{my heart and desires}

i wouldn't normally do this. post a paper that i wrote for a class. i'm not posting it because it's the best writing i've every done... it's actually far from that. i'm posting this because it's my heart and desire. as you will read later if you make it through the entire paper after spending spring break in St. Louis and 5 weeks in Ethiopia last summer my heart has really changed.

i have been wanting to do a diabetes concentration for a while and have been unsure of what i want to end up doing with my PharmD degree. God keeps revealing to me my heart and desires as i continue to ask what the future holds. i have known for a while that i have a heart for impoverished and underprivileged populations but just in the last couple months He has reaffirmed it through the things i'm learning in class and integrated pharmacy hours i get to do at a free clinic this summer.

i know all these desires may change. next year i could want to do something totally different with my career. but for now this is my heart and so i figured i'd share it. this is the love i have...

The losing streak of Diabetes in impoverished communities

According to the Center of Disease Control and prevention the prevalence rate of obesity in the United States is to be estimated at 30% or higher.¹ This is an alarming percentage due to the fact that obesity is one of the largest risk factors for the developing type II diabetes. Diabetes has become a wide spread disease among Americans and it has not shown any signs of improvement in the past couple years. Obesity is not the only risk factor for type II diabetes, environmental and socioeconomic factors such as living in an impoverished neighborhood can contribute to an individual’s likelihood of developing the disease.² Many of these communities experience a high rate of obesity and diabetes due to lack of access to health care. Typically these communities are made up of a higher percentage of racial minority individuals who are at or below poverty level, such as Hispanics. Persons classified within these communities do not have adequate health insurance or resources available to be able to be educated on health issues such as diabetes. A larger percentage of these populations are unaware of their risks of diabetes or how to accurately treat their disease due to the limited health care available to them. The risks associated with minority populations and diabetes is a growing issue especially in larger cities where most of these minority-impoverished communities are located.

Solving the issue of the increased incidence of diabetes in impoverished communities is not an easy fix. As mentioned before many of these communities lack the resources to be able to provide health care while at the same time they have the highest prevalence rates of diabetes. For adults 20 years or older an estimated 25.6 million people have diabetes. Of that 25.6 million, 12.6% are non-Hispanic black, 11.8% are Hispanic and 7.1% are non-Hispanic whites.³ That is a minimum of 4.7% difference between the white population and the racial minority populations. Further analysis of these statistics shows that for every one non-Hispanic white diagnosed with diabetes (majority) roughly 1.6 Hispanics (minority) are diagnosed as well. These statistics do not take into account the immeasurable percentage of the minority population that is undiagnosed.

Reaching the underprivileged and undiagnosed diabetes is the major issue health care providers are facing. With the passing of the universal health care reform one would assume that this would help improve the available of care for these patients however there are still barriers to overcome. The universal health care bill will provide all individual insurance and access to a health care facility which could help ease the burden of payments for the minority populations who do not currently have insurance. However, access to care is not the only issue that is keeping patients from care. Many of the minority impoverished populations are not receiving adequate care due to cultural and class barriers that result in individuals choosing against health care. A study by the Agency for Healthcare Research and Quality (AHRQ) found that diabetic Hispanics did not receive health care for their condition due to financial barriers as well as reluctance to place ones medical needs above family members, distrust in therapy options and a preference of traditional remedies.⁴ Providing financial means for these individuals in only a small portion of what is causing the discrepancies and inequalities in care.

The largest road block for both the minority populations as well as the health care providers is the lack of education. The issue at hand is not a one sided fix; both sides are facing similar issues and are unaware as to how to fix them. The large incidence of diabetes in the Hispanic population, diagnosed and undiagnosed, is not solely their fault. Many of these Hispanic populations lack the education that is necessary to overcome their barriers or to understand the importance of diabetes and their risk. Insufficient education is a result of health care professionals being undereducated on interacting with minority populations. To be able to change an individual’s perspective we must first be able to understand it. It is crucial for health care providers to be able to understand the effects of race and poverty so they are able to identify the barriers the population may be facing and determine the cause of them. To perpetuate change in perspectives and eliminating barriers health care providers should move toward distinguishing social, environmental, and behavioral factors that are malleable.⁵ Setting out to completely amend barriers that are causing inequality is not the answer; understanding and working directly with patients in these populations is the key.

Pharmacists as health care providers can contribute substantially to the effort of reaching the minority and impoverished populations. Pharmacists are readily available to the public and therefore are more accessible. Since pharmacists are more available to the public there is more patient interactions that occur. Pharmacists have the opportunity to work with patients in some situations on a more personal level. Due to all of these reasons there should be more pharmacist involvement in dealing with diabetes in minority populations. More programs such as the Ten City Challenge should be established where pharmacists work directly with patients with diabetes as “coaches”.⁶ Breaking down the medical provider-patient relationship and building a more coach-player relationship could be more beneficial. The coach-player relationship is more familiar to more individuals and seems to provide less distance in ranking between the patient and provider. The coach role implies the provider is there to work directly with the patient involving them in their treatment, not just evaluating and then prescribing a change. Implementing this type of program in minority communities would help loosen some of the barriers faced in treating these patients. When working in these minority populations pharmacists and other health care providers face the challenge of varying the way they provide care to these communities to be most culturally sensitive. Focusing more on the coaching patient, providers are able to identify more with patients and customizing their care provided to the patients becomes easier.

As a future pharmacist I hope to step outside the typical pharmacist role and work more directly with patients. My desire for my career is to work in the inner city with minority and impoverished populations specifically focus on treating and educating on diabetes. I want to break the mold of what a pharmacist should look like and do. There is a demand for pharmacist everywhere but for me the area we are needed most is the areas we are not already in. pharmacy is changing and I want to be apart of that change in a new way. As a pharmacist I want to take advantage of the opportunity to affect the growth of diabetes in minority populations. It is a complex issue but I know someone has to start somewhere to begin the battle.

Diabetes has hit close to home in the past couple of years. After watching my father being diagnosed with diabetes and struggle with lifestyle changes I have a stronger desire to help individuals battling diabetes. Serving the impoverished in the United States and abroad has also made me more aware of the real issues individuals in underprivileged communities are facing. I have learned through watching my father battle with his disease how a pharmacist can play a crucial role in helping patients with diabetes. Not only do we have the expertise in the medications that are available to patients but more importantly we are there to work directly with patient, supporting them, to improve their therapy and outcomes. I hope to someday be that support for a population that does not receive enough of it or in the right way. I want to be able to relate to and understand the patients in the inner city who are typically overlooked. To be able to build relationships with my patients and move toward a more coach-like persona I think it is important to live in the neighborhood where you work and serve. Working and living in the inner city will help me to establish a relatable understanding of what my patients are living with on day to day bases. I also believe that living in their communities will help eliminate the class barriers between myself and patients, allowing for a more trust worthy relationship to be built. After serving in the inner city of the Unites States and in third world Africa my eyes have been opened to the needs of individuals who are not receiving adequate care. My awareness of diabetes and the needs of racial minorities have lead to my desire to partake in establishing health care facilities to provide care for diabetes in impoverished neighborhoods.