June 1, 2007

Lack of funding hurts diabetes cause for minorities

By Tamika Petty
SCRIPPS HOWARD FOUNDATION WIRE

WASHINGTON - Minorities with diabetes are less likely to be diagnosed and treated properly, diabetes professionals said this week. Without more money to do more research and provide better treatment, they said the number of diabetes patients will grow.

The American Diabetes Associations says there has been a 61 percent increase in diabetes cases since 1990. An estimated 20.8 million people in the U.S. have diabetes, or 7 percent of the population. Of that group, 6.2 million don’t know they have it.

Minorities are more likely to have diabetes, the ADA says - 13.3 percent of adult African Americans have the disease, along with 9.5 percent of adult Latinos.

The ADA, in conjunction with the Congressional Tri-Caucus - made up of the African American, Latino and Asian American Pacific Islander caucuses - briefed congressional staff members and others Tuesday on the unique needs of combating diabetes in minority communities.

“I believe diabetes is a health disparity in our community. ... We are 12 percent of the population but are 40 percent of the people on dialysis,” said Dr. L. Natalie Carroll, past president of the National Medical Association, which represents African American doctors.

Kidney disease is one of the many complications that plague diabetes sufferers.

The ADA says African Americans are 2.7 times as likely as other racial groups to suffer from lower-limb amputations, with men 1.4 to 2.7 times more likely than women to have amputations. Carroll said many of these men are working class, and to lose a limb is to “condemn an entire family to deeper poverty.”

Leanear Randall, 57, of Stafford, Va., who is black, has had diabetes for more than a decade. Randall’s father, also diabetic, had a leg amputated after stepping on a rusty nail. He said there was no alternative: “His circulation was compromised, and the tissue began to die.”

Randall, who is retired from the Army, said he knows better programs could help. When he worked as a lab technician at a hospital in San Antonio, the hospital consistently performed amputations.

“The hospital was amputating legs, like two or three a week because people did not have the knowledge, or couldn’t discern... the proper way to eat,” he said.

Fixing the problem will require more money, but forging a unified effort to identify and treat patients is hampered by language issues in immigrant populations and what Randall called a fatalistic attitude among some.

“I think we have this belief that we’ll live forever and it won’t happen to me. In the black community we ... think we’re going to live a short life or live forever. There is no intermediate things, like, ‘I think I’ve made it, and I’m outta this,’ or, ‘I’ve got it, oh well,’” he said.

Any overweight American with lax diet and exercise habits could be prone to diabetes. The ADA operates several programs, including Feria de Salud (Spanish for health fair) targeting the Latino community; Project Power, a faith-based initiative targeting the black community, and Take Care of Your Heart, targeting the Asian and Pacific Islander community.

Several of the briefing’s experts said each of the initiatives has positive results, but language barriers, funding shortages and inferior health service often thwart the programs’ efforts.

Carroll discussed problems that hamper effectively treating diabetes in the black community. For example, she said, many government and insurance agencies will pay for only so much insulin per month. Patients who need more are out of luck.

She said it is “an environment that is hostile to the minority community.”

While one of the best ways to combat diabetes is regular exercise, Carroll said many poor blacks can’t take walks or evening jogs because their neighborhoods aren’t safe.

Another issue discouraging to Carroll is the rate of diabetes-related lower limb amputations in the black community. She said many blacks are forced to have amputations and aren’t given alternative options, such as revascularization - a process of restoring functionality to organs or limbs.

Jeffrey B. Caballero, executive director for the Asian American and Pacific Community Health Organizations, cited problems with diabetes outreach among Asian Americans and Pacific Islanders. Caballero said a large number, more than 40 percent, of AAPI have limited English proficiency and insurance.

“Many come with no idea how to apply for health care. ... One of the biggest barriers we have is explaining how the health system works,” he said.

There are more than nine dialects in the AAPI community, mainly in Hawaii. Caballero said that Hawaiians are one of the largest groups susceptible to diabetes, and many are unaware they’re at greater risk for type 2 diabetes at a lower body mass index than non-Asians.

Speaking on behalf of the Latino community, Aida Giac-hello, professor at Jane Ad-dams College of Social Work at the University of Illinois at Chicago, asked, “How can we best impact our community, through public policy?”

Giachello said that poverty is tied to diabetes, and the limited availability of healthy food in poorer communities leaves them with fewer options.

Giachello was adamant that the disparity in quality of health care affects Latinos as well as women.

“Women and ethnic/racial minorities get worse medical care, regardless,” she said.

Giachello said that because of heavy workloads in clinics and hospitals doctors rely on poor practices to diagnose patients.

Giachello said that the public response to diabetes is to blame the victim instead of looking at the greater community.

“Eat better, don’t be poor,” she said, but with more than 44 percent of Latino homes headed by women living below the poverty line, doing so is difficult.

Randall echoed her arguments.

“The people that really have issues are the poor. People who don’t have medical insurance, they have the hardest time with diabetes. The hospitals don’t want to talk to you if you don’t have medical insurance,” he said. “Most poor people ... they elect to have daily survival things.”

“If it’s not an epidemic, it’s going to be one soon,” Randall said.

Caballero said his organization is working hard to combat the struggle that many impoverished AAPI have getting educational information and health care.

Giachello, whose husband and other relatives died of diabetes-related illnesses, said it’s important to raise diabetes funding and awareness. She said diabetes is the third leading cause of death among Latinos and is now the leading cause of death in Mexico.

One thing that all the speakers agreed on was the lack of funding needed to actively combat diabetes.

“Funding in recent years has been pretty static. ... We need an increase,” Carroll said.

Carroll said many schools no longer require physical education or home economics. Home economics helped communicate good ways to prepare food, and physical education is vital for young people, especially with vending machines and unhealthy school lunches.

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