Action Plan

Intervention: Promote good health in schools across the country

Implementation: To implement this intervention plan, I propose that public health officials will contact local governments and public school/authority boards about speaking at an assembly towards the beginning of school. Parents will be encouraged to attend this meeting. Public health officials should convey the importance of good health, and the effects that bad health has on an individual. After the initial assembly, students will discuss health issues as well as their own health in smaller, advisory-like groups. In these smaller meetings, students will be given the opportunity to keep a log of what they eat and when they exercise for each week, as long as they feel comfortable doing so. This log will be handed in to the advisor at the end of every week. Barriers to this action plan include students' self-consciousness of their health and therefore their unwillingness to keep the weekly logs. This barrier can be overcome (to some extent) by using communication to show the students across the country are participating in the same thing (see below). 

Communication/Dissemination: There will be email notifications as well as signs throughout the schools to remind the students about the initial assembly, as well as the weekly meetings. Students will be informed, through mass media, that they are not the only ones involved in this intervention plan; schools across the country will be doing the same. Through emails, students will be encouraged to keep weekly logs of their overall health. Again, they will be reminded that schools across the country are partaking in the same exercise. 

Evaluation: The key to the evaluation of this intervention plan will be the weekly review of the health logs. This includes public health officials involved in the process reviewing the data in the logs as well as identifying the numbers of logs turned in per week at each school (process measures). Desired outcomes include an increasing number of students filling out weekly logs, as well as an overall amelioration of the students' health (outcome measures). 

Interventions

There has been an increasing incidence rate of adult onset diabetes among young adults over the past decade in the United States. A current intervention to minimize the problem of this increasing incidence rate is the new treatment options. Certain drugs, such as DPP-4 Inhibitors, Incretin mimetics, GLP analogs, and new types of insulin work to lower blood glucose level and/or increase the amount of insulin in the blood. This intervention is targeting the biological key determinant of the body’s level of insulin resistance. In addition to these drugs that are currently FDA approved and widely used, new drugs are being made that will serve by reabsorbing glucose from the urine, rather than by affecting the insulin level in the blood.

In addition to the current interventions that are in use, there are more potential interventions that can help minimize the problem of increasing type 2 diabetes among young adults. One such potential intervention would be to promote good health in schools (secondary intervention) around the country. This approach would target the biological key determinants of poor diet and physical inactivity. Another potential intervention would be to promote good air quality (primary intervention), as bad air quality has been reported to be a factor causing type 2 diabetes. Lastly, a third potential intervention would be to lower costs of insulin shots (secondary intervention), targeting the economic key determinants presented above.

Options Decision Criteria	Intervention 1: Promote good health	Intervention 2: Promote good air quality	Intervention 3: Lower costs of insulin shots
Effectiveness	2	2	2
Feasibility	3	3	1
Sustainability	3	2	3
Cost	3	2	3
Cost effectiveness	2	2	3
Political acceptability	3	3	1
Social will	3	3	3
Potential for unintended risks	2	2	2
Potential for unintended benefits	2	2	2
Total/conclusion	23	21	20

By looking at the Decision Matrix above, the most effective final recommendation is to promote good health in schools throughout the country. Overall, this seems to be the most effective method of intervention for several reasons. It seems that the heart of most diabetes cases among young adults stems from either genetics or the patient’s upbringing. There is nothing we can “fix” about the genes someone gets. Thus, we must focus on changing their upbringing. A factor that is most important in doing so would be to allow the patients to live healthier lives; this can be done through eating healthier, exercising, and generally treating one’s body in the right way. By promoting good health, public health officials can most effectively convey this point.

Works Cited:

http://diabetes.webmd.com/features/new-treatments

Stakeholders

There has been an increasing incidence rate of adult onset diabetes among young adults over the past decade in the US. In public health, a stakeholder is defined as persons, organizations, or other groups who share a stake in the issue at hand. One of the biggest stakeholders in the issue presented in the problem definition are the patients who suffer from type 2 diabetes. As most of the key determinants of the disease revolve around unhealthy eating and/or a lack of physical exercise among young adults, a logical intervention would be to help these young adults eat healthier and to increase their physical exercises. However, this is easier said than done. It would be relatively difficult to cause such immediate change in the general population of young adults who have spent their entire lives eating whatever they wanted and not exercising. Changing their habits is something they would have to comply with, and it requires cooperation and agreement. In order to give these young adults incentive to comply with these guidelines, public health officials should begin by educating these patients and the general population about how important it is to treat your body correctly. Further, officials should do their best to surround the patients with healthier options; for example, they should impose guidelines that schools must follow about Physical Education and cafeteria food options, as well as reach out to the parents of the young adults in order that they provide a healthier environment for their child. 

Another stakeholder in the issue presented in the problem definition are policymakers of the institutions/the parents of the patients that are to abide by the public health guidelines set by officials. For example, following from the argument regarding PE requirements and healthier food options in schools, the state and local governments, as well as the boards of the schools, must agree to comply with these actions. Getting these stakeholders (who are all authority figures) to comply should not be as difficult as getting the patients to comply- they will not be AS affected. Though, the biggest way to increase compliance is to inform these authority figures about how important health is among the affected young adults. 

Lastly, another stakeholder in the issue present in the problem above would be those that must fund the change to healthier behaviors, namely, the parents of the young adults affected by type 2 diabetes. For example, parents might find that allowing their child to lead a healthier lifestyle can be more expensive, time consuming, and harder in general. Fully engaging in a healthier lifestyle appears to entail buying healthier foods (which are sometimes more expensive), seeking education about diabetes, finding exercise facilities, etc. However, public health officials may deal with this issue by portraying to these parents that being healthier is not always harder and more expensive; rather, it is just a different lifestyle. It is important that these officials show the parents that following these guidelines is not such a burden. 

Key Determinants

Table One: Key Determinants of Diabetes

	Human Factors	Agent or Vector	Environment: Physical	Environment: Socio-Cultural
Pre-Event	-Excess calorie intake -Poor diet -Physical inactivity	-Body’s insulin resistance (before development)	-Quality of air	-Genes -Upbringing -Socioeconomic status
Event		-Body’s insulin resistance		-Presence/abundance of insulin shots
Post-Event	-Obedience of correct procedures for diabetes [i.e. insulin injections when required]	-How the body cope’s with an increased blood glucose level		-Costs of healthcare -Quality of social care

           

There has been an increasing incidence rate of adult onset diabetes among young adults over the past decade in the US. As shown in Table One, there are many key determinants that can be attitude to diabetes. Starting in the top left hand corner, human factors that affect the patient pre-event (before they are diagnosed with diabetes) include excess calorie intake, poor diet, and physical inactivity. Together, these three things may cause obesity, which increases the insulin intolerance among the affected; this intolerance is a pre-development of diabetes. In certain ways, humans affected with diabetes also have control over the disease after the initial onset. For example, by obeying the doctor’s recommendation to inject oneself with insulin (either daily, weekly, or when needed), the affects of the disease may be mitigated.

            In addition, there are also key determinants of diabetes that are controlled by the agent of the disease- the patient’s body. Both before and during the onset of diabetes, the extent of the body’s insulin resistance determines the severity of the disease. After diagnosis, each patient’s body will react differently to the increased blood glucose level caused by the insulin intolerance. The way the body copes with these effects can also determine the severity of the disease.

            The physical environment also plays a role in determining the effects of diabetes. For example, studies show that the quality of air in a person’s environment is linked with the onset of type two diabetes among a younger population. When the air quality in an area is bad (smoke, carbon monoxide, nitrogen dioxide, particulate matter, etc), it is more likely that young adults develop insulin resistance that can eventually lead to diabetes. In addition, bad air quality has been found to lead to obesity among the youth. Therefore, those young individuals who have been exposed to bad air quality throughout childhood have a predisposition for obesity and insulin resistance, and therefore are put at a very high chance of developing adult onset diabetes in their young adults years.

            Lastly, socio-cultural factors of the environment are also key determinants of diabetes. Before the diagnosis, one’s genes, upbringing, and socioeconomic status affect one’s likelihood of diabetes. For example, young adults with a genetic predisposition to diabetes are more likely to develop adult onset diabetes at a younger age. Likewise, one’s upbringing affects the likelihood of diabetes diagnosis. For example, if one grows up in a household with obese parents and does not watch what he/she eats, then that person will likely suffer from obesity as well. This person will be at a higher risk of also suffering from adult onset diabetes at a younger age. Socioeconomic status (SES) goes hand-in-hand with the way one’s upbringing affects the likelihood of diabetes diagnosis.  Those of a lower SES are more likely to be affected by adult onset diabetes at a younger age. This could be for a multitude of reasons; for one, many of these people have not had the proper education about how to be healthy. Many may smoke, suffer from obesity, or engage in other activities that are found to be unhealthy. This all increases the likelihood of being affected by type two diabetes. In addition, the presence or abundance of the insulin shot in a community may affect how one copes with the disease. For example, it may be hard to supply third world countries with enough insulin shots for all, which may cause the effects to be worse in some people with the disease. Lastly, the quality and abundance of healthcare and social care has obvious affects on those with diabetes- namely, the worse the healthcare provided, the harder it is to cope with the disease.

Works Cited

http://www.idf.org/diabetesatlas/5e/the-social-determinants-of-diabetes-and-the-challenge-of-prevention  

http://www.diabetesandenvironment.org/home/contam/air

Diabetes II

There has been an increasing incidence rate of adult onset diabetes among young adults aged 0-20 years over the past decade in the US. Public Health officials have set out on a 5-year, multicenter study called SEARCH for Diabetes in Youth in order to better help with the problem of increasing incidence rates. This form of active surveillance allows public health officials to examine the current status of diabetes among young adults in the US. As stated by the CDC, the "Childhood Diabetes Registry will study the prevalence, incidence, natural history, and quality of care of children with diabetes and will help identify future programs and interventions." 

As determined by the CDC, over the past three decades, the percentage of the population among people aged 0-44 with diagnosed diabetes increased from 0.6% to 1.8% of the population, amounting to a total increase of 200%. Although the case count of diabetes is greater in people aged 65 and above, the percentage of the population with diagnosed diabetes is increasing fastest in those aged 0-44 years. Considering the total population (not differentiated by age), the incidence rate of diabetes over the past decade in US adults aged 18-79 years has greatly increased, as the number of new cases has gone from 1104 in 2000 to 1735 in 2010. However, more specifically, the rate of new cases of type 2 diabetes among young adults aged 10-20 years was 8.5 per 100,000 people in 2010. 

Children diagnosed with adult onset diabetes are typically between 10 and 19 years of age, have a family history of diabetes, suffer from obesity, and have an insulin resistance of some sort. In addition, many young adults recently diagnosed with adult onset diabetes are among racial minorities (specifically, Black, Asian, Hispanic, and American Indian). 

A direct indicator of an increase in incidence rates of type 2 diabetes among young adults is a noted increase in blood glucose level in young adults. As a symptom of diabetes is an increase in blood sugar, there is a direct correlation between glucose level and diabetes. Another direct indicator of an increase in incidence of type 2 diabetes is increased fatigue among high school students, as well as an increased frequency of urination in high school students. In addition, there are also indirect indicators of an increase in type 2 diabetes among young adults. For example, an increase in reliance on fast food restaurants among high school students will in turn cause obesity, which can lead to adult onset diabetes in the youth. 

An increase in blood glucose level is a very good direct indicator of diabetes. This data is reported by physicians and public health officials, making it accurate and plausible. It is a strong, direct measure that is objective and accurate. However, an increase in fatigue and an increase in urination among high school students is a much weaker indicator. Information about fatigue and urination patterns is self-reported data on the part of many high school students, and the results of self-reported surveys may contain bias or falsehood. It is entirely dependent on teenagers' decisions to be truthful in answering survey questions. An increased dependence on fast food is another self-reported statistic, and therefore depends on how truthful teenagers are in answering survey questions. 

http://www.diabetes.org/diabetes-basics/diabetes-statistics/

http://www.cdc.gov/diabetes/pubs/estimates11.htm#3

http://diabetes.niddk.nih.gov/dm/pubs/statistics/#NewCasesDDY20 

http://www.cdc.gov/diabetes/projects/cda2.htm 

http://www.cdc.gov/diabetes/statistics/incidence/fig1.htm 

http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm

http://www.cdc.gov/diabetes/projects/cda2.htm

Diabetes

There is an increased prevalence of diabetes in the US, as it is predicted that by 2050, 1 in 3 US adults will be affected. According to the CDC in Atlanta, Georgia, Diabetes is "common, disabling, and deadly." Among adults, diabetes is the seventh leading cause of death in the country, as 8.3% of the United States population is affected (25.8 million diagnosed cases, 7.0 million undiagnosed cases). 

Diabetes is characterized by a shortage of insulin, a decreased ability to use insulin, or both, in the body. In patients with diabetes, glucose (and fats) are not taken up properly by the cells, and therefore remain in the blood. This can be very damaging to vital organs over time. There are many types of diabetes. Type 1 diabetes is an autoimmune disease that is usually first diagnosed in children and young adults. Type 1 diabetes accounts for roughly 5% of the diabetic population. This type of diabetes is thought to be caused by genetics or environmental factors. Type 2 diabetes is that which effects roughly 90%-95% of the diabetic population, and is mostly diagnosed in older patients. It is thought to be associated with family history, obesity, inactivity, and old age, and can be prevented by making healthy food choices, staying physically active, and not gaining a lot of weight. This type of diabetes varies by race and ethnicity. Gestational diabetes is that which forms in pregnant women, and is usually cured with delivery. It is a form of glucose intolerance that is most prevalent in minorities, as well as women who are already prone to diabetes (family history, obesity, etc). In addition, there are other types of diabetes that account for less than 5% of all diabetes cases. 

Incidence rates of diabetes are increasing. In 2010, 1.9 million new cases of diabetes were diagnosed in people aged 20 years or older. With more people affected, there will be an increase in problems caused by diabetes, such as blindness, kidney failure, and amputations of feet and legs (not related to accidents or injury). I find it interesting to study the effects of diabetes on the US population not only because it is one of the leading causes of death in the country, but also because it leads to other injuries (such as those listed above), which can socially effect those affected with the disease. In general, a person with diabetes as a shorter life expectancy. Further, diabetics have twice the risk of dying on any given day as a person of similar age without diabetes. 

According to the CDC, diabetes is both preventable and controllable. With the proper education, one can learn how to prevent the disease early on in life. Another reason why diabetes is an interesting disease to study is because with proper intervention, public health officials can control and hopefully reduce its prevalence. On average, diabetics spend more than twice as much on medical expenses than those who are unaffected. By controlling or preventing diabetes, public health officials could also help people save a lot of money. Unlike many of the other leading causes of death in the US, diabetes is one that which public health officials, if properly intervened (education, policies, guildines), can push out of the leading causes of death in the future. 

http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm 

Contagion

The movie Contagion is about an outbreak of a terribly, deadly, unidentified disease. It is originally thought that this outbreak was a bioweapon meant to kill thousands, but the CDC in Atlanta ultimately finds that the disease is genetically similar to a virus found in pigs and bats, and is caused by the MEV-1 virus. With knowledge of the MEV-1 virus, doctors at the CDC were able to make a vaccine against the virus. At the very end of the movie, we find out how the outbreak of the virus started: it was traced back to a bat in China, and ultimately ended up in Beth's body. Overall, I thought this movie was very good- and it was definitely worth seeing twice. 

Outbreak can be defined as the sudden or violent start of something unwelcome, such as war or disease. The movie's premise is that of a giant outbreak of an unidentified disease (later found to be a virus). The outbreak results in an extreme and sudden outbreak investigation, which was focused at the CDC in Atlanta. Doctors hurriedly worked to find the source of the outbreak as well as to prevent the spread of additional cases. Medically, one of the correct responses to an outbreak is an outbreak investigation. Socially, one of the correct responses to an unknown outbreak is isolation of those who are infected, and quarantine of those who are not (and technically those who are). This separation of the infected and the non infected can help to prevent further spread of the disease. 

Throughout the movie, there are definitely places where public health agencies ideally should have been better prepared for the outbreak and its effects. Although public health agencies did take control of putting the infected in isolation and everyone else in quarantine, I think they could have been more prepared by making sure there was no spread of disease through things such as food and water. As the cause of the virus was at first unknown, I think better precautions regarding the spread of disease through food and water is plausible. For example, what if a non infected person in quarantine ate pork, which came from a pig who was infected with the virus? Another way that public health agencies could have been better prepared is to increase the staff and services at hospital facilities for the time being. It is obvious that the more staff available, the more people will come to the hospital and the better chance they have at regaining health. This is the same as saying the more hospital beds, the more patients will stay overnight at the hospital. By increasing the availability of doctors who can attend to infected patients, the better chance they have of becoming healthier. Despite these two criticisms, I think the public health agencies and doctors handled the outbreak of the MEV-1 vaccine well.