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NUT301 Community And Public Health Question AIM –  Complete the assignment using MY case study plus 1 peers to illustrate how the determinants of health impact on people and their health or their ability to manage their health. Reflection To Include Analyse how the social determinants of health have been involved in the manifestation of disease in the case studies; Analyse how the social determinants of health have affected the ability of the people in the case studies to access services, manage their health problem and maximize their health. Annex A ArmY Soldier Case Study History James is a 49-year-old military member who lives in Adelaide. On his 5 yearly medical assessment he was diagnosed with Type 2 Diabetes. James also has a high BMI of 33, suffers from PTSD has ongoing lower back issues and knee injuries as a result from overseas deployments. James father also had Type 2 Diabetes and died of a heart attack at the age of 55. James has a current medical classification of J31 – ‘Not Fit for duty and Undergoing Rehabilitation/Specialist Medical care’. James is currently under review from the Department of Veterans Affairs to seek liability and compensation. James current role is sedentary administration.  1.1 Why Do You Think You Developed This Health Problem/S? On return from overseas deployment, James was diagnosed with PTSD. As a result, he gained significant weight, became alcohol dependent and suffered a lower back injury to L4, L5, S1 Lumbar. He required a spine fusion surgery which was unsuccessful. He later received another surgery which was partly successful. James also had an injury to his Right ACL and required surgical repair. His unhealthy lifestyle and reduction in physical activity has resulted in 20kg weight gain, he has high blood pressure, high cholesterol, depression and anxiety from these conditions. 1.2 How Has It Impacted On Your Life? Not only has James been removed from his permanent role as a combat arms soldier, but he has been medically downgraded. This means he is not fit for duty in an operational overseas role. His PTSD, depression and anxiety have led to James having regular psychological appointments to deal with day to day life. James has been prescribed tablets ‘Metformin’ to control the diabetes and is also required to test his blood glucose levels. He has been advised he needs to get his levels back to the ranges of 4.0-7.8mmol/L or will be facing medical discharge. James is single with no dependants.  1.3 What Do You Find Most Difficult In Trying To Manage This Health Problem? James battles with his food and alcohol dependency when he feels depressed. He turns to these things to make himself feel better. He isn’t able to conduct physical training to the high level he once could which also leads to his depression. His weight gain and recent diabetes diagnosis has also been detrimental to his mental health. He feels ‘broken’.  1.4 What Services Have You Used To Help You Manage Your Health Problem/S?  James has excellent support within the Australian Defence Force. Free Medical, Free Psych, Department of Veterans Affairs, Defence Community Organisation, Chaplains and a good support network within his work. James has also been referred to a Dietician for weigh reduction and has lost 5kg in one month. James’ surgeons were also external specialists. 1.5 What Services Have Been Most Helpful? James stated that the Dietician was excellent and provided him with the skills to cook at home and to maintain a healthy lifestyle. James also works with a Physical Training Instructor to maintain weight and stay conditioned within his restrictions. 1.6 Have You Had Any Difficulties Accessing Services For Your Health Problem? If So, Please Explain The Difficulties: No. Defence has an excellent health care system. Sometimes there may be a wait on appointments, however if its urgent then there are always options to be seen.  1.7 How Do You Think Health Services Could Be Improved To Help You Manage Your Health Better? Probably more education on the types of diseases that people like him may be prone to later in life. He stated that he’s always eaten whatever he wanted and could drink as much as he liked…care free! But after his accidents and lack of exercise everything changed and became a spiralling flow on effect of complications. Weight gain = Diabetes.  Full Consent and name changed Annex B Case Study: 34 Year Old Male With Type 2 Diabetes Top of Form Summary Of Case The case study participant is “Jared” (not real name), a 34-year-old man who has been living with diagnosed type 2 diabetes for the past 5 years.  His diabetes is currently treated with metformin, which he takes morning and night. He has been unemployed on a long-term basis and lives at home with his mother and brother.  He has suffered depression on a sporadic basis for a long time and has been on a disability pension for several years. Why Do You Think You Developed This Health Problem? Jared feels that his diabetes developed because of his poor diet and because he has been overweight for a long time.  He attributes being overweight to too large portion sizes and poor diet including not enough fresh fruit and vegetables.  He also thinks genetics may have played a part in the development of diabetes as there is a family history of the disease. How Has It Impacted On Your Life? Post-diagnosis Jared is more aware of the impact that certain foods and too much food have on his blood glucose levels and generally pays more attention to what he eats.  He avoids high sugar foods and drinks and tries to keep portion sizes down.  For Jared, the biggest impact that diabetes has had on his life is dealing with almost constant fatigue and frequent episodes of feeling unwell.  If Jared eats too much in one sitting, the adverse effects on his wellbeing can last days unless he acts to reduce his blood sugar levels by missing meals or exercising. The other main effect of his diabetes is that wounds, especially on his feet, tend to heal very slowly.  This can make it difficult for him to exercise during the healing process and therefore manage high blood sugar levels. What Do You Find Most Difficult In Trying To Manage This Problem? Jared feels that the requirement for constant monitoring and management of his condition is difficult.  What Services Have You Used To Help You Manage This Problem? After Jared’s diagnosis, he was placed on a Chronic Disease Management Plan by his GP and was referred to a Dietician and an Exercise Physiologist.  These services were partly covered by Medicare under the CDM scheme.  He has also obtained services from a Podiatrist at his own cost, and because of this consultation has better knowledge of how to look after his feet and what shoes to wear.  He also applied to join the National Diabetes Service Scheme, which enables him to obtain glucose testing strips at a discounted rate.  Jared hasn’t sought the services of any Allied Health Professionals for some time and now just sees his GP for a check-up and blood test every 3 months. What Services Have Been Most Helpful? Jared feels that the services provided to him have been “pretty great”. He is appreciative of the fact that all his GP appointments and pathology tests are bulk billed and of the extensive knowledge that his GP has about his condition and how to best manage it. Have You Had Any Difficulties Accessing Services For Your Health Problem? If So, Please Explain The Difficulties. The main difficulty was the process involved in joining the National Diabetes Services Scheme, including the paperwork involved and the time lapse before application and registration.  He feels he should have been joined up automatically by his GP or Medicare. Another difficulty was getting an appointment with a registered dietician.  As there are only two dieticians in town (servicing a population of 70,000), he had to make appointments 2 to 3 months ahead.  This made follow up appointments pointless. How Do You Think Health Services Could Be Improved To Help You Manage Your Health Better? Jared would like to see new technology developed for measuring blood sugar on a real time basis, like on a watch, so he could better manage his blood sugar levels and avoid having to continually prick his finger with the lancet. He also thinks that having regular access to a Medicare funded weight loss coach, as opposed to an exercise physiologist, would help him to keep to a plan to lose weight, decrease his medication requirements and maybe even cure his disease. Answer Social Determinants Of Health Introduction The current study focuses upon the social determinants of health and the impact it produces upon the overall health of an individual. It consists of a number of social and biological factors which could strongly affect the mental and physical well being of an individual.  In this respect, the environment and the social circumstances within which a person lives has a profound effect upon the physical and mental well being of the individual. The social determinants of health comprises of a number of factors which could be discussed over here with regards to their impact upon the life of an individual and the community as a whole. The factors consist of health, education, economic stability, neighbourhood and community context. It has been seen that an amalgamation of all these factors influence the lifestyle of an individual. In this respect, health and economic stability have been associated with sufficient education and job opportunities. Discussion On Social Determinants Of Health The social determinants of health are a much more comprehensive term and consist of a number of factors. Each one of the factors produced differential expression upon the life of individual people. As mentioned by Stevenson (2018), the society and the neighbourhood of an individual produce a strong impact upon their mental and emotional well being. In my opinion, the poor economic or living condition can subject an individual to a number of health issues.  As suggested by Adler  et al. (2016), social discrimination of any from can affect the psychological well being of an individual. Thus I think, discrimination based on language, community, race, religion could subject one to social isolation leading to mental health issues such as depression and anxiety. The education and level of knowledge possessed by an individual also governs their approach towards health.  I also think the lack of effective knowledge along with cultural paradoxes could prevent an individual from a approaching the appropriate healthcare channel. In this respect, the individual suffering from mental illnesses are often subjected to great amount of societal stigma. Hence, they have often been seen to hesitate in taking help from the mental healthcare channels. The health of an individual and community is determined by access to various support services received from home, neighbourhoods and community (Mitrou et al., 2014). The determinants of health also comprises of the pattern of social engagement and a sense of security, which is established by becoming an integral part of the society. As mentioned by Braveman and Gottlieb (2014), the equitable access to health and social care services for each and everyone within the community can also promote general well being. Effects Of Social Determinants Of Health In The Manifestation Of Disease In order to understand the effect of the social determinants of health on the overall health and well being of an individual a number of case studies could be considered. In this context, James was a 49 years old military member living in Adelaide. He was diagnosed with type 2 diabetes and had a high BMI of 33. James suffers from post traumatic stress disorders (PTSD) and has lower back of knee injuries owing to overseas deployments. The high BMI, presence of type 2 diabetes and PTSD has resulted in James be declared as unfit. The unhealthy lifestyle and the reduction in physical activity has led the patient put on  considerable amount of weight, which further contributed in a number of health complications. James had been removed from his position of a combat soldier. Additionally, the uncontrollable diabetes could result in him losing his role of a sedentary administration. In this respect, a number of factors had combined to produce significant impact in the life of the James. For instance, removal from his job role of that of a combat soldier and the future risk of medical discharge has developed anxiety within the patients. Here, the poor physical health of the patient has resulted in him being removed from his present job role. I think the loss of present job role and future prospects of medical discharge affected James on a psychological level, as a result of which he started developing anxiety disorders. The depression and anxiety could further complicate the patient health by affecting some of the basic metabolic function and activities (Badland et al., 2014). As mentioned by Marmot and Allen (2014), low mood disorder have been seen to produce a significant impact upon the level for production of hormones such as epinephrine and non-epinephrine which further regulates the amount of production of blood sugar level to a considerable amount. Effects Of Social Determinants Of Health On The Ability Of People To Access Health Services Or Manage Their Health  Some of the social determinants of health have a considerable effect on the ability of people access health care services. As mentioned by Garg, Boynton-Jarrett and Dworkin (2016), based upon the ability of an individual to access healthcare services they could preferably manage their health conditions in the long run.  In the presented case scenario, James was removed from his job role of that of a combat soldier and was put in a sedentary officer role. Hence, in the lack of adequate finances the patient will not be able to avail appropriate medical services (Baum & Friel, 2017). Thus, the future risk of medical discharge made the patient dependent upon mental health and anxiety treatment and care services. Though, James received appropriate mental healthcare services, he was an alcoholic and lacked sufficient physical exercise in his daily routine.  Hence, access to a physiotherapist could help James manage his conditions better. On the other hand, the case study of   Jared could be highlighted over here who was a 34 years old man living with type 2 diabetes for the past five years. He had been unemployed for a very long time and had been living on disability pension. He had been suffering from sporadic depression. Jared had been prescribed metformin for the control of his diabetes. Jared had been particularly careful of what he had been eating, as eating large potion unhealthy meals have affected his health severely. He finds the management and monitoring of his condition difficult.  Jared was put on a chronic disease management plan and was also put under a dietician and exercise physiologist. Some of his services were covered partly by the Medicare. Jared applied to the National Diabetes Service Scheme for availing some of the diabetes management features such as the glucose testing strips at discounter rate. However, the paperwork involved and the time lapse before application and registration often becomes very cumbersome (Social Determinants of Health Alliance, 2015). Additionally, there was difficulty in getting adequate access to healthcare services as there were very few dieticians available who he could actually approach for the making of his diet plan. Jared also felt that the lack of access to Medicare funded weight loss coach resulted in an economic burden on his part, as he had not proper and adequate source of employment. Implemented Steps  Some of the steps and procedure which could be implemented over here for providing the patient   with equitable healthcare services were revision and modification of the national and government policies. For instance, the paper works involved in getting help from national service commission for diabetes care and management were huge. Also I think, the lack of a fast paced technology made the management of diabetes condition difficult for the patient.  In my opinion, reduction of the delivery time of the proper health care services along with incorporation of fast paced technologies could also reduce the recovery time of the patient. Conclusion  The current assignment discusses the social determinants of health and the manner in which its impact upon the life of particular individuals and community as a whole. In the current study, two different case studies have been taken into consideration. For instance, James had been removed from his present job role based upon his physical and mental ill health. Additionally, he was suffering from the anxiety of medical discharge which could make him vulnerable to economic instability. In the lack of money he would not be able to avail diabetes care or mental healthcare services which could make his conditions worse. Hence, a lack of community based free healthcare services was one of the major deficits. Additionally, the cumbersome process of applying to social funds for availing long term care services makes an individual vulnerable to poor health (AIHW, 2018).  Additionally, the lack of adequate support from social and personal channels such as friends and families can further affect the quality of care. Hence, the some of the healthcare policies need to revise in order to provide adequate health care services at faster pace and affordable prices to the general public. Additionally, community wide campaign and support programs can also help in the generation of sufficient awareness regarding health management aspects. References  Adler, N. E., Cutler, D. M., Jonathan, J. E., Galea, S., Glymour, M., Koh, H. K., & Satcher, D. (2016). Addressing social determinants of health and health disparities. National Academy of Medicine. Perspectives: Vital Directions for Health and Health Care Initiative. AIHW. (2018). Australia’s health 2018. Canberra: AIHW. Retrieved July 2018 from 2018/contents/table-of-contents Badland, H., Whitzman, C., Lowe, M., Davern, M., Aye, L., Butterworth, I., … & Giles-Corti, B. (2014). Urban liveability: emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health. Social science & medicine, 111, 64-73. Baum, F., & Friel, S. (2017). Politics, policies and processes: a multidisciplinary and multimethods research programme on policies on the social determinants of health inequity in Australia. BMJ open, 7(12), e017772. Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31. Garg, A., Boynton-Jarrett, R., & Dworkin, P. H. (2016). Avoiding the unintended consequences of screening for social determinants of health. Jama, 316(8), 813-814. Marmot, M., & Allen, J. J. (2014). Social determinants of health equity, 25-34. Mitrou, F., Cooke, M., Lawrence, D., Povah, D., Mobilia, E., Guimond, E., & Zubrick, S. R. (2014). Gaps in Indigenous disadvantage not closing: a census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981–2006. BMC Public Health, 14(1), 201. Social Determinants of Health Alliance. (2015). What are the SDOH? . Retrieved July 2015 from Stevenson, F. (2018). Social Determinants of Health. Sociology as Applied to Health and Medicine, 23.

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