Running Head: DIABETES HEALTH DISPARITIES 1

Diabetes Health Disparity among African Americans

Aime Achat

University of South Florida

DIABETES HEALTH DISPARITIES 2

Diabetes Health Disparity among African Americans in St Johns County

St Johns County has been considered among the top highest ranking counties in Florida

in health, however not all members of their population are receiving the same benefit. Upon

further research of the county using Florida Health Chart (2015), African Americans deaths due

to diabetes are 8.9% higher than Whites in St Johns County and 21.2% higher in the state of

Florida.

Overview of St. Johns County

St. Johns County is located in the North East area of Florida between Jacksonville and

Palm Coast. This county encompasses many cities such as St. Augustine, St. Augustine Beach,

Hastings, Ponte Vedra Beach, and Nocatee. According to the (2015) U.S. Census Bureau, the

population of St. Johns County is 235,087. According to the St. Johns County Government

(n.d.), the three major employers in St Johns County are St. Johns County School District,

Flagler Hospital, and Northrop Grumman, a defense contractor.

St. Johns County is considered a large fringe metro city. According to Florida Health

Charts (2015), the population is 89.7% white, 6% black, and 4.3% other. The major healthcare

systems in the county are: Flagler Hospital, Vicars Landing Nursing Home, and Bayview

Healthcare. However, there is only one major hospital in the county which is Flagler Hospital.

Comparison of Local vs State Populations

According to the U.S. Census Bureau (2015), the population of St. Johns County as of

2015 is White 89.3%, Black 5.6%, American Indian 0.3%, Asian 2.8%, Pacific Islander 0.1%,

two or more races 1.9%, and Hispanic 6.4%. In keeping with the U.S. Census Bureau (2015),

the population of Florida, in comparison to St. Johns County, is White 77.7%, Black 16.8%,

American Indian 0.5%, Asian 2.8%, Pacific Islander 0.1%, two or more races 2%, and Hispanic
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17.6%. Based on the U.S. Census (2015), 6.5% of families are below the poverty level

compared to the state of Floridas 12.2%. The population at or above age twenty five with a high

school diploma is 93.9% compared to the state of Florida 86.9% (U.S. Census, 2015). The

population older than five years old that does not speak English is 8.4% in St. Johns County and

28.1% in Florida (U.S. Census, 2015). According to County Health Rankings (2016), the ratio of

primary care physicians to patients were in 1:1080 in St. Johns County and 1:1380 in Florida.

Analysis and Interpretation of Data

Identified Strengths

A strength of St. Johns Countys health behaviors is impaired driving deaths due to

alcohol is two percent lower than Floridas status of 29%. According to the CDC (2015), motor

vehicle accidents amount to one death every 53 minutes. This is a strength for St. Johns County

that can still be improved over the years to decrease more deaths. In the areas of clinical care,

compared to Floridas 68%, St Johns County has a mammography screening rate of 73%. This is

a positive finding because this can indicate that the county places health screening as a priority

and may also consider to increase screening for diabetes as well. A strength of the social

economic area, the high school graduation rate in St. Johns County is ten percent higher than

Floridas 75%. Literacy is important for a community because there is a higher potential for

increased health literacy and therefore a chance of decreased illnesses over time.

Identified Weaknesses

In health behaviors, St Johns County is three percent higher than Floridas seventeen

percent for excessive drinking. Excessive drinking can lead to other health problems over time

that can affect major organs such as the liver and the heart. According to Babor et al. (2012),

heavy alcohol use is a risk factor for diabetes and with the formation of the disease later on it can
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exacerbate hypoglycemia and neuropathy. The area of physical environment has an effect of a

long commute by driving alone is four percent higher than Floridas thirty eight percent. This

has a strong impact on the health of the county because it can affect the respiratory status of the

very young to the very old. Through research using mice exposure to fine particulate matter, the

mice developed vascular insulin resistance in the study (Haberzettl, P., O'Toole, T. E., Bhatnagar,

A., & Conklin, D. J., 2016). Hospitalizations from amputation of a lower extremity due to

diabetes in St Johns County was 14.3% in whites compared to 57.2% in blacks; compared to the

state of Florida, the amputations for white diabetics were 21.9% and black diabetics were 65.4%.

This affects the African American community because there are disparities that affect their health

that are being overlooked by the public community.

Identification of a Priority Health Issue

A priority health objective of Healthy People 2020 (2014) is reducing the rate of diabetes-

caused deaths. More specifically for St. Johns County, the Healthy People 2020 goal would be

reducing the deaths of African Americans with diabetes. According to FL Health Charts (2015),

12.5% of Whites and 21.4% of Blacks in St Johns County were dying compared to the state of

Florida where the statistics were 17.3% of Whites and 38.5% of Blacks. This is a large

difference of health disparity among Caucasians and African Americans in diabetes-induced

deaths.

Discussion and Application of Community Health Models

The importance of community health models are to address how to decrease chronic

disease, decrease health disparities in underrepresented communities, and improve support

among communities. The determinants of health model involve many factors such as personal,

social, economic, and environment which when combined can address population based issues
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due to having interventions that affect multiple aspects of a community (Savage, Kub, & Groves,

2016). According to Healthy People (2014), there are factors that relate to the population based

issue of diabetes in the African American community such as lifestyle factors diet, physical

activity, drug use, and personal hygiene, biological age, sex, and family history, impact of

health system access to care, lack of insurance coverage, lack of availability, and high cost, and

environmental factors buildings, quality of care due to location of neighborhood, housing,

exposure to physical hazards, and physical barriers.

Population Diagnosis

The African American population in St. Johns County are at risk for diabetes-related

death due to health disparities.

Communication/Population-based Interventions

Primary level of prevention involves preventing the disease from happening such as

losing weight and eating healthy foods before it becomes a risk, secondary level of prevention

involves trying to detect the disease by screening and decrease the disease before it progresses

further, and tertiary prevention involves the process of trying to reduce the damage of the disease

already performed on the body.

Primary Level of Prevention

According to Venditti (2017), type 2 diabetes can be prevented through interventions such

as lifestyle changes and moderate diet modifying foods to cultural preferences and

socioeconomic status. The stakeholders are the African American community due to the high

number of incidences affecting their population and health care providers due to the large

number of patients they have to treat who have diabetes complications. A financial resource for

members of the society that have a lower income can use the Supplemental Nutrition Assistance
DIABETES HEALTH DISPARITIES 6

Program (SNAP) resource for receiving assistance in purchasing food items. Along with the

ADA (2014), Project Power which is funded by the American Diabetes Association (ADA),

involves the African American community in diabetes awareness through their churches and

teaches the basics of diabetes to lifestyle changes in six workshops. The community health nurse

can assist with helping eligible applicants apply for SNAP and inform applicants about the

SNAP-Ed website which has resources for eating healthy on a budget. The nurse can also help

coordinate with the various churches leadership to enroll for the ADAs Project Power and

follow up as needed with health education.

Secondary Level of Prevention

According to Siu (2015), screening for diabetes can be done using an A1C test which

gives an average blood glucose from the past three months, a fasting blood glucose test, or an

oral glucose tolerance test. The stakeholders are the African American community due to the

high risk in its community and health care professionals to assist patients who are at risk for

having diabetes and to start early treatment to avoid further complications. According to the

ADA (2014), there are many tools on their website in identifying a risk of diabetes such as Type

2 Diabetes Risk, My Health Advisor, and a BMI calculator which can be done at home for a

preliminary assessment. However, since it is a preliminary test, there are low cost clinics such as

Azalea Health and the health department in St Johns County or if the person has health insurance

they can get screened at their primary physicians office. The ADA (2014), has a program called

Live Empowered targeted for the African American community to receive education materials

designed for their specific cultural needs. The community health nurse can provide information

about these resources through African American community gathering areas such as Greek

organizations, churches, barbershops, and hair salons.

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Tertiary Level of Prevention

A common occurrence of chronic diabetes is neuropathy in the feet which is very painful

and without proper care can lead to limb amputation. According to Florida Health Charts (2013),

hospitalizations from amputation of a lower extremity due to diabetes in St Johns County was

14.3% in whites compared to 57.2% in blacks. The stakeholders are the African American

community which is affected, hospitals due to large number of cases of amputation procedures,

and the health care providers to limit the number of diabetes complications. According to Kirk et

al. (2015), people with diabetes can have a better understanding of their illness by being able to

identify symptoms which can therefore lead to better self-care practices. As stated by ADA

(2016), symptoms to look for can be skin changes, calluses, foot ulcers, and poor circulation

which can be monitored at home and examined by a podiatrist annually. According to Bus et al.

(2016), there are techniques such as casting, footwear, and off-loading methods (bedrest or

crutches) which can help reduce foot ulcers and therefore prevent amputations in the future. The

community health nurse can use case management to collaborate a multi-disciplinary approach to

a clients management of diabetes.

Development of Health Policy

The implementation of a health policy in this county is to decrease deaths resulting from

diabetes-induced complications especially in the African American population. This policy can

be executed by primary intervention through lifestyle change and modification to diet (Vendetti,

2017). The proposal to reduce deaths from diabetes is an ongoing problem that can be solved by

increasing awareness, modifying health behaviors, and maintaining health promotion throughout

the community. The stakeholders are the African American community, health care providers,
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hospitals, and community activists. A popular supporter of the proposed health policy is a

famous black actor named Anthony Anderson who was diagnosed with diabetes at the age of

thirty-one. The African American community will support the policy due to the high prevalence

of diabetes-induced deaths in their community. Health care providers and hospitals will support

the health policy due to the increase number of amputations in the hospital that could have been

prevented. There are no known opposing forces as of yet to the proposed health policy because

of the high demand for decreasing the incidence of the disease and the financial factor already

funded by various government groups and private organizations.

The general plan to put the policy into action would be to present findings and research to

African American leaders to gain support. By speaking to the leadership officials of the

community such as a pastor can greatly influence approval of the community. The use the

African American communitys resources can be used to help spread the awareness churches,

barbershops, hair salons, and Greek organizations to gain support of the African American

community. This proposal will impact the county by reducing the number of deaths in the

African American population which is a minority group, reduce unnecessary hospitalizations due

to diabetes-induced amputations, and improve the overall health of the population health in

general by promoting awareness and prevention of diabetes.

Conclusion

Diabetes is a disease that can be easily controlled by maintaining good health, but it can

quickly spiral into many other health conditions and affect different aspects of life. In St. Johns

County, there are a large number of African Americans that are dying due to diabetes-induced

complications. Creating this health policy will help to save lives and improve the general health

of the population.
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This paper is relevant to my nursing career because diabetes has an enormous impact on

the nation as a whole. Diabetes type two can be prevented by lifestyle change and diet, however,

as time passes this disease has become more prevalent even in younger patients. During clinical

rotations, many of the patients that are in the hospital have diabetes or a complication due to

diabetes. Even in my own family, my mother has recently been diagnosed as pre-diabetic and

has started a change to changing her lifestyle and eating habits. With improvements over the

years to health care, we have improved health dramatically, but preventing a disease is better

than trying to cure it.

Aimee - a much improved paper - very focused on purpose of paper - see comments as you move

forward in your career and are called on to write.

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van Deursen, R. W. (2016). Footwear and offloading interventions to prevent and heal

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