City dwellers often consider rural America as a throwback to the “good old days” of the past. But in relation to obesity and diabetes, people living outside urban areas present a grim future.
Last week I had the possibility to moderate Panel Discussion on Rural HealthHosted by the Association for Healthcare Journalists (AHJC) in Birmingham, Alabama. The discussion highlighted disturbing diabetes statistics, raised some serious issues, and explored creative solutions.
More than 8% of Americans now have diabetes, a percentage that is predicted to grow together with our waistlines. Diabetes is already the leading reason behind kidney failure, non-traumatic amputations, and latest cases of blindness within the country. It is the seventh leading reason behind death, and would rank higher if heart disease deaths as a result of primary diabetes were included. What would a high rate of diabetes appear like?
The answer lies outside of nearly every metropolitan area within the diabetes belt that stretches across the southeastern United States. For example, there are several rural counties around Birmingham, Alabama where about 20% of the population has diabetes.
“Diabetes is certainly not evenly distributed across the country,” said Dr. Andrea L. Cherrington, associate professor on the University of Alabama at Birmingham (UAB). Pointing to the CDC county-level map prevalence of diabetes. It's not only rural versus urban, Dr Cherrington added. Diabetes rates are higher in urban areas within the diabetes belt than in urban areas outside the diabetes belt.
Dr. Cherrington pointed to the following map. US counties with the highest obesity rates. This map looks almost an identical to the diabetes map. The answer to obesity is healthier nutrition and more exercise. What makes weight management difficult in rural communities?
The answer to that query will look familiar to anyone who has been to the less-advantaged parts of any American town or city: barriers to health. These include:
- Limited access to health care, especially to specialists akin to endocrinologists
- Minimal exposure to diabetes education
- Safe sidewalks, exercise facilities, and limited access to grocery stores with reasonably priced produce.
- High poverty rate.
Such barriers get in the best way of exercising, eating a healthy food regimen, and making other healthy lifestyle decisions. They also result in obesity and its many consequences.
“Living with diabetes is not easy,” said Dr. Cherrington, noting that managing the disease requires mastering a posh schedule of medicines, exercise, self-care and doctor appointments. “If you base that behavior on those health barriers, it becomes really difficult. If you don't have the resources, it's easy to see how disparities can happen.”
Diabetes/obesity solutions cross the agricultural/urban divide.
Fighting the obesity epidemic has been the life's work of panelist Bonnie A. Spear, professor of pediatrics on the University of Alabama at Birmingham and a nationally recognized expert on childhood and adolescent obesity.
Spear noted that chubby and obese children and adolescents turn into obese adults. Obese children who turn into obese adults are at the next risk of developing diabetes and other chronic conditions.
Too often, Spears argued, we fuss over details like whether schools should offer chocolate milk as an alternative of allowing schools to earn cash from campus vending machines, which frequently sell sugary soft drinks and snacks. They sell Too often, she said, we worry concerning the costs of providing breakfast and lunch to too many children when skipping breakfast and poor nutrition are linked to lower test scores and difficulty concentrating. And after we worry that American kids are falling behind academically, physical education classes are the primary to go—although fit kids do higher in academic subjects than unfit kids. Creating a healthy school environment is critical to stopping obesity and diabetes in the following generation of adults.
A serious problem in relation to adults with diabetes today is the shortage of primary care physicians. While there are fewer of them in cities, noted Dr. William Curry, associate dean of primary care and rural medicine on the University of Alabama, Birmingham, the issue is commonly worse in rural areas, especially for those Those who lack transportation.
Community medical examiners could also be a part of the reply, suggested Dr Cherrington. Her work shows that community medical examiners—people trained to supply diabetes education and outreach—can have a huge impact on the well-being of individuals with diabetes living in rural areas.
This work has turned her focus to cities, as she now leads Birmingham. Cities for Life Program. Led by the American Academy of Family Physicians, with support from pharmaceutical company Sanofi US, this system borrows from the agricultural community medical expert concept wherein doctors refer diabetes patients to “patient navigators” who guide them. Helps find local resources akin to nearby workouts. Classes or mobile farmers markets.
In addition to this system's clinical component, its community component utilizes a Community Action Team of greater than 80 organizations drawn from local primary care, health, civic, business and charitable organizations. This is a giant a part of the trouble. mydiabetesconnect.com website, which shows people where to search out resources in their very own neighborhoods.
Will it work? The program is just a yr old, but Dr. Cherrington believes Birmingham will eventually turn into a model for diabetes control—each urban and rural.