Assignment: Health Disparity And Structural Violence

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Assignment: Health Disparity And Structural Violence

Assignment: Health Disparity And Structural Violence

In the article, “Health Disparity and Structural Violence: How Fear Undermines Health among Immigrants at Risk for Diabetes”, it reports the interconnectedness between fear and health. High levels of poverty and a decreased sense of educational attainment is directly linked to interconnectedness between fear and health. It was reported that participants commonly feared cost of health care, language, discrimination, immigration status, and cultural disconnect.

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First, it was reported that low economic status correlates with high uninsured rates. Economic insecurity is one prominent dimension of fear in relation to the financial burden associated with illness. It has been reported that people fear seeking health care with concerns of the cost involved (Practice, 2013).

Next, participants voiced strong concerns regarding discrimination that immigrants face on multiple levels on a daily basis. They feel that those lacking English- speaking skills are discriminated by health care. Participants report that discrimination often begins in the disapproval of the receptionist who makes them feel like a burden or ashamed of themselves (Practice, 2013).

Lastly, people fear their inability to discuss the fact that they use traditional remedies to cure health problems. Many people hide their alternative medicine routinely in the fear that their doctor will scold them (Practice, 2013).

I do agree that structural violence perpetuates health disparity. Unfortunately, these are common fears in many people in the United Stated and I am ashamed that these are the fears related to health care. Many people go uninsured because of fears and only seek medical attention in a time of an emergency. Although, their emergency could have been prevented if they were not scared of seeking medical attention before the emergency occurred.

In the United States, diabetes has become an epidemic (Boyle, Thompson, Gregg, Barker, and Williamson 2010; Centers for Disease Control and Prevention 2011). 
In the United States, diabetes affects 8.3% of the population (about 25.8 million individuals), with type-2 diabetes accounting for the vast majority (almost 95%). (Centers for Disease Control and Prevention 2011). 
Furthermore, about quarter of the population has been diagnosed as pre-diabetic (Centers for Disease Control and Prevention 2008), and current trends show that diabetes prevalence could reach one-in-three individuals by 2050. (Boyle et al. 2010). 
These figures show that diabetes is serious national issue, yet the risk of developing diabetes is not the same for everyone. 
Diabetes is associated with large differences based on race and ethnicity. 
When compared to non-Hispanic whites, minorities have higher prevalence of diabetes (Centers for Disease Control and Prevention 2011; Community Preventive Services Task Force 2011). 
Hispanics are 66 percent more likely to be diagnosed with diabetes, while Mexican Americans are 87 percent more likely (Centers for Disease Control and Prevention 2011). 
Diabetes is the sixth greatest cause of death in Albuquerque, New Mexico (New Mexico Health Policy Comission 2009). 
Our preliminary research indicated that diabetes and pre-diabetes were prevalent among those sampled in the Hispanic immigrant community where this study was conducted, with 29 percent of those undiagnosed and ignorant of their deteriorated health state (Mishra et al. 2012).


Although ethnicity is one risk factor (Hanis, Hewett-Emmett, Bertin, and Schull 1991; Samet, Coultas, Howard, Skipper, and Hanis 1988), research shows that diabetes risk is influenced by wide range of factors. 
Furthermore, an Institute of Medicine report (2002) identifies “health care system policies and practices…[with]…racial bias, discrimination, stereotyping, and clinical ambiguity” (Smedley 2012, p. 993) as essential determinants in the formation and maintenance of disease and inequity. 
As result, the etiology of diabetes is complicated by the interaction of several risk variables, some of which aren’t normally the focus of public health study. 
This fact has ramifications in terms of both prevention and therapy. 
Because the causes of diabetes are multifaceted, preventing or treating it solely from biomedical standpoint is rarely effective; however, efforts to improve health are unlikely to result in meaningful change without an understanding of the relationship between health and the broader social forces that cause disparity.


Despite research into broader factors that contribute to disease and disparity, the public health model for diabetes prevention and treatment has tended to focus on getting people to change their diet and physical activity levels, or to be “compliant” with prescribed diabetes maintenance actions and medications (Diabetes Prevention Program Research Group 2002). (Bahati, Guy, and Gwadry-Sridhar 2012). 
Expanding the focus to include more expansive factors such as historical and structural racism, changing international economic relationships that affect employment, housing policy that defines neighborhood residence, immigration policy, or government subsidies to industrial agriculture is generally considered beyond the scope of study and thus avoided in public health research. 
However, because of the expanding diabetes “epidemic” (Lam and LeRoith 2012), focus on social determinants of health is increasingly considered as more appropriate for tackling diabetes than focus on individual behavior (Fisher, Chesla, Mullan, Skaff, and Kanter 2001; Peyrot, McMurry Jr, and Kruger 1999; Schulz, Zenk, Odoms-Young, Hollis-Neely, Nwankwo, Lockett, Ridella, and Kannan 2005). 
Groundbreaking research on social determinants of health (e.g., Kawachi and Bruce 2006; Marmot and Bell 2009; Syme and Frohlich 2002) and how “social variables ‘get into the body’ to produce disease” (Syme 2005) led to focus on disease mechanisms that were previously unknown or unimaginable. 
Chronic stress (Cohen, Doyle, and Baum 2006; Kopp, Skrabski, Szé kely, Stauder, and Williams 2007), for example, is now recognized as significant and cumulative influence on health and health disparities (Cohen, Doyle, and Baum 2006; Kopp, Skrabski, Szé kely, Stauder, and Williams 2007). (Davey Smith 2003; Evans and Schamberg 2009; Raphael, Anstice, Raine, McGannon, Rizvi, and Yu 2003). 
The social determinants approach recognizes that health behavior is influenced by more than just an individual’s desire to improve (Caban and Walker 2006; Cabassa, Hansen, Palinkas, and Ell 2008; Mendenhall, Seligman, Fernandez, and Jacobs 2010). 
Human activity is now well-documented in the social determinants literature to the extent that it is imbedded in circumstances outside of individual authority and structured by institutionalized relations, surroundings, and policies (CSDH 2008). 
This has resulted in an increasing interest in environmental and policy reform (e.g.,,, as well as need to foster “community empowerment” (Brennan Ramirez, Baker, and
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