Evaluation of the Program

                The intervention that will be used for the problem of diabetes in the African American community is basically providing residents with the opportunity to purchase healthy foods at grocery stores within. This will happen by use of different participation of certain institutions, mainly grocery stores, hospitals and clinics. In this intervention, patients can be referred to the program where they can trade in certain amounts of money for a certain amount of “healthy money” or vouchers that can be used in designated grocery stores that will participate in the program. In these stores, only certain items will be able to be purchased with the money, which will of course be healthier for the at risk or already diabetic patients. (Maybe patients can rack up points at the cash register that they report back to their doctors)

                To implement this intervention there would have to be cooperation of the hospitals, clinics and grocery stores that I plan to run the program in. For the beginning of the program there won’t be as many participant institutions until we have evaluated the program to ensure that it has been going as planned.  I suppose I would have to approach the heads of the hospitals in order to see if they are on board with the program and if they have to then ask their superiors. In addition to this, grocery stores would need to be approached as well. It would have to be taken into consideration whether the grocery store is public or privately owned. In addition to this, producers of the foods that are planned to be put on the list would have to be approached as well.

                Possible barriers, of course, include the fact that the stakeholders won’t agree to the plans. To overcome this, perhaps there could be incentives in place for the stakeholders so that they want to participate in the program. Also, there could be a barrier in exactly understanding how the regular currency will be traded in for representative money at grocery stores.

                A good way to communicate the program to stakeholders is to hand out pamphlets to residents in the communities to be targeted. It would be beneficial to actually get people who are at risk or already have diabetes within those communities to pass them out because others would be more persuaded rather than have outsiders handing them out. Putting up posters in common, popular spots would be helpful as well. In Baltimore, there are a variety of faiths and religions, so perhaps it would be helpful to hold information sessions or place posters inside of churches for example. To get other stakeholders like grocery stores and hospitals on board, data about the program and how we see the benefits of the program on patients, might persuade them, especially since these places are within the communities where these residents live.

Evaluating the program is next. One way to do this is to record the number of program participants and whether they are actually purchasing items using the vouchers and which items. Also there can be a count of the amount of patients that were recommended to the program and those that actually decided to enroll.  Some outcome measures that can be used are evaluating the patient’s attitude towards healthier food options and towards the program in general. There can also be a survey of patients and residents to see if they actually saw or heard about the program and that will show well the communication of the program’s existence is going. Also, doctors can track the patient’s health from the beginning of the program until a set amount of time enrolled in the program and see if the patient showed improvements over that time.

Interventions

A current intervention that addressed my problem that was tested focused on the idea that having one’s peers as a form of social support when dealing with chronic illness will actually improve and influence the behaviors of those who have the illness. For this study, they looked at background information about how this model worked in other situations and in other places, for example, for people with hypertension. The intervention that they implemented was used in west Baltimore city. Basically, they first recruited members of the community to become community health care case managers in their specific communities. They then trained these workers extensively about what the program entailed and about diabetes. These community healthcare workers made weekly in home visits and phone calls with patients. They did everything from helping the patients to keep their appointments to making sure they were taking their medications appropriately to monitoring for signs of complications. The key determinant they addressed was that there were increasing hospitalizations and emergency room visits for patients with diabetes who were on Medicaid.

                A possible strategy that identifies the issue of food deserts is to incorporate more farmers’ markets within these communities. By doing this, residents have more consistent access to quality, healthy foods. Perhaps these farmers markets should also be actively advertised within the communities and hold other attractions so that residents are more likely to attend. Maybe there’s something there for kids, which can then lead to the parent having to take the child to the event and indirectly will be susceptible to purchasing some of the produce.

                Another possible strategy is to provide incentives to patients who come in regularly for their checkups and for physicians who will agree to see these Medicaid patients. Such incentives could be pay bonuses for physicians and healthy meal vouchers at their local grocery store for the patients. This is just a way to get the diabetic patients in the hospital and seen by a professional that can track their progress and analyze if there are any potential complications in the future so that they can be reduced.  This addresses the issue of Baltimore residents being of low socioeconomic status and many are on some type of public health insurance.

                Lastly, because a large majority (over 70%) of residents in Baltimore are associated or affiliated with some type of religious group, perhaps it would be a good idea to get these institutions involved as well. For instances, churches can hold health fairs, sponsored screenings, or day-clinics to get their members to be aware of the statistics. Perhaps health professionals can enter these institutions and provide presentations on the epidemic that is present in the African American community. This is more of a primary method, aiming at educating Baltimoreans about diabetes and how to prevent the illness.

Options Decision Criteria	Intervention 1: Food deserts	Intervention 2: medicaid	Intervention 3: churches
Effectiveness	2	2.5	1.5
Feasibility	2.5	1	2.5
Sustainability	2	2.5	2
Cost	2	1	2
Cost effectiveness	2	2	2
Political acceptability	2.5	1.5	2
Social will	2.5	1.5	2.5
Potential for unintended risks	3	1.5	3
Potential for unintended benefits	3	3	3
Total/conclusion	21.5	16.5	20.5

The best intervention seems to be the first one based on the idea of food deserts. This scored the highest from the decision criteria, which all seemed appropriate for determining the best interventions. 

Possible Stakeholders...

There are several stakeholders that play a role within developing an intervention for diabetes in the African American community. It is important to recognize who the stakeholders are within the area that you plan to implement a program because those are the people who will have to be convinced or approached for support and resources in the event that the program you are implementing will affect them.

        Possible stakeholders include the population that obviously is going to be directly impacted: African Americans. Besides this, there are other organizations and persons to be considered. There can be food suppliers and grocery stores, local/state/government contracting and government budgets (fiscal analysts or those who control the budget of the area), health insurance companies, hospitals and physicians.

The beginnings of some possible interventions for this problem for example could be the development of more efficient grocery stores within urban areas to decrease the amount of food deserts. Stakeholders for this intervention include the local or state governments who have to make room in their budgets to build more grocery stores. They would also have to provide staff and training for these new stores. You would need the cooperation of those individuals who live in the area where the stores are planned to be built, especially in the case that residents might need to be displaced, unless the stores were built on vacant lots or other places. In this case, there may be opposition from the local governments, especially if there budget spending is limited and they would like to put the money they have towards other areas that they deem more necessary. This can be addressed by ensuring some type of payback towards the government for each grocery store that is established.

Another intervention is to provide more fresh and healthy foods for lower prices. Stakeholders in this intervention could be farmers and those who grow the produce, the companies who manufacture the produce, the stores that distribute and sell the produce, and even the government because of the decrease in profits (i.e. taxes) that will be incurred from the lower prices. There may be opposition from farmers because there income will be impacted by the lower costs. Perhaps there could be an incentive for farmers who participate in the intervention over a certain amount of time or how much of their products were purchased in consumer markets.

The stakeholders will obviously have many concerns about what the implementations might mean to them in the long run. For many of the stakeholders, the loss of money is a huge factor in whether they will comply or negotiate with the implementation plans. They may also be concerned about how their participation looks to other groups and organizations that they support. Even more important, they may be concerned about what they may gain from negotiating with the task force.

All About Key Determinants

There has been increased prevalence of Diabetes among African Americans 18 years and older in the United States between 2002 -2010. There are a variety of key determinants that factor into this diabetes epidemic on many levels. Biological determinants include race,  gender, physical activity, and previous health-related problems such as obesity and hypertension.  Social and Cultural factors are things such as ethnicity, socioeconomic status, group norms (soul food, curvy women), daily lifestyle habits (working multiple jobs, not enough time to cook), education (being aware of healthier options), media influence, and social support. In addition to these are environmental determinants such as the distance to grocery stores, access to gyms, and quality of neighborhoods. Economic factors include the price of foods, medication costs, and employment status. There are also political determinants such as access to healthcare/quality of healthcare and even medication costs.

To analyze these determinants and see how much they contributed to the development of diabetes, many studies were done. The Food, Identity, and African-American Women With Type 2 Diabetes: An Anthropological Perspective analyzed the importance of food in African American culture and relationships, predominantly among women. They found that food was sort of a way to welcome others, and to show gratitude those who the food was given too felt they had to eat plenty. One interviewee stated that, “The old people that I work around, they show me they love me and really care for me, they feed me. They feed me a lot. They feed me like five times a day, not thinking, well, this child needs a balanced nutrition meal so he won’t get fat.” Other research was done on another basis as noted in Social determinants of health among African Americans in a rural community in the Deep South: an ecological exploration. Researchers interviewed African Americans in a systematic way which included questions from several different categories of ecological levels such as individual, relational, and environmental. As a result of these interview responses, they put together possible determinants of health. This included lack of social capital, political cronyism, poverty, racism, and local economy. Although this study does not particularly identify diabetes determinants, they can also be applied to this disease. Another study, Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention, focused on diabetes in the population of African Americans in Detroit, Michigan. Something they found was that the city had a higher rate of mortality from the disease than the state itself, (note: Detroit is predominantly African American).  They also identified that African American women were the least active and the most overweight among many groups and bridged a link between this and the development of type 2 diabetes. The researchers suggest that race-based residential segregation is one of the overarching issues that have a trickling effect down to the health disparities seen in the US.

There are many key determinants that contribute to the prevalence of diabetes among the African American community. I intend to identify those that relate to my problem definition through more research.

Liburd, Leandris C. "Diabetes Spectrum." Food, Identity, and African-American Women With Type 2 Diabetes: An Anthropological Perspective. American Diabetes Association, n.d. Web. 01 Apr. 2013.

Scott AJ, Wilson RF.  Social determinants of health among African Americans in a rural community in the Deep South: an ecological exploration. Rural and Remote Health 11: 1634. (Online) 2011.

Schulz, Amy J., Shannon Zenk, and Angela Odoms-Young. "Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention." PMC. American Journal of Public Health, Apr. 2005. Web. 01 Apr. 2013.

Diabetes in African American Communities

There has been increased prevalence of Diabetes among African Americans 18 year and older in the United States between 2002 -2010. Diabetes among the America is an important topic of discussion because it is predicted that the rates of the disease will increase as it is evident that more Americans are becoming obese. This disease is even more of an issue within the African American community being that despite being a minority within the US, the rates of diabetes within this group are almost 2 times more likely than non-Hispanic whites (Disease and African Americans).  Diabetes is 7th leading cause of death in Americans and the cause of major issues such as heart disease and stroke. Diabetes also is a contributing factor to other health problems like hypertension, kidney disease, blindness, and even limb amputations. The cost of diabetes related care is also reason to address this public health issue as healthcare spending is an important topic within US politics.

There are various avenues that can be assessed to determine why this health issue is occurring. Indicators, both indirect and direct, contribute to understanding the factors that play a role in diabetes among this group. According to the CDC’s 2003 National Fact Sheet, in 2002, “11.4% of all non-Hispanic blacks aged twenty years or older have diabetes.” In addition to this, the United States’ Diabetes Crisis among African Americans: Today and Future Trends reports that 5,547,700 of 40, 951, 000 (roughly 13.5%) African Americans had diabetes in 2010 and projected a growth to about 20% in 2025. From this data it is apparent that the trend of this disease is definitely increasing.  This data is strong evidence in that it also gives future predictions if actions are not taken against combating this disease.

In today’s American society and culture, life is moving by fast. It’s no doubt that there is only so much time in the day, and with adults having such busy lives they may have to make decisions that can later on impact their health. There are many players that can greatly affect the non-healthy choices that are made that can cause diabetes. Social culture and education all indicate the trend of diabetes in the African American community. The idea of “Soul Food” has long been embedded in the lifestyles of many African Americans. This food, although is just a heavenly taste, is not particularly nutritious because of the way that it may be prepared. A study of African Americans in California showed that fast food restaurants were most preferred among eat out dining options at 29% (Cowling 2). Although the data is a strong inclination of poor diet options, the data was self-reported and may have included bias. Not only does food choice factor into the big picture, but education levels perhaps. In a press release by the CDC, it was noted that, “2007-2010, women 25 years of age and over with less than a bachelor’s degree were more likely to be obese (39 percent-43 percent)” (Press Release). This is just one statistic that shows that those who are less educated are more likely to be obese. Obesity is on the road to diabetes. Other factors that can be evaluated include socioeconomic status, fast food restaurant density within urban communities, unemployment rates, food deserts, obesity, prices of healthy food versus unhealthy food, family history and access to healthcare prior to diagnosis.

"Press Release." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 May 2012. Web. 28 Mar. 2013

"2003 National Diabetes Fact Sheet." Centers for Disease Control and Prevention. N.p., 20 May 2011. Web. 27 Mar. 2013.

"Diabetes and African Americans." The Office of Minority Health. US Department of Health and Human Services, 28 Aug. 2012. Web. 30 Mar. 2013.

"United States’ Diabetes Crisis among African Americans: Today and Future Trends."Institute for Alternative Futures. Institute for Alternative Futures, 2011. Web. 30 Mar. 2013.

Cowling, Linda L. Health and Dietary Issues Affecting African Americans. California Food Guide: Fulfilling the Dietary Guidelines for Americans. N.p.: n.p., n.d. 1-2.California Department of Healthcare Services. California Department of Healthcare Services, 20 Sept. 2006. Web. 25 Mar. 2013.

Problem Definition: Childhood Depression

Children and teenagers face many new changes throughout their lives during those times of growth and exploration. In the United States there has been an increase in rates of depression in teenagers between 12-17 years old from 2004-2009.

                Childhood depression is an especially relevant problem. For one, these children eventually grow up to become adults that have to live and be able to function in a fast-paced world. Therefore, it is important to address mental health problems such as this in children early so that they can be treated. In addition, depression can also be the cause of or go hand in hand with other health problems. Children with depression can suffer socially as well as physically and mentally. Socially, children who suffer from depression tend to withdraw from situations and people. They also may become moody or indulge in negative behaviors such as drugs and risky behaviors. It may also be difficult for them to express their feelings or emotions. One of the correlations is that depression is also linked to suicide. Depressed children may begin having thoughts related to death because of their low-self-esteem and may often seem hopeless and alone. Relating this to public health, prevention of mental health diseases can ultimately help prevent these unfortunate and untimely deaths.

                This topic is very interesting because depression in children can sometimes go by under the radar. It is important for parents to observe their children and be able to see symptoms and act on them promptly. I would like to investigate how depression even begins and how it is diagnosed. I would also like to understand why it is occurring at faster rates and due to what factors whether it be because of the media, school pressures, or things like sudden life changes and being immersed in different environments. Because depression in children once was not seen as common place, or the children’s behaviors was just disregarded as being moody, seeing how depression was actually expanded to including children is also really interesting.

                Childhood depression is socially relevant in that it affects a very important and vulnerable part of the population. As a child it may be difficult to cope with everything that it is occurring in your life. When others understand and respond appropriately, they can make the situation better instead of making it worse. In addition to this, the mindset of society, with the media, name brands, and the notion that it’s better to be cool and popular, feeds into behaviors such as bullying. If I remember correctly, in school kids were relentless, but they are not fully aware that their behavior can impact someone else so negatively. Treatment and pressures like this are taxing on adults, much less on the minds of children who are constantly learning and trying to find themselves.

                All in all, it is essential that the cause of this trend is identified so that measures can be taken to sufficiently decrease these cases of depression. Seeing that depression can cause other health problems, preventing this mental illness can then aid in the prevention of others perhaps.

                

"Contagion"

                The movie Contagion is about a pandemic that began at one source and then quickly spread to other people in many countries. The movie covers an array of topics about what could happen if a situation like this was made a reality. Many people were quarantined and dying because the disease was spreading quicker than the CDC and other medical personnel could develop a vaccine to combat it. As the outbreak continues to spread and a drug was developed that could contain the virus, human civilization begins to break down as people were driven to loot and riot. Vaccines are given out via lottery and slowly civilization returns. At the end we realize that the virus came originally came from a bat which transferred it to a pig, then to a chef who then gave it to Beth where it all began. In relation to public health, I feel like this movie captures in its allotted time, the essence of what the goal of public health is. Prevention of diseases and containing them, among other things, is the purpose of the field and if something as drastic as what occurred in the movie happens, I suppose we can expect to see everything and every aspect in full action.

                Many concepts from class relate to and are shown in the movie. Outbreaks are defined as a disease that occurs in great numbers than expected within a community. An outbreak can occur and spread just as rapidly as it happened in the movie. It depends on the disease that you are dealing with. The outbreak investigation involved tracking down where the pandemic started and projecting the amounts of people that may become infected and over what period of time can it be expected to see these occur. Also, developing a solution for the virus and then approximating the amount of time that it can be expected for the vaccination to be verified and then ready for disbursement to the public is also important. Isolation involves separating sick people from others in the case that they may spread the illness to others. This occurs in the movie when many of those who had the illness were placed together. Also, many people in the public isolated themselves from others in order to protect their own health. The concept of quarantine is different in that it separates those people who may have been exposed to a disease, but have not yet showed symptoms of being ill. This also relates to the movie in the sense that everyone who was thought to be infected was purposely set apart from the rest of the population. Quarantine is essential in taking preventative measures against increasing infections and death toll rates.

                Since 9/11 the possibilities for non-conventional ways to spread terrorism has become a realization. The use of biological weapons has become a factor in the way the U.S. prepares for future threats. In the movie, public health agencies could have been better prepared if they had better communication, not only between them, but with how they informed the public. I understand that they did not want to cause panic, but the people also deserve to know what they are up against and how to protect themselves. Also, because the world had never seen anything like the pandemic in the movie, they weren't prepared to effectively prevent the spread of the disease and identify it and its origins. There also should have been better protocols in place for worst case scenarios where a disease spreads uncontrollably.