refugees face with regards to their diabetes.

Research limitations include the small and convenience sample used for the study, which does not contribute to generalizability. However, our findings contribute to the limited but growing studies on Southeast Asian refugees in the United States, and emphasize the need for health care providers to consider the illness experience, health beliefs, and the social context of Southeast Asian refugees with diabetes. Although the adults in this study were not recent immigrants, their immigrant history and experiences influenced their understanding and management of their diabetes.

Few qualitative studies focus on the health of Southeast Asians in the United States (Hmong, Laotian, Cambodian, and Vietnamese). This study has potential value for clinicians, social workers, and community providers serving ethnic minority populations, specifically Southeast Asians. In this study, older immigrant adults faced generational challenges that impacted their chronic illness (Type 2 diabetes).

Diabetes is a chronic and challenging disease and requires personal daily self-management decisions and skills. For that, it is necessary that patients have sufficient information and health literacy to make the right choices and decisions in their self-care. Sequentially, health literacy has great relevance and influence in the daily lives of people with diabetes, since it encompasses the necessary skills to manage disease and health. Health literacy can be a relevant factor to consider when tackling diabetes self-management. Thus, for the prevention and treatment of diabetes, it is essential to promote individual health literacy. The quality of communication and patient-centred communication style seems to be a key aspect for the health literacy.

Professional interpreter use improves care in patients with limited English proficiency (LEP) but inequalities in outcomes remain. We explore the experience of US Latinos with LEP and diabetes in language discordant care.

We conducted in-depth interviews of 20 low-income Latino patients with diabetes and LEP. We interviewed participants in Spanish, digitally recorded and transcribed interviews, and read transcripts to identify themes and interpret meanings using interpretive phenomenology as theoretical framework.

While patients preferred, and experienced greater trust in, language concordant clinical encounters, they did not believe that language discordance affected outcomes because they felt that these depended largely on their compliance with physicians’ recommendations. Patients also downplayed structural barriers to care and outcomes. Self-blame was paradoxically encouraged by physicians’ praise vis-à-vis favorable outcomes.

Limitations include small and convenience sample and limited generalizability. However, findings illustrate communicational dynamics between patients and clinicians with important implications for health care practice and policy. They support the perception that trust develops best within language concordant care, which underscores the importance of recruiting clinicians with diverse language skills. They highlight the importance of sensitizing clinicians to the social determinants of health, which may be overlooked when treating patients with conditions requiring substantial self-management, like diabetes. Language barriers in health care must be understood in the broader context of structural inequalities in health care. The necessary emphasis on self-management may (inadvertently) strengthen the hegemonic view that places responsibility for diabetes outcomes on patients’ ability to self-manage their condition to the neglect of social/political determinants of diabetes.

Studies have quantitatively examined the effects of language discordant care on diabetes outcomes, yet few have done so qualitatively. To our knowledge, no study has attempted to understand the experience of language discordance from the perspective of LEP patients with diabetes and how this experience may explain observed differences in outcomes.

We investigate how career disruptions in terms of job loss may impact morbidity for individuals diagnosed with type 2 diabetes (T2D). Combining unique, high-quality longitudinal data from the Swedish National Diabetes Register (NDR) with matched employer–employee data, we focus on individuals diagnosed with T2D, who are established on the labor market and who lose their job in a mass layoff. Using a conditional difference-in-differences evaluation approach, our results give limited support for job loss having an impact on health behavior, diabetes progression, and cardiovascular risk factors.

Drawing on ethnographic observations of diabetes (self-)management in French-speaking Switzerland and semi-structured interviews with healthcare practitioners, people living with diabetes and their relatives, the chapter aims at shedding light on self-tracking practices of people living with diabetes. It explores the ways people with diabetes measure and learn to recognise body symptoms of hypo- and hyperglycaemia through self-quantification, and act consequently. In particular, the chapter investigates recent medical devices – continuous and flash glucose monitoring systems – that reconfigure the work of health providers and self-care practices. It shows the self-monitoring practices and the resulting self-awareness people living with diabetes develop in interaction with technology and caregivers in order to undertake embodied actions. By pointing out that new technologies have facilitated the access to personal body information and the sharing of it, self-monitoring is also questioned as a form of surveillance, opening up issues of power and control over patients’ behaviours. With regard to this, the chapter illustrates that, occasionally, people with diabetes resist ‘docility’ through micro-powers at the level of everyday life by refusing to engage in their use and by developing personal strategies or ‘tactics’.