Diabetes prevalence is higher along U.S.-Mexico border than in nonborder regions, and numerous community-based organizations are addressing this diabetes disparity through prevention and management programs. However, the nature, scope, and effectiveness of these efforts and programs are not well documented. This study aims at identifying key characteristics of diabetes programs in a Texas-Mexico border region with a predominately Hispanic, underserved population. A survey is administered to 84 community-based organizations in the Lower Rio Grande Valley (LRGV); 25 organizations respond. Nineteen programs related to diabetes and healthy lifestyle behaviors are identified in the LRGV. The majority of the programs are based on guidelines of national and state professional associations and agencies; target low-income and minority populations; are offered at no cost; and include program evaluation activities. Future research should examine the effectiveness, as well as the fidelity of the guidelines, of diabetes programs in the border region.
We consider the ethical aspects of the relationship of the psychiatrist to the community. We initially use the framework of a “social contract” to explore psychiatrists’ and communities’ reciprocal expectations for one another. We then argue that the concept of an “alliance” between the psychiatrist and community provides a more accurate, productive lens for psychiatrists to advocate and change in their communities. We apply this framework to the following ethical challenges that may arise when psychiatrists become active in their communities: (1) disagreements with allies about public policy; (2) difficulties separating professional expertise and personal values; (3) boundary tensions arising from patient contact outside the usual framework of treatment; and (4) the loss of the psychiatrist’s monopoly on cultural authority.
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