Modern society has shifted our definition of health and how it’s affected. Health is not simply indicated by a dysfunctional organ but includes the social and psychological implications that may contribute to it. The social determinants of health refers to the different aspects of social practices and conditions (e.g. lifestyle, living and work situations), status position (e.g. income, education and occupation), stressful circumstances, poverty and discrimination together with economic, political and religious factors that affect the health of individuals either positively or negatively (Wilkinson & Marmot, 2003). Social determinants do not only stimulate illness but also enhance prospects for coping with or preventing disease and maintaining health. It is important to understand these factors with regards to clinical practice as it would be very beneficial in treating patients as a whole and not just the disease. This essay will explore the social and psychological factors that could affect the treatment management of a newly diagnosed patient with diabetes.
Diabetes is a disease in which there is an excess amounts of sugar in the blood. This event makes patients with diabetes at higher risk for kidney damage, cardiovascular diseases, blindness, stroke, amputations of limbs and other complications alike. Type 2 diabetes is also known as adult onset diabetes which usually develops in people after the age of 40. This type features the ability to produce insulin but the cells are unable to use it to control blood glucose levels. Early stages of type 2 can usually be controlled through diet and exercise, but if this fails, then oral medications and/or insulin injections may be required (Cockerham, 2008).
There are different factors that increase the risk of a person developing diabetes. There is a strong linkage with being overweight, as the more fatty tissue a person has, the more resistant your cells become to insulin (Kahn, Hull, & Utzschneider, 2006). However, you do not have to be overweight to have type 2 diabetes. Fat distribution is also a contributing factor, whereby people who are more ‘apple-shaped’ (stores fat primarily in the abdomen) increases the risk of type 2 diabetes than if you stored fat elsewhere in the body. Inactivity also plays an important role in increasing the risk of type 2 diabetes, physical activity helps in weight control and uses glucose as energy to make cells more sensitive to insulin (American Diabetes Association, 2009).
As outlined above, the primary risk factor for type 2 diabetes is obesity. In the scenario given, there is no indication that the patient is overweight however, given that the patient lives in a deprived area, is divorced and has 2 young children. The combination of all these three is suggestive that the patient could potentially be under an enormous amount of stress. It is evident that stress has a causal role in poor health (Ng & Jeffery, 2003). Divorce is a very stressful time for the patient and due to this stressor, the patient may have taken up an unhealthy relationship towards food (Elfhag & Rasmussen, 2008). It can therefore be argued that a chronic unhealthy relationship with food could have possibly caused the precipitation of the disease and a continuation of this can worsen the condition of the patient in the future.
With regards to the development of the disease, there is an association between negative life experiences and poor diabetes control (Stenström, Wikby, Hörnquist, & Andersson, 1993). The impact of these stressful events may cause the patient to either find less motivation to stay healthy or to even to take their medications. Stress can also cause a change a person’s physiology where insulin needs can be altered (Salleh, 2008). This means that the disease can be worsened by stress if it was not dealt with at all.
Stress is also true for the opposite by which the diagnosis of type 2 diabetes induces a major impact in a person’s life. Chronic illness diagnosis is life changing as the patient will have to make lifestyle changes such as eating a healthy diet, checking their blood sugar levels on a regular basis and making sure they adhere to any medication treatment that is suggested by their practitioner. This all adds up to more stress that the patient may feel like she has already too much to worry about, such as work and paying the rent, taking care of the kids therefore she wouldn’t want to worry about eating a piece of cake and would probably see this as a reward for all her hard work (Cockerham, 2008). This situation is particularly true especially in people who have lower incomes. There is an association between class position and eating habits (Acheson, 2011). Michael Calnan (1987) in Britain, found that women in both middle class and working classes both recognise the importance of fresh foods in diets of their families however, diets that are high in fibre and low in fat were recognised more by middle-class women. Middle-class women also tend to avoid food that were processed that were fatty or had too much sugar. In fact, one middle class woman explained that the differences in diet between classes:
“The unskilled worker was bored with his work, does not eat a good meal in the middle of the day. Pertaining to eating something like jam sandwiches. While the office worker is more likely to send his money on proper food and that the factory worker is more likely to spend his money on booze and cigarettes.” (Calnan, 1987).
The constant association between class and eating habits has been widely acknowledged. A study in Canada showed that there is cost directly influences food intake and an indirect linkage of eating patterns associated with particular classes This suggests that there is an existing social gradient with respect to social classes (Power, 2005).
The health effects of living conditions goes beyond the quality of housing, water, and air. In the developed world, it includes the structural conditions in disadvantaged neighbourhoods. Living in a low income neighbourhood has implications for transportation and access to decently priced food. The transportation links in a deprived area is scarce and often people may not have access to cars or are able to afford public transport. This means that they may not be able to go to a proper supermarket which sells healthy and nutritious food (Kirkup et al., 2004). People often resort to near-by shops which tend to be convenience stores or corner shops that have limited supply of fresh food and alternatively stock package or processed food (Drewnowski & Specter, 2004). The resulting factor is that people who live in deprived areas have less access to healthy food. The concept of ‘food desert’ therefore exists especially in America where there is a difficulty in an urban area to buy affordable or good quality fresh food (Walker, Keane, & Burke, 2010).
Some people may feel tired of checking their blood sugar levels and taking medications and would rather give in to the desire to smoke, drink heavily or simply eat sweet and a high fat diet (all of which they need to avoid) in order to maintain a momentary pleasure. The avoidance is particularly more difficult when other forms of entertainment may not be accessible. For example, if someone has less money, they would not be able to afford to go to the gym. Low cost foods that are unhealthy make it ultimately easier for people with low income to lead an unhealthy lifestyle. Foods that are “healthier” such as in health food shops are so much more expensive making it unaffordable (MacIntyre, McKay, & Ellaway, 2005).
Living in a deprived area predisposes a person to fear, crime and a lack of personal safety that advocates anxiety to an individual. When a person has type 2 diabetes, one of the ways to manage it is by losing excess weight or becoming more active which can be achieved through simple ways such as walking or running outdoors. However, this can be proven to be difficult if a person lives in a deprived area if there is a major concern about safety and security (Cockerham, 2008).
The substandard housing, lack of heater on cold days and air-condition on hot days, trash and litter on streets, lack of shops, and features of concentrated poverty can promote depression in patients. Depressive symptoms in diabetics, is found to be associated with medication non-adherence in patients in type 2 diabetes (Naranjo, Fisher, Arean, Hessler, & Mullan, 2011). Therefore, the treatment management of the patient can be affected which can worsen the condition of the patient. In this instance, it is important to look out for depression in the patient as to why they are not taking the medications.
The impact of being a single mother being diagnosed with a chronic illness can be devastating as it forces her to take up a new lifestyle which points towards being healthy. This means that there is added pressure on top of the existing ones. As a result, being a single parent increases the rate of clinic non-attendance (Baumer, Hunt, & Shield, 1998). Living with a chronic illness also means that they are susceptible to complications and in diabetes as it can affect driving, an increase in headache occurrence and regular feet cramps (Papatheodorou, Papanas, Banach, Papazoglou, & Edmonds, 2016). This can impact on the parent’s ability to be able to take her children to school and generally looking after them. Being a single mother also makes it more likely to complicate the management plan of the patient. Since single mothers are known to have a busy timetable, they may not be able to attend regular clinics that is aimed to check whether their diabetes is well controlled. They might not also be attending support groups that are available that would give insight as to how to manage their disease more efficiently. This can result in the worsening of the disease over time leading to further complications in the future. Furthermore, the lack of time may mean that single mothers put less effort in healthy living because they simply could find the time to exercise. It is therefore important to pay close attention to the social factors involved that affect the treatment of someone with diabetes and make sure that there are different treatment options available to single mothers that enable them to attend clinics and support groups.
In conclusion, a greater focus should be given to interventions that increase self-efficacy and social support to patients with type 2 diabetes. Clinicians should be aware that pharmacological intervention is only a part of the whole treatment regimen for the patient. There are different sociological and psychological factors that affect a patient’s adherence to their treatment management. The Marmot review aims to tackle social determinants of health by creating condition by which they take control of their own lives (Marmot, Allen, & Goldblatt, 2012). Although it is important to become aware of the social determinants of health, tackling it within the healthcare industry will be difficult as it is not something that can be changed overnight. There is obviously a structural problem that needs to be dealt with instead. In the case of the scenario above, the patient’s circumstances cannot be changed however, we need to make sure that as clinicians, we maximised treatment and support that is available to the patient in order for her to adhere to her medications and not further worsen her condition.
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