Policy Analysis: Juvenile Diabetes

Juvenile diabetes, also identified as type 1 diabetes (T1D), is a chronic, life-threatening autoimmune condition that mostly affects children and young adults. According to a study by Yewchuk, Morrison and Yewchuk (2012, p.232), T1D affects millions of adults on a global scale and approximately 440,000 children under the age of 14, with 70,000 new diagnoses in children every year. In T1D, the body does not produce insulin. Basic biological knowledge indicates that insulin is very significant in the transfer of glucose from the bloodstream to the cells for Adenosine Triphosphate (ATP) synthesis. To help people with juvenile diabetes, various treatments in combination with insulin therapy are required. This form of diabetes management is extensive and detailed. Thus, it requires proper policy structures from the healthcare and education departments. With children being the primary target, this means that there has to be a proper coordination between an education system, the government, and parents when it comes to effectively managing the condition. As such, the agenda of this analysis is to scrutinize the prevailing policy disposition with regards to proper management of juvenile diabetes.

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How T1D Is Affecting the Policy Arena

Living with diabetes can feel overwhelming for parents and children because constant vigilance is required for proper care (Naranjo& Hood, 2013). Similarly, a study by Yewchuk et al. (2012) acknowledges that recent studies have shown glucose extremes can have devastating deleterious effects on a childs learning capability. As proven in the overview section, T1D can be fatal when improperly handled. As such, the policy issue related to T1D management in children is that there are no proper coordination programs in learning institutions to ensure that standard care is provided to young learners. Within their analysis, Beran, Yudkin and Atkinson (2013) acknowledge that there has been improved management of T1D on a global scale. However, one pressing issue is the persistent high rate of deaths that result from the lack of insulin supply. This is not a condition that only affects people in poor countries, but also established economies such as the US. The reason for this is because the cost of insulin is still high. For people who are in need of life-long insulin therapy, the burden ends becoming heavier as time passes by. Beran et al. (2013) also acknowledge that besides the cost issue, poor-resourced countries or regions experience inadequate diagnostic tools and poor coordination of health experts with people living with juvenile diabetes. As such, these are some of the issues that policy makers, at different levels, need to put into consideration when aiming to improve the conditions of T1D individuals.

Current Politics of the Issue

In an analysis presented by Herman and Cefalu (2016), the issue of contention is the Affordable Care Act (ACA). One of the important agendas of the ACA was to expand Medicaid. Given the politics of the issue, almost a half of the states expanded their Medicaid while the other lot chose to remain defiant. Using the work of Kaufman et al., Herman and Cefalu (2016) indicate that within the states that expanded their Medicaid, people with T1D were diagnosed at an early stage, which is medically beneficial. Despite the positivity, some pundits view ACA and Medicaid to be a negative aspect that is expensive to the taxpayers. However, Herman and Cefalu (2016) categorize all these as mere politics that end up affecting people with chronic diseases. With vast research showing that Medicaid expansion positively influenced the rate of early diagnosis and better management in states that implemented it, mere politics have to be set aside and much emphasis put on the provisions of the Affordable Care Act, which is almost being repealed for political reasons.

Level in the Policy-making Process

Most policies and legislative provisions are within their implementation phases and the evaluation and termination. In 2015, the American Diabetes Association (ADA) planned to increase federal funding for diabetes research programs. This has proved useful in developing affordable insulin to T1D patients. The federal association also put into perspective the issue of insurance for the relevant parties, mainly dwelling with available accessible options (ADA, 2014a). However, besides implementing available policies, the ADA is currently battling the lawmakers with regards to repealing the Affordable Care Act without an immediate replacement. Such a politically-motivated maneuver would end up affecting most of the patients that are currently covered by the Act and Medicaid.

Part 2: Policy Analysis Framework on Juvenile Diabetes

Social Factors

Diabetes is a condition that cuts across all ethnicities with the latest statistics from the Center of Disease Control (CDC) (2015) showing that for the adult population aged 20 and above, American Indians and Native Alaskan communities lead by 15.9% while non-Hispanic whites are the lowest with 7.6%. In combating T1D, much emphasis has been put on biological and behavioral factors, as it is evident from the report provided by the CDC in 2015. However, Hill, Nielsen, and Fox (2013) show that it is significant if more emphasis is also put on the impact of the physical and social environment. Within their analysis, Hill et al. (2013) indicate that the Affordable Care Act, which is responsible for providing health insurance to diabetes patients, has not been socially effective. Even though section 4302 of the Affordable Care Act provides an opportunity for advanced data collection, which can be useful in enhancing social determinants of T1D, Hill et al. (2013) deem it necessary for the social scope of the policy to be expanded. The failure of improving necessary social standards is directly linked to soaring of juvenile diabetes in the country. Alternatively, social factors present an effective avenue of tackling the TID dilemma in the general population.

Ethical Factors

Earlier studies from the ADA show that while manypeople suffer from diabetes, the severity of related outcomes differs with each ethnicity. For instance, compared to their Caucasian counterparts, African Americans show severe complications such as amputations and kidney failures, a factor that reflects on how treatment should be approached differently. Further insights into the varied complications show that certain ethnic groups (the minorities) receive poor quality of healthcare with regards to diabetes management. The reason for poor medication was due to lack of coverage by medical policies. By reflecting on the Affordable Care Act, it is important to note more people, especially the minorities, were included thus becoming eligible for quality healthcare (Herman &Cefalu, 2016). It is only in states where Medicaid has not been expanded that patients from minority ethnicities continue to receive poor health care resulting in devastating side effects.

Legal Factors

The ADA has been committed to making sure that there are no further incidents of discrimination involving diabetic people. People with chronic health conditions face discrimination from the public, an aspect that the ADA through proper policy structures continues to prevent through education, negotiation, litigation, and legislation. For instance, the organization intervened in one case where an applicant was turned down for a police officer position because he was diabetic. In a legal analysis carried out by Gordon, Rapp, Dimmick and Jackson (2011), the Americans with Disabilities Act and section 504 of the Rehabilitation Act of 1973 provided maximum legal protection against the discrimination of diabetic people. Learning institutions are supposed to make sure that students get enough support with their insulin intake, but as explored by Wood (2013), limited resources such as the shortage of school nurses still make this a significant problem. Significantly, employers still use ill-considered standards such as blanket bans to discriminate against diabetic employees.

Historical Factors

As acknowledged above, American Indians and Alaskan communities exhibit a higher prevalence rate of diabetes (type 1 and type 2), more than any other racial group. A study by McLaughlin (2010) shows that this was not always the situation for the natives. Taking a step to 100 years ago, diabetes and other chronic diseases were not even known, but they are currently the leading health issues. Major attributes to the current scenario include the changes that forced many natives into reservation camps, high-stress environments that are social triggers of the increased diabetes prevalence rate. The policies that limited Indians into camps are responsible for their changing lifestyles (McLaughlin, 2010). However, although inadequate, significant steps have been taken to address high prevalence rate of diabetes in high prevalence areas.

Economical Factors

The government spending on diabetes management programs has increased significantly in the recent years. A report from the CDC (2015) shows that the government puts into use a substantial amount of money in combating diagnostic problems and ensuring insulin availability to patients with juvenile diabetes. In 2012 alone, the federal government used approximately $245 billion where $176 billion was used in direct medical costs while $69 billion was spent on indirect costs. With the increasing prevalence of both juvenile and type 2 diabetes in the country, the government is being forced to spend further to alleviate the problem unless, by 2050, CDC predicts that one in every three adults will have been diagnosed with diabetes if the current trend continues.

Nursing Position Statement on Juvenile Diabetes

Given the long-term prevailing discrepancy of adequate quality care within learning institutions, nurses have recently come together and vowed to help students with their administration of insulin. Despite strong policies that require learning institutions to be responsible for the welfare of diabetic students, shortage of resources and a limited number of registered nurses continue to be an issue. As such, the recent decision by nurses to help schools is useful to diabetic students. The position statement was agreed upon by the American Nurses Association (ANA), ANA/ California, California School Nurses Organization, and the ADA in 2014. The agenda is the continuous provision of care to students with diabetes in school settings (ADA, 2014b).

Part 3: Policy Options/Solutions

No Change: Using Motivational Interviewers to Help Teenagers in Schools

The basis of this solution is to have trained professionals who can link well with diabetic teenagers in school environs and motivate them to adhere closely to the required medication regimen. In a study carried out by Borus and Laffel (2010), teenagers often encounter both physical and social changes as part of the development process. However, these changes are usually hard for teenagers surviving with chronic conditions. Borus and Laffel (2010) indicate that the level of depression is 15% higher in diabetic teenagers than in normal individuals. With the strict regimen that TID patients are supposed to adhere to, it is easy for suffering teenagers to develop a rift with their families, more so when they are coerced into eating in a certain way or maintaining a given lifestyle. When such a rift exists between the teenagers and their parents, motivational interviewers (in this case the trained professional nurses) are required to provide the necessary encouragement. Learning institutions as earlier analyzed have proven to be ineffective in strictly adhering to the needs of diabetic students. As such, using the skills of registered nurses who have vowed to help learning i...