Advocacy to impact population health Process

Advocacy to impact population health Process

I) Identify

Greeting Honorable Governor Ralph Northam and Chief Diversity Officer Dr. Janice Underwood

My name is Cassandra Singleton, and I am the Neuroscience Director at Memorial Regional Medical Center. In my role, I oversee the operations and clinical care practices of a vast number of African Americans who have uncontrolled diabetes and complications due to improper management and limited access to healthcare.

(S) Situation

Diabetes significantly impacts the African American Population with alarming health disparities. For example, in 2018, African Americans were twice as likely as non-Hispanic whites to die from diabetes. In addition, in 2017, they were 2.3 times more likely to be hospitalized for lower limb amputation than non-Hispanic whites(Center for Disease Control and Prevention [CDC], 2021). Policy H.R. 2178 “Minority Diabetes Initiative Act” will allow funding to provide diabetes prevention, care, and treatment programs in minority communities. In addition, routine healthcare for diabetic patients, including eye care, foot care, and management of complications, can be provided (H.R. 2178-117th Congress, 2021-2022). If this policy is not enacted, there could be exponential growth in disparities, mortality, and morbidity. According to Han et al. (2019), disparities in diagnosis and control type 2 diabetes are most evident in African Americans with lower socioeconomic status. Currently, Virginia’s African American prevalence rate for diabetes is 17.6%, higher than the national rate of 15.5%(CDC, 2018).

(B) Background

There must be a sense of urgency to shift the paradigm of health disparities and social determinants of health, preventing better health outcomes for African Americans. It is only through policy action that health inequities can be decreased (Brown, 2021). For example, it deeply saddens me to see the volume of African Americans admitted to the Neuroscience unit with positive MRI for stroke due to uncontrolled diabetes. Patient risk assessment for readmissions yielded responses that they couldn’t afford the insulin, the primary care physicians could not see them until a month or more post-discharge, or could not access a healthcare facility due to the location of their residence. Yet, they live in low-income areas with poor food choices and limited or no access to healthcare.

(A) Assessment

African Americans will continue to seek acute care for complications of diabetes if provisions are not put into place to mitigate the health inequities. H.R. 2178 will help provide overdue resources needed to meet the needs of this vulnerable population. African Americans’ hospital admissions per 100,000 for uncontrolled diabetes without complications are 114.3%(CDC, 2021). In addition, the estimated cost of diabetes care for Virginia in 2018 was $6.1 billion, and lost wages were $2.3 billion (ADA, 2018). Thus, enacting this bill will aid in improving health outcomes and reducing the economic impact on the state for this chronic disease alone. Organizations such as the American Diabetes Association [ADA], (n.d.) advocate for all people to be covered under public and private health insurance; this coverage should include access to medications, tools, education, address food insecurities, and promote health equity at-risk populations.

(R) Recommendations

As a Neuroscience Director working in collaboration with interprofessional team members to provide care to African Americans seeing first hand the impact the disparities have on the population and the healthcare system, I ask you to consider enacting H.R 2178. I offer my support and voice to support the enactment of this bill, which would positively impact African Americans and other minorities in the state of Virginia. I want to thank you for sparing your time to hear concerns, and I am hopeful you will take action.

(S) Salutation

Cassandra Singleton, MSN,RN

Neuroscience Director

8260 Atlee Road

Mechanicsville, VA 23116


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