Population Health: Diabetes in Vellore, India

Samantha Gibbs Vellore, India 5 Nursing Students 4 weeks Population-Based Clinical Objectives

● Understand how culture, environment, and other social determinants of health influence health outcomes of communities ● Explore differences and similarities between Indian and American culture ● Investigate the increase in the rate of diabetes in India Background Top 5 Leading Causes of Death & Disability 2016 in India (Institute for “In India, the steady Health Metrics and Evaluation, 2016) migration of people from 1. Ischaemic heart disease [14.3%] rural to urban areas, the 2. Diabetes [4.9%] 3. Self-harm [4.3%] economic boom, and 4. COPD [3.7%]* 5. Iron-deficiency anaemia [3.6%] corresponding change in life-style are all affecting ● Population of India: 1.342 billion (2016) the level of diabetes” ● As a country, India (31.7 million) has (Kaveeshwar, 2014). the highest number of people with diabetes mellitus followed by China (20.8 million), and then the United States (17.7 million) Christian Medical College, Vellore

● Main hospital campus: 2,384 beds ● Private hospital, research center, and educational institute ● Highly respected institution in the country and internationally ● Shadowed in the Emergency Department, Pediatrics, Labor and Delivery, and Mental Health Clinic

Pictures: Main CMC campus College of Nursing Community Health

● There are 4 different community health programs for Vellore, and we spend most of our time in CONCH - College of Nursing Community Health Clinic ● CONCH is a nurse run clinic focuses on home visits, health camps, and other projects to generate health awareness among community members ● Our team spent 2 weeks in Perumugai Village with the CONCH nurses Top picture: Family we met on a home visit

Bottom picture: Community health clinic located in Perumugai Village, Vellore Diabetes in Perumugai Village

● Diet consists of many fried foods, simple carbohydrates (white rice), and sweets ● Especially for women within the village, a majority of the day is spent watching television inside the home ● The built environment does not allow for easy access to exercise ○ Too hot to walk outside ○ “Workout culture” does not exist ○ Gyms are not easily accessible and are marketing to men only Individual Level Intervention

● During home visits, CONCH nurses: ○ Screen individuals at risk for diabetes ○ Refer individuals to CMC for further treatment when necessary ○ Blood sugar checks ○ Ensure individuals are taking their medications correctly ○ Educate about the importance exercise and eating a healthy diet

Teaching community members about what a healthy diet consists of Community Level Intervention ● CMC plans community wide events, such as the Centenary Run, in order to normalize and encourage physical activity ● There are health camps held by the community health department at CMC for prevention and treatment of diabetes among other health concerns Systems Level Intervention

● The Ministry of Women and Child Development and the Food Safety and Standards Authority of India (FSSAI) has taken action to promote healthy snacks in schools and decrease marketing of unhealthy food and drinks to children (WHO, 2016) ● FSSAI provides regulations for processed foods to display nutrition information on the product packaging to provide an opportunity for prevention of diabetes (WHO, 2016) ● Implementation of a social marketing campaign using SMS text messaging to enhance prevention and management strategies for diabetes and increase health literacy regarding diabetes management (WHO, 2016) Conclusions & Recommendations ● The College of Nursing Community Health program has a huge impact on Vellore and the surrounding villages in decreasing the rates of diabetes within the community ● Preventative care is key! ○ Healthcare providers should continue to educate regarding the importance of diet and exercise ○ A culture of exercise has not yet formed, but Vellore is taking steps to encourage it’s community members to embrace exercise as an activity of daily life ○ School age children should continue to be a large focus in the prevention of diabetes due to the habits that form during this age Most Profound Cultural Experience Pongal Harvest Festival Most Profound Clinical Experience CONCH Home Visits Special Thanks to: ● Dr. Mani for making this learning experience possible through The Robinson Scholarship ● All the faculty and staff at Christian Medical College for being so welcoming and kind References

Kaveeshwar, S. (2014). The current state of diabetes mellitus in India. Australasian Medical Journal, 7(1), 45-48. doi:10.4066/amj.2014.1979

World Health Organization. (2016). World health day: diabetes [PDF File]. Retrieved from http://www.searo.who.int/india/mediacentre/events/world_health_day/whd-technical-paper-4 -april.pdf?ua=1

Institute for Health Metrics and Evaluation . (2016). Tamil Nadu: Disease Burden Profile, 1990 to 2016 (Rep.). Institute for Health Metrics and Evaluation . Retrieved March 1, 2018, from http://www.healthdata.org/sites/default/files/files/Tamil_Nadu_- _Disease_Burden_Profile%5B1%5D.pdf