As of 2023, it is estimated that Type 2 diabetes (T2D) affects approximately 783 million people worldwide, with South Asians presenting the highest age-adjusted comparative diabetes prevalence among adults (90,204.5 people). Ethnicity has been highlighted as a major risk factor for the development of T2D with central adiposity, insulin resistance, and unfavorable lipid profile identified as predominant signals of alarm. Leading databases, including Web of Science, Medline, PubMed, Google Scholar, and ScienceDirect, were consulted, and manual searches were carried out for cited references in leading diabetes-related journals. Genetic predisposition, central adiposity, and unfavorable lifestyles, including physical inactivity and an unhealthy diet, have been found to be associated with the prevalence of T2D in migrant South Asians. Additionally, “Westernization,” acculturation, socioeconomic factors, and lack of awareness regarding seriousness and consequences of the disease have also been identified as contributors to the development of T2D in this population. However, the higher prevalence of T2D in migrant South Asians may not be entirely attributed to genetic predisposition; hence, ethnicity and associated modifiable risk factors warrant further investigation. Preventive measures and appropriate interventions are limited by the lack of ethnic-specific cut-off points for anthropometric and biological markers, as well as by the absence of reliable methods for dietary and physical activity assessment.
Article
Diabetes in South Asians
Sara Garduño‐Diaz and Santosh Khokhar
Article
Disparities in Healthcare Access and Outcomes Among Racial and Ethnic Minoritized People with Intellectual and Developmental Disabilities
Sandy Magaña, Nazanin Heydarian, and Sandra Vanegas
Compared to the general population, people with intellectual and developmental disabilities (IDD) face worse health outcomes, and outcomes are even worse for children and adults with IDD from minoritized populations. Examining the intersection of people with IDD from minoritized groups is critical to understanding appropriate policies and services that promote health among all people with IDD. People with IDD from minoritized racial and ethnic groups have greater exposure to detrimental social determinants of health, which leads to poor access to adequate healthcare and poor health outcomes. Policies that aim to improve health outcomes among people with IDD and that are related to their disability and appropriate accommodations are not enough. Policies need to address poverty in families, racism and discrimination, poor housing, and other social determinants that are more prevalent among minoritized populations.
Most research on racial and ethnic disparities among children and adults with IDD has been conducted in the United States. While there is emerging research globally on racial and ethnic disparities, there a paucity of this research in the field of IDD. Furthermore, there may be detrimental health effects for other minoritized groups, such as religious minorities, but research is lacking in this area. Clearly, more research on these intersections is needed in the global context.
Article
Drowning: Global Burden, Risk Factors, and Prevention Strategies
Aminur Rahman, Amy E. Peden, Lamisa Ashraf, Daniel Ryan, Al-Amin Bhuiyan, and Stephen Beerman
Drowning has been described as a major global public health problem and has recently been acknowledged by a United Nations Declaration on Global Drowning Prevention. While drowning impacts countries of all income levels, the burden is overwhelmingly borne by low- and middle-income countries (LMICs) who account for 90% of the global death toll. In addition, there is scarce data collection on drowning in LMICs, so the magnitude of drowning may be far greater than is represented. A range of factors including sex, age, education, income, access to water, a lack of swimming skills, certain occupations like commercial fishing, geographically isolated and flood-prone locations, preexisting medical conditions, and unsafe water transport systems, influence the risk of drowning. Some behavioral factors, such as alcohol or drug consumption, not wearing life jackets, and engaging in risky behaviors such as swimming or boating alone, increase drowning risk. Geopolitical factors such as migration and armed conflict can also impact drowning risk. There is a growing body of evidence on drowning prevention strategies. These include pre-event interventions such as pool fencing, enhancing community education and awareness, providing swimming lessons, use of lifejackets, close supervision of children by adults, and boating regulations. Interventions to reduce harm from drowning include appropriate training for recognition of a drowning event, rescue, and resuscitation. An active and/or passive surveillance system for drowning, focusing on individual settings and targeting populations at risk, is required.
Drowning requires coordinated multisectoral action to provide effective prevention, rescue, and treatment. Therefore, all countries should aim to develop a national water safety plan, as recommended in the WHO Global Report on Drowning. Further research is required on the epidemiology and treatment of drowning in LMICs as well as non-fatal and intentional drowning in both high-income countries (HICs) and LMICs. Effective and context-specific implementation of drowning prevention strategies, including pilot testing, scale up and evaluation, are likely to help reduce the burden of both fatal and non-fatal drowning in all countries.
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Environmental Health in Latin American Countries
Luiz Augusto Cassanha Galvao, Volney Câmara, and Daniel Buss
The relationship between environment and health is part of the history of medicine and has always been important to any study of human health and to public-health interventions. In Latin America many health improvements are related to environmental interventions, such as the provision of better water and sanitation services. Latin America’s development, industrialization, and sweeping urbanization have brought many improvements to the well-being of its populations; they have also inaugurated new societies, with new patterns of consumption. The region’s basic environmental-health interventions have needed to be updated and upgraded to include disciplines such as toxicology, environmental epidemiology, environmental engineering, and many others. Multidisciplinary and inter-sector approaches are paramount to understanding new profiles of health and well-being, and to promoting effective public-health interventions.
The new social, economic, labor, and consumption aspects of modern Latin American society have become more and more relevant to understanding the complex interactions in the region’s social, biological, and physical environment, which are essential to explaining some of the emerging and re-emerging public-health problems. Environmental health, as concept and as intervention, is simple and easily understood, but no longer sufficient to achieve the levels of health and well-being expected and required by these new realities. Many global changes such as climate change, biodiversity loss, and mass migrations has been identified as main cause of ill health and are at the center of the sustainable development challenges in general, and many are critical and specific public health. To face this development, other frameworks have emerged, such as planetary health and environmental and social determinants of health. Public health remains central to some, such as the improved environmental-health agenda, while others assign public health a relative position in a variety of overarching frameworks.
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Implementation and Dissemination of Evidence-based Programs for the Prevention and Management of Chronic Conditions in Older Adults: Theoretical Perspectives and Case Examples from the United States
Marcia G. Ory, Chinelo K. Nsobundu, and Yeka W. Nmadu
More than 50 million Americans are currently 65 and older, with current projections estimating that there will be nearly 100 million by 2060. While there is great variability among the older population, many older adults will be disproportionately affected by negative health and well-being consequences associated with chronic diseases, increased fall risk, and physical inactivity. The implementation and dissemination of evidence-based programs can play a major role in the prevention and management of these conditions, thus improving quality of life for the growing number of older adults worldwide. These goals are consistent with the World Health Organization Declaration of the Decade of Healthy Ageing.
Research and practice around evidence-based programs for chronic illness management and related conditions in older adults have spearheaded many new opportunities to promote healthy aging as well as revealing challenges in getting effective programs and policies implemented and widely disseminated. For example, most evidence-based programs are not readily scalable or sustainable. Reasons for this may include delay in implementing programs as a result of contextual barriers or the lack of infrastructure for dissemination. These challenges emphasize the need for strategies to ensure the successful implementation and dissemination of evidence-based programs for older adults.
Dissemination and implementation science (DIS) provides a broad framework to design interventions and identify implementation strategies that work in diverse real-world clinical and community settings to meet the need of diverse populations. Advancements in research and practice require a basic understanding of (a) principles of DIS; (b) relevant theories, frameworks, and conceptual models; (c) awareness of national and international case examples of chronic disease, falls, and physical activity initiatives for better management of health and functioning in older adults; and (d) shared lessons from research and practice. This lens helps underscore the importance of the evidence-based program movement to the aging services network.
Article
Migrant Health in Refugee Camps: A Neglected Public Health Issue
Manuela Valenti
There are 1 billion migrants in the world today, which means that one in seven of the world’s population are migrants. Of these, 272 million are international migrants and 763 million are internal migrants. It is estimated that around 70 million of the world’s migrants, both internal and international, have been forcibly displaced.
Many things force people to leave their homes in search of a better future: war, poverty, persecution, climate change, desertification, urbanization, globalization, inequality, and lack of job prospects. Migrants remain among the most vulnerable members of society even when their living conditions improve after migration.
Migrant women and children are a particularly vulnerable group and have a great need for basic and preventive health care.
Many refugees and migrants are young and in good health, but hard living conditions and difficulty accessing basic health care can affect their state of health. Many of them face inhuman journeys during migration and live in refugee camps with very low standards of hygiene; when they find a job, they are often exploited. All these things can also affect their mental health.
Migrants struggle with similar challenges as other marginalized groups when it comes to access to health care, but they face the additional barriers of mobility, language barriers, cultural differences, lack of familiarity with local health care services, and limited eligibility for publicly and privately funded health care.
Governments should provide affordable preventive and basic health care to refugees and migrants not only because it is a human right but also because in the long term it can lower the costs of the whole health care system.
Article
Rebooting Education: A Keystone to Ending Racial and Ethnic Minority Health Disparities
William A. Vega and Esther J. Calzada
Undermining educational attainment at any stage is a threat to life course health. A strong educational platform is required for adequate human development in the 21st century because it provides a foundation for lifelong knowledge, skills, and competencies that protect health. The importance of educational attainment for health has been acknowledged but remains understudied as an interdisciplinary issue. In US American society, unequal educational opportunity is a historical reality and is reflected in health disparities among African American and Latinx populations over the life span. Reform efforts have been initiated for decades, yet gains in educational attainment show limited progress and wide disparities in lifetime health persist. Educational attainment is a fundamental social determinant of health because it leverages higher income, improves the management of other social determinants of health, improves social skills, improves occupational life chances, and extends life expectancy. The reverse is also true. Low educational attainment that is intergenerational imperils human development by failing to prepare youth with the capabilities to overcome structural disadvantages and poverty, which themselves imperil development. African American and Latinx populations in the United States, who together represent nearly 100 million people and who will be the largest component of the majority-minority American population by the year 2046, confront a web of aversive social determinants, including poverty in de facto segregated communities, violence and trauma, toxic exposures, poorly compensated and often temporary employment, a lack of universal health insurance, racism, and sexism in their daily lives. Clearly, there are social, biologic, and psychological issues associated with the educational attainment and health gradient, and early childhood learning experiences represent a critically important opportunity for human potential by advancing cognitive performance, problem-solving ability, motivation to learn, and overall structural and functional brain development. Families from low educational attainment backgrounds experience the negative impacts of social determinants in their daily lives, and their children’s life chances are diminished by poorly funded schools with ineffective educational programs. Putative causes and potential responses to overcoming the historical problem of neglect have been identified, and there are promising efforts at educational system reform aiming to promote health with effective programs and comprehensive strategies that will close the gaps in educational attainment.
