Abstract
Chronic diseases disproportionately affect ethnic and racial minorities. Pacific Islanders, including the Marshallese, experience some of the highest documented rates of type 2 diabetes. Northwest Arkansas is home to the largest population of Marshallese outside of the Republic of the Marshall Islands, and many migrants are employed by the local poultry industry. This migrant population continues to increase because of climate change, limited health care and educational infrastructure in the Marshall Islands, and the ongoing health effects of US nuclear testing. The US nuclear weapons testing program had extensive social, economic, and ecological consequences for the Marshallese and many of the health disparities they face are related to the nuclear fallout. Beginning in 2013, researchers using a community-based participatory (CBPR) approach began working with the local Marshallese community to address diabetes through the development and implementation of culturally appropriate diabetes self-management education in a family setting. Preliminary research captured numerous and significant environmental barriers that constrain self-management behaviors. At the request of our CBPR stakeholders, researchers have documented the ecological barriers faced by the Marshallese living in Arkansas through a series of qualitative research projects. Using the Social Ecological Model as a framework, this research provides an analysis of Marshallese health that expands the traditional diabetes self-management perspective. Participants identified barriers at the organizational, community, and policy levels that constrain their efforts to achieve diabetes self-management. We offer practice and policy recommendations to address barriers at the community, organizational, and policy level.
Highlights
Chronic diseases, such as heart disease, overweight/obesity, and type 2 diabetes, disproportionately affect ethnic and racial minorities [1,2,3]
Springdale, Arkansas is home to the largest population of Marshallese migrants in the continental United States, and migration from the Republic of the Marshall Islands to the United States continues to grow due to climate change, limited health care and education infrastructure, and ongoing health effects from US nuclear testing in the Republic of the Marshall Islands [7,8]
In order to explain the context of the diabetes epidemic in the Marshallese community, it is important to understand the historical relationship between the Republic of the Marshall Islands and the United States
Summary
Chronic diseases, such as heart disease, overweight/obesity, and type 2 diabetes, disproportionately affect ethnic and racial minorities [1,2,3]. Between 1946 and 1958, the US military detonated 67 fission and thermonuclear devices on Marshall Island atolls, which were equivalent to 7,200 Hiroshima-sized bombs The largest of these detonations–a single 15 megaton hydrogen bomb over 1,000 times the power of the Hiroshima bomb–occurred on Bikini Atoll, exposing Marshallese to widespread radioactive fallout [10,11]. In addition to nuclear testing, a growing body of literature suggests the prolonged and rising rates of obesity and diabetes among Pacific Islander populations are exacerbated by the adoption of Western lifestyles, and a lack of access to health care and to health education [14,15]
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