Background
(approx. 800 words) Provide detail about the public health problem, its impact on the socially disadvantaged context/setting/population and the approach to solving the problem to date.
This will establish the need for the project: why it is important to undertake this project. You will also need to identify the target group/population and/or the specific disadvantaged context your project aims to target and describe fully (demographics, characteristics, etc.); for example, indigenous youth aged 12 -20 who smoke and reside in metropolitan Adelaide.
Back ground
In Australia, Type II Diabetes is considered a chronic disease that is growing at an alarming rate. Diabetes Mellitus type 2 (DM2) is recognised globally as a rising health concern with an average 1.6 million deaths occurring just in 2015 due to elevated blood sugar, and the prevalence of DM2 further increasing to 8.5% from 4.7% across the years 1980-2014 (“WHO | Diabetes,” 2017). Furthermore, this condition rose from 108 million suffers, to 422 million between those years (“WHO | Diabetes,” 2017). Although DM2 is of mass concern globally, the Australian Indigenous people living in rural communities are disproportionately influenced by the rise of DM2, and are four times more likely to develop this disease than non-indigenous Australians (Diabetes Australia, n.d.). Unfortunately, medical intervention is rarely attainable due to cultural values, medication cost and a lack of access to general practitioners (Steering Committee for the Review of Government Service, n.d.). Type II Diabetes develops as a result of the pancreas being unable to synthesize the required amount of insulin, causing the body to respond by becoming resistant to it. As a result of this issue, a person will experience
levels of blood sugar which are higher than normal (Hyde et al., 2018). Some of the health complications, which can be as a result of diabetes, include, but are not limited to, erection dysfunction, diseases of the eyes, kidney complications, damages of the nerve, an increased risk of getting strokes and cardiac arrests (Huo et al., 2018). In extreme cases, amputations of limbs may occur as a result of the nerve damages, traumatic injuries and infections which may develop in the body.
The rising figures of people developing Type II Diabetes among Aboriginal communities is attributed to inadequate physical activities, the rising number of obese individuals, change in dietary and is also more prevalent in elderly (Chamberlain et al., 2016). Low consumption of fruit, vegetables, lack of nutrients, reduced consumption of phytonutrients and an increase in highly processed, sugary and sodium rich foods are associated with the leading primary risk for the burden of DM2 among these populations (Henryks & Brimblecombe, 2016). It is particularly challenging in these rural communities as diets are unpredictable and food access and cost are varying factors permitting poor nutritional status (Council of Australian Governments, n.d.).
Current programs and evidence suggest that by actively incorporating regimes with health and lifestyle advice among these populations, significant and positive outcomes can be made, such as the programs implemented in rural Darwin communities called ‘Cooking healthy and physical activity project (CHAPA)’, funded by The Australian Government Department in 2008-2009 (Australian Indigenous HealthInfoNet, n.d.). Another program, diabetes prevention program (DPP) was introduced through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) also, revealing positive results. Both programs noticed modest weight loss, through changed dietary patterns and increasing physical activity, noting that these could delay/prevent DM2 onset in participants groups, through improving insulins effectiviness in the body, as well as processing glucose adequately (Australian Indigenous HealthInfoNet, n.d.; National Institute of Diabetes and Digestive and Kidney Diseases, n.d.).
It is evident that applying improvements in dietary and lifestyle, whilst providing education to Aboriginal communities suffering from a high prevalence of DM2, can delay onset and development of this disease state. By utilising the naturopathic approach, remaining culturally sensitive and appropriate, this modality, can provide insight into all aspects of health, utilising diet with nutritional emphasis, and lifestyle changes (Australian Government Department of Health, 2016). A recent retrospective analytical review assessed a multitude of patients from a naturopathic clinic providing care to more than 38’000 patients per year, to gather information regarding patient status and details of treatment proposals, specifically in DM2 (Bradley & Oberg, 2006). The review, emphasised, that naturopathy provides a unique, whole system approach. Advice was given in regards to diet and lifestyle, which was comprehensive and supported by high levels of evidence (Bradley & Oberg, 2006). Utilisation of techniques to reduce stress, increase exercise, utilise herbal prescriptions and nutrition supplementation, which are often combined to address multiple systems effected, within this disease state (Bradley & Oberg, 2006). Significant improvements were seen in parameters measured such as: HbA1c, low density lipoproteins (LDL) and high-density lipoproteins (HDL) cholesterol, triglycerides and blood pressure (Bradley & Oberg, 2006). Clearly, there is evidence in the congruency of utilising naturopathy as a primary modality in the treatment of DM2. However, cultural barriers exist in Indigenous populations and these must be addressed, to achieve a successful program. As Aboriginal culture regards health in terms of physical wellbeing, social, emotional, cultural and spiritual wellbeing of the individual and community, it is applicable that the naturopathic principles can be applied in the same context, as these ideologies align (Burrow & Ride, 2016). The importance of the ‘whole’ and a strong connection to land, culture and family must remain present in both naturopathy and Aboriginal culture (Burrow & Ride, 2016). Although these familiarities exist between naturopathy and Aboriginal beliefs, current data states that involvement of an Aboriginal health care worker, can help improve effectiveness of programs (Burrow & Ride, 2016). The workers provide help in the in delivery of care, provide comfort to Aboriginal people, break down barriers of communications and culture that may exist between staff (in this instance a naturopath), as well as provide appropriate self-management support (Burrow & Ride, 2016). Therefore, an assumption can be made, that to provide an extremely effective program, the help of an Indigenous Australian worker may need to be utilised.
The above mentioned provides insight into the importance of undertaking project LGBH in rural Aboriginal communities, as the detriment of DM2 continues to rise. Although programs like CHAPA have been implemented, a long term holistic program that aligns the health beliefs of naturopathic medicine and Aboriginal culture can provide a successful program to be utilised effectively and efficiently to reduce the burden of DM2, whilst simultaneously improving the length and quality of life of these underprivileged minorities within Australian community.
Purpose
(approx. 500 words) A rationale for the project is necessary. You will need to explain why you are aiming to tackle this public health problem in a particular way. Provide the evidence from the academic literature for Natuopathy to the problem. Use the academic literature (peer reviewed research and academic data sources) to make a compelling ‘case’ for why your CM approach will be helpful to address the public health problem your project. You will also need to explain; how Naturopathy will complement and/or improve upon existing approaches to solving the PH problem, and; justify other aspects of the intervention e.g. what is the evidence for using an educational or other type of intervention approach
The complexity of this condition makes the aetiology DM2 multifaceted and associated risk factors that are considered irreversible include, genetics, race, ethnicity, while reversible factors, are factors such as: smoking, physical activity and diet (Sami, Ansari, Butt, & Hamid, 2017) . The table attached in appendix 1, shows the risk factors for associated Aboriginal communities, which align with these reversible and irreversible risk factors.
In more recent years, a growing body of evidence has been formed, focusing on the effectiveness of changing diet and lifestyle in DM2 to deter the disease state, rather than, a more conventionalist understanding of the ‘incurable disease.’ Through the recognition of the evidential links between diet, lifestyle and stress in the development of DM2, significant changes can be seen in both the development, prognosis and management of this condition (Chen et al., 2015). The current understanding for the pathogenesis of DM2, in literature states that the biochemical reactions that occur under stress (physical, mental and emotional) have consequences that lead to the development of DM2, these being: a disruption in hormonal regulation and glucose homeostasis, the direct effect of cortisol on glucose metabolism and insulin, and the indirect effects of stress on diet and exercise (Marcovecchio & Chiarelli, 2012) . Furthermore, dietary behaviours and lifestyle factors including physical inactivity are reported to the major contributing factors for the rapidly increasing development of DM2 amount all countries, leading to raised HbA1c levels, weight gain, poor vascular integrity, reduced metabolism, poor lipid metabolism, and increased levels of blood sugar, spiking the cascade that leads to insulin resistance (Sami et al., 2017).
As clearly identified earlier, Naturopathy utilises a variety of resources that enable improvements in these parameters through guiding dietary and lifestyle patterns (Bradley & Oberg, 2006). An example of this includes, but is not limited, to the extensive research, evaluating the approach of a Mediterranean diet in the favourable prevention of DM2. Two studies gathered: a systematic review and randomized double blinded placebo control trial with 534,906 patients showed that adhering to this diet is linked to a reduction in the risk factors of metabolic syndrome, attributing this to: a regulatory effect on HDL, reduction in waist circumference, reduced triglycerides, lowered blood pressure and blood sugar (Kastorini et al., 2011). The diet focuses on a plant-based, high Omega-3 fatty acids, showing a reduction in arachidonic acid, improved metabolism of EPA/DHA thus, reducing leukotrienes thromboxanes, prostaglandins and improving cyclic AMP, leukotriene B5 and prostacyclins (Calder, 2010).
Through this evidence, it is obvious that there is a place for naturopathic medicine and the invaluable educating tools of dietary and lifestyle factors this modality provides, for communities with the populations of Indigenous Australians.