Volume 31 Number 2 |
Spring 2010 |
Theme Editor's Message |
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Diabetes and Tough Economic Times Susan Yake, RD, CD, CDE, CLC Changes in the economy hit everyone. Our patients face the difficulties of managing a chronic disease with fewer resources, particularly less money and less health insurance. As registered dietitians we are practiced in connecting patients with appropriate help. But are we equipped to face the really tough times? Do we have resources for those who have lost jobs, lost health insurance, or lost homes? How do we handle the stress of our own job insecurity? The economic outlook appears grim. Unemployed Americans reached 15.3 million in December 2009 with an unemployment rate of 10% (1). Since the recession started in December of 2007, unemployment has risen by 7.6 million and its rate has doubled. Nearly 46 million Americans are currently without health insurance (2). About one out of every six U.S. residents under age 65 is uninsured for health care. During the last decade, the cost per person of health care has risen over 40 percent. The National Coalition on Health Care estimates that nearly seven million Americans will lose their health insurance coverage during 2009 and 2010 (3). The number of people covered by private insurance is decreasing; both Medicaid and Medicare increased enrollment by 14% between 2007 and 2008 (4). In 2008, 7.3 million or 9.9% of children were uninsured with 15.7% of children in poverty uninsured (4). The Hispanic population is the most likely to be uninsured. In 2008, over 30% of Hispanics (14.6 million) were not covered by medical insurance; 10.8% (21.3 million) of non-Hispanic Whites and 19% (7.3 million) Blacks were uninsured (4). This issue of On the Cutting Edge explores the challenges we are facing in these tough economic times. We begin probing these challenges with an interview with Richard LeMieux who went from wealthy to homeless quite unexpectedly. He opens our eyes to that misunderstood world and provides us with tips on helping the homeless. Cotton Sarjahani, RD, tackles the challenge of getting nutritious food to all populations. Hailing back to the early “victory gardens,” he introduces us to the concept of “civic dietetics” and provokes us to think “outside the box” in our dietetic practices. Our patients cannot learn to eat well to manage their diabetes if they do not have access to food. Kaitlin Hammond, RD, walks us through the programs that are available to help people get enough to eat. Cathy Franklin, MS, RD, explains the changes that have occurred in the Women, Infants and Children Program so that we can help our clients utilize this resource. Before we can connect our patients to the appropriate resources, we need to know if our patients are struggling with poverty. But, how do we ask them? Gail Brandt, EdD, RD, provides us with helpful interviewing techniques to elicit appropriate information from patients without embarrassing them. Patti Geil, MS, RD, FADA, CDE and Tami Ross, RD, CDE, have created a ready-to-copy patient handout to help guide our patients to eat healthy on a lean budget. Schools also face difficulties in economic downturns and students often need our help in eating healthfully and managing a chronic disease. Dora Rivas, MS, RD, SNS, discusses the achievements of one school district in Texas in meeting special dietary needs of students. She offers suggestions for working with school districts to ensure that the nutritional and special dietary needs of students with diabetes can be met. Virginia O’Kelly, RD, CDE shares her experience working in a federally qualified health center that serves primarily low-income Caucasians and Spanish-speaking Hispanic farm workers. Jeffrey Walker, PharmD Candidate, and Michael Fischer, Dietetic Intern, have provided concise information on patient assistance programs that are currently available. Sandra Parker, RD, CDE, and Julia Walters, RD, CDE, graciously share their story of how the economy took away their dream jobs and what they did to recover. We hope that this issue will provide you with tools and resources to enhance your practice as well as increase your awareness of new career opportunities. The theme team for this issue included Johanna Dwyer, DSc, RD, Jan Norman, RD, CDE, Kelly D. Horton, MS, RD, CD, OTCE Editor Nell Stuart, MS, RD, LD, CDE, and OTCE Associate Editor Elizabeth Quintana, EdD, RD, LD, CDE. I would also like to acknowledge the Hunger and Environmental Nutrition (HEN) Dietetic Practice Group for their outstanding contribution to this issue of OTCE. Kelly D. Horton, the current HEN Chair, provided creative inspiration and guidance throughout the whole process; HEN members Cotton Sarjahani, RD and Kaitlin Hammond, RD, contributed articles; and Alison Harmon, PhD, RD, LD, Kim Prendergast, MPP, RD, and Caroline Webber, PhD, RD, served as reviewers. I wish to give a special thanks also to Johanni Burani, MS, RD, CDE for not only helping us to review but also serving as a mentor. References
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