Diabetes among Palestinians in Israel: Reducing diabetes inequalities through community action research

Rates of type 2 diabetes (hereafter diabetes) are increasing worldwide, both in industrialized and industrializing economies. Diabetes spares no social group, yet disproportionately affects minorities and the poor, who also have limited access to healthcare services, thus higher prevalence of diabetes complications. Such is the case of Palestinians in Israel. Studies show that the prevalence of diabetes in the age range 25-64 is 1.5 times higher among Arabs than among Jews, complications 2.6 times more common, and diabetes-related deaths 1.5 higher among the former than among the latter.

Our project seeks to improve diabetes care and reduce the incidence of complications in the Palestinian population of Arraba, a major historical city in the Galilee, where over 50% of the families live in poverty. Preliminary assessments indicated that among 550 patients using the diabetes care services of a local non-profit, Al-Taj for Health and Heritage, 38.7% had an HbA1C greater than 9% (compared to a national average of 18% of patients with such values). The specific goal of our study is to achieve a 25% reduction of HB A1C levels over a six month period in a randomized patient sample with an Hb A1C of over 9%.

To this effect, we are implementing a community-based diabetes care/education program that emphasizes diabetes self-management and patient empowerment. The program is being developed collaboratively between American researchers and the above mentioned NGO, and includes the production of culturally appropriate educational material, patient education workshops, diabetes support groups, home visitations, and regular clinical checkups.