HLTH 1036 Global and National Health

Report

Student name: Anshdeep Kaur

Student number: 110409013

Introduction
Diabetes is recognised as a chronic health disease which occurs when the pancreas is unable
to generate enough insulin. It can also occur when the body is unable to efficiently utilise
the insulin which it produces to help regulate blood glucose levels in the human body (WHO,
2022).

The focus of this assessment task is to write a report on a selected health issue provided and
state its connection to the determinants of health. Furthermore, the report will investigate
the effect of the health issue on individuals as well as the Australian society and will state
any research findings. This report will also examine the roles and responsibilities of the
registered nurse in terms of advocating, mediating, and enabling health promotion in
relation to the selected health issue (University of South Australia, 2023).

This report holds significance in the context of nursing practice as nurses play a vital role in
the provision of dietary and lifestyle advice to individuals who are at the risk of developing
type 2 diabetes. As a result, this will assist them in reducing their risk. In addition, nursing
practice also focuses on advocating for diabetes and raising awareness in the society
regarding the early signs and symptoms. This way, diagnosis and treatment of diabetes can
be undertaken in a prompt and effective manner (Independent Nurse, 2020).

Part A: Diabetes

Impact on the individual

Diabetes is categorised into three major groups: type 1, type 2 and gestational. Type 1
diabetes can be described as when the body produces a deficient amount of insulin.
According to research, in 2017, there were approximately 9 million individuals diagnosed
with type 1 diabetes worldwide (Healthdirect, 2022). Type 2 diabetes, however, is the result
of the body being unable to use the insulin which it produces effectively. Studies indicate
that 95% of individuals diagnosed with diabetes have type 2 diabetes (Healthdirect, 2022).
Gestational diabetes occurs during pregnancy through raising blood sugar levels, which in
turn, can inflict changes to the pregnancy and the child’s overall health. There are a range of
psychological and social impacts that diabetes can impose on an individual. As an individual
undertakes self-management of the condition, they may undergo complications in managing
the process. It is essential that individuals with diabetes are extensively educated about the
condition, so that it will result in a boost of self-faith and empowerment. Being diagnosed
with diabetes can negatively affect the quality of life of the individual. Studies indicate that
an increase in distress and depression are psychological impacts associated with individuals
with diabetes. In addition, the inception of complications such as kidney damage and heart
disease can come with the potential to aggravate the psychological impacts of this
developing health condition (Schabert, et al., 2013). A diabetic individual may face social
stigma in many areas, such as in social relationships and the workplace. This can negatively
affect the individual as they may fear being judged or discriminated against for having
diabetes, thus limiting social interaction with others, such as friends and family members. It
is vital to enhance resilience amongst diabetic individuals, so they have confidence to reach
out for support and interact with others, without any fear or judgement (Speight, et al.,
2012).

Impact on the community

The prevalence of diabetes in Australia has a range of impacts on the Australian community.
These impacts include the burden of disease and the cost of health expenditure for the
health issue. A burden of disease can be defined as a measure of the number for years of
healthy life lost from coping or dying because of a disease or injury (AIHW, 2023). Statistics
from research conducted by the Australian Institute of Health and Welfare indicate that in
2018, Type 1 diabetes resulted in the Disability Adjusted Life Year (or DALY) of
approximately 17,000 individuals in Australia (AIHW, 2023). The rate of burden was
recorded to be higher in the male population (aged 45-49) and the older population (aged
90 and above) (AIHW, 2023). Studies also indicated that the burden rates were almost two
times higher in regional areas as well as for individuals living in low socioeconomical regions
(AIHW, 2023). However, statistics of Type 2 diabetes differ from those of type 1 diabetes.
51% of the disease burden were from individuals aged between 65-84 (AIHW, 2023). From
this, the DALY rate was 1.5 times higher in the male population when compared to the
female population (AIHW, 2023). Whereas, for females aged 85 and above, the DALY rate
was approximately 1.4 times higher when compared to their male counterparts (AIHW,
2023). In 2018-19, a record $3 billion of health expenditure was assigned towards diabetes
research, management, and treatment interventions (Diabetes Australia, 2022). This
contributed as an overall representation of 2.3% of the total disease expenditure in
Australia (AIHW, 2023). These statistics conclude that factors such as the cost of health
expenditure and the burden of disease have a significant impact on the prevalence of
diabetes on the Australian community.

Part B: Effect of social determinants of health on diabetes

Social determinants of health (or SDoH) can be described as the non-medical factors in
which an individual is born, grows, lives, works and ages (Hill, 2016). They are generally
addressed based on the population and aim to achieve concepts such as health equity,
social justice, and continuous improvement in an individual’s life (Frier, et al., 2022). This
concept is interconnected with diabetes. The prevalence of diabetes in the Australian
population is dependent on the quality of SDoH on the individual. Studies indicate that poor
SDoH conditions can result in an individual diagnosed with diabetes as this results in them
being able to poorly self-manage their condition (Frier, et al., 2022). Socially disadvantaged
individuals living with diabetes are more prone to facing challenges when self-managing
their condition. The management of diabetes consists of a range of biomedical and
behavioural processes. By widening the biomedical perspective of diabetes care, the clinical
and professional management provided can help to address the SDoH more effectively. This
can result in the individual knowing how to self-manage their condition more effectively.

A study was conducted in 2017 to observe and investigate the effects that SDoH have
towards the prevalence of the Australian population living with diabetes (Hill, et al., 2017). A
population size of approximately 7 million Australians with diabetes was included in this
study including First Nation’s peoples. The results of the report indicated that there was
evidence that social factors played a crucial role in the risk of disease (Hill, et al., 2017). The
male population has a higher risk of developing diabetes, especially if they are of a low
socioeconomic status in comparison to females with a low socioeconomic status. Research
also indicates that the prevalence of diabetes appears to be greater in regions of higher
income when compared to low-income regions (‌Richards, et al., 2022). Countries with
higher population levels are depicted to have a lower prevalence of diabetes in the
community. A rise in unemployment rates is known to lower the prevalence of diabetes.
This could be due to undertaking a very inactive lifestyle, such as sitting down watching T.V.
or sitting down whilst driving ‌(Richards, et al., 2022). Conversely, a decline in
unemployment rates would lead to individuals consuming an unbalanced dietary intake,
which can increase the prevalence of diabetes amongst the community ‌(Richards, et al.,
2022).

In addition, geographical location is a social determinant which is known to display an

influence on diabetes control in the Australian society. A study was conducted in Western
Australia in 2015 which aimed to investigate how the reference to location affects the
control of diabetes in a general practice setting (Jiwa, et al., 2015). The results of the study
concluded that older adults above the age of 75 comprised of around 9.3% of the
population sample (Jiwa, et al., 2015). Many of these adults had very high blood glucose
levels and were congregated amongst two “hotspot” areas. They also had a significant risk
towards hyperglycaemia and cardiovascular disease, which may be caused because of SDoH,
which in this case is based on geographical location.

Part C: The role of the Registered Nurse in health promotion

The registered nurse plays a vital role in health promotion and upholds many
responsibilities. Aside from care, nurses also uphold other responsibilities such as lowering
disease burden, administering medication and being equipped with the capability to work
with other multidisciplinary teams. A registered nurse practicing in community-based
settings has specific tasks and responsibilities which they are required to fulfil, one of them
being health promotion (ANMAC, 2019). Health promotion consists of several guidelines,
standards, policies, and procedures which a registered nurse must comply by. Institutions
such as Nursing and Midwifery Board of Australia (NMBA) outline the standards of practice
which a registered nurse must adhere by (NMBA, 2016).

In addition, the Australian Health Practitioner Regulation Agency and the Australian Nursing
and Midwifery Accreditation Council (ANMAC) have their own set of standards and
guidelines designed to enable registered nurses to manage their rights and responsibilities.
As stated in standard 7 of the Registered Nurses’ Standards for Practice, registered nurses
are required to undertake safe, comprehensive, and evidence-based interventions to
achieve successful health outcomes for individuals and for groups (NMBA, 2016). Health
promotion is a fundamental example of how registered nurses can become competent to
achieve this standard. The Ottawa Charter for Health promotion can be viewed as a
beneficial and educational resource to registered nurses to practice the three key strategies
of enabling, advocating, and mediating (WHO, 1986). This way, the registered nurse can
design and implement strategies to lower the prevalence of diabetes in the community and
assist individuals diagnosed with diabetes to manage their condition more effectively. The
NMBA states that in addition to the Registered Nurses’ Standards for Practice, enablement
is a key strategy to maintain the capability for practice of a registered nurse. This strategy
can be developed through the education and empowerment for the community to be
capable to make their own choices and decisions. Standard 2 of the Registered Nurses’
Standards for Practice discusses how it is incredibly vital that the registered nurse plays a
key role in the advocacy of the health needs and rights of the target population. This helps
to build and maintain a therapeutic connection as well as focus on the areas of concern
(WHO, 1986).

In relation to diabetes as a health issue, registered nurses must be equipped with the ability
to implement the strategies of enablement, advocacy, and mediation to facilitate health
promotion, as per the Ottawa Charter for Health Promotion. The registered nurse can
construct strategies to educate target patients to change their lifestyle habits, such as diet
and exercise. In addition, mediation is essential for educating individuals with diabetes on
how to check for the regulation of their blood sugar levels. This increases their
independence to successfully monitor their blood sugar levels regularly so that they can be
maintained. Advocacy of the needs of individuals with diabetes can alert the wider public,
such as national and government organisations to implement more health promotion
strategies, such as screenings and hosting clinics (Furber et. al., 2017).

Conclusion
Diabetes is a chronic health disease which affects more than 9 million individuals worldwide.
Social determinants of health (SDoH) are factors which influence the prevalence of diabetes
in the society. These factors can include income, socioeconomic status, geographical
location, and lifestyle. The registered nurse plays a significant role towards addressing
diabetes prevalence amongst the Australian community. They are taught to implement the
strategies of enablement, advocacy, and mediation to boost health promotion in society.
The Ottawa Charter for Health Promotion and the Registered Nurses’ Standards for Practice
are important resources which address the roles and responsibilities of a registered nurse
which align with their scope of nursing practice. Improvement in health outcomes for
individuals diagnosed with diabetes can take place through raising awareness and
promoting individuals to effectively self-manage their condition. The registered nurse can
promote this self-independence approach for individuals by implementing strategies which
aim to educate individuals to modify their lifestyle habits, such as diet and exercise. This
report will be an asset in the near future as it will assist registered nurses, in partnership
with other health professionals, to implement community-based strategies and
interventions to successfully address health issues and concerns in society. By doing so, they
can ensure that every individual is treated with care and respect and that their rights are
met.

Word Count: 2,075 words

Reference List:

Diabetes. (2022). Trusted Health Advice | healthdirect.

https://www.healthdirect.gov.au/diabetes

Diabetes. (2022). World Health Organization (WHO). https://www.who.int/news-room/fact-

sheets/detail/diabetes

Diabetes: Australian facts, Burden of diabetes - Australian Institute of Health and Welfare.
(2023). Australian Institute of Health and Welfare.
https://www.aihw.gov.au/reports/diabetes/diabetes/contents/impact-of-diabetes/burden-
of-diabetes

Frier, A., Devine, S., Barnett, F., McBain-Rigg, K., & Dunning, T. (2022). Incorporating social
determinants of health into individual care—a multidisciplinary perspective of health
professionals who work with people who have type 2 diabetes. PLOS ONE, 17(8), e0271980.
https://doi.org/10.1371/journal.pone.0271980

Furber, C., Pusey, H., Busby, A., & Stringer, E. (2017). Integrating public health practice into
the graduate’s role through pre-registration education. British Journal of Midwifery, 25(5),
321–327. https://doi.org/10.12968/bjom.2017.25.5.321

Global and National Health. (2023). University of South Australia.

https://lo.unisa.edu.au/mod/assign/view.php?id=3098487

Hill, J. (2016). Understanding the Social Factors That Contribute to Diabetes: A Means to
Informing Health Care and Social Policies for the Chronically Ill. The Permanente Journal,
17(2), 67–72. https://doi.org/10.7812/tpp/12-099

Hill, K., Ward, P., Grace, B.S. et al. Social disparities in the prevalence of diabetes in Australia
and in the development of end stage renal disease due to diabetes for Aboriginal and Torres
Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand. BMC Public
Health 17, 802 (2017). https://doi.org/10.1186/s12889-017-4807-5
Jiwa, M., Gudes, O., Varhol, R., & Mullan, N. (2015). Impact of geography on the control of
type 2 diabetes mellitus: a review of geocoded clinical data from general practice. BMJ
Open, 5(12), e009504. https://doi.org/10.1136/bmjopen-2015-009504

New AIHW data highlights the cost of diabetes. (2022). Diabetes Australia.
https://www.diabetesaustralia.com.au/blog/new-aihw-data-highlights-the-cost-of-diabetes/

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice.
Nursing and Midwifery Board Ahpra. https://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Registered Nurse Accreditation Standards 2019 | ANMAC | Australian Nursing & Midwifery
Accreditation Council. (n.d.). Www.anmac.org.au. Retrieved March 25, 2023, from
https://www.anmac.org.au/document/registered-nurse-accreditation-standards-2019

Richards SE, Wijeweera C, Wijeweera A (2022) Lifestyle and socioeconomic determinants of

diabetes: Evidence from country-level data. PLOS ONE 17(7): e0270476.
https://doi.org/10.1371/journal.pone.0270476

Schabert, J., Browne, J.L., Mosely, K. et al. Social Stigma in Diabetes. Patient 6, 1–10 (2013).
https://doi.org/10.1007/s40271-012-0001-0

Speight, J., Browne, J.L., Holmes-Truscott, E. et al. Diabetes MILES-Australia (management

and impact for long-term empowerment and success): methods and sample characteristics
of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in
Australian adults. BMC Public Health 12, 120 (2012). https://doi.org/10.1186/1471-2458-12-
120

The nurse and diabetes care. (2020). Independent Nurse.

https://www.independentnurse.co.uk/content/blogs/the-nurse-and-diabetes-care/
World Health Organization. (1986). Ottawa Charter for Health Promotion.
https://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf