The Public Health Perspective: The National Diabetes and Women’s Health Action Plan

Michelle D. Owens, PhDCenters for Disease Control

and Prevention

Obesity and Diabetes Epidemic

Obesity and diabetes: major causes of morbidity and mortality

Association with diabetes 300,000 adults die of obesity-related

causes Diabetes: 5th leading cause of death

Risk Factors for Diabetes and its Complications Living in poverty Working in small companies with few

benefits Being uninsured; lacking access to care Being overweight and not exercising

Sedentary Lifestyles and Obesity

Lifestyle factors: type 2 diabetes Obesity and weight gain Physical inactivity

Sedentary behaviors

Public health campaigns to reduce obesity and type 2 diabetes

Impact of sedentary behaviorsTelevision watching and eating behaviors

study (Hu, Li, Colditz et al, 2003)Males: 29 hours per week of televisionFemales: 34 hours per week

Television Watching

TV watching: lower metabolic rate Exposure to food advertising Hu study with women:

Assessed average weekly time watching TVAmount of time on average: physical activity50,277 women in final analysis

Hu study results

Women and watching tv: more likely to smoke, drink alcohol, and less likely to exercise

Higher intake of total energy, total saturated fats

Lower intakes of fish, vegetables

Hu Study Results 6 years follow-up: 3,757 women became

obese Association between tv watching and obesity 1,515 newly diagnosed cases of type 2

diabetes Association between time spent watching tv

and risk for type 2 diabetes

Hu Study Results

30% of obesity cases and 43% of type 2 diabetes cases can be prevented

Concerns with tv watching and risk of obesity and type 2 diabetes

Diabetes Prevention Program Study (DPP) Diabetes Prevention Program supports Hu

study findings Diet, exercise, and behavior modification

reduce risk of developing type 2 diabetes Lifestyle intervention group Impact on participants 60 and older Metformin-only group

Diabetes: Priority health issue for DHHS

Requires collective energies

National Public Health Initiative on Diabetes and Women’s Health

The National Public Health Initiative on Diabetes and Women’s Health

Phase 1: Assessment: Diabetes and Women’s Health Across the Lifestages

Phase 2: Proposed Recommendations for Action

Phase 3: Implementation of the National Agenda for Public Health Action

Phase III

Diabetes and Women Initiative Sponsored by

American Diabetes Association

American Public Health Association

Association of State and Territorial Health Officials

Centers for Disease Control and Prevention

Public Health Vision

Prevent or delay diabetes Provide women support Promote appropriate care Prevent, delay, minimize

complications

The National Agenda for Public Health Action

Collaboration among many partners

Mobilizing diverse organizations

Goals of the Initiative Garner attention of multiple sectors of

society Develop priority strategies, policies, and

research Unite partners for diabetes prevention and

control Empower women to adopt prevention

strategies

Diabetes and Women’s Health

Across the Life Stages

Challenges: The Adolescent Years

Lack of diabetes education/prevention materials

Lack of awareness of need for weight control

Plethora of fast food options Insufficient recreational activities

Challenges: The Reproductive Years

Barriers to self-care: impact of multiple roles

Limited time for physical activity and healthy eating

Weight gain and pregnancy

Challenges: The Middle Years Challenges are similar to those

experienced in the reproductive years

Needs of children, grandchildren, and aging parents may influence self-care

Challenges:The Older Years Vulnerability to other chronic illnesses Disability Poverty Depression Urinary incontinence Injurious falls Pain

Strategy Areas of the Action Plan Advocacy and Policy

Services and Programs

Communication and Education

Research and Surveillance

Ten Major Steps to Action: The Recommendations1. Strengthen advocacy2. Expand community-based health promotion3. Encourage and support diabetes prevention

and control programs4. Fortify community programs

Ten Major Steps to Action: The Recommendations5. Expand population-based surveillance6. Educate community leaders7. Encourage risk assessments, quality

care in health care settings8. Ensure access to quality services

Ten Major Steps to Action: The Recommendations

9. Encourage health care coverage10. Conduct public health research

Call to Action Conference: Update

October 2003 Call-to-Action Conference Implementation of National Agenda

Implementation Will require multiple partnerships

Develop coalitions, ways to collaborate

Build upon existing resources

Identify gaps

American Diabetes Associationwww.diabetes.org 800-342-2383

American Public Health Associationwww.apha.org 202-777-2534

Association of State and Territorial Health Officials www.astho.org 202- 371-9090

Centers for Disease Control and Prevention/Division of Diabetes Translation Toll-free number: 1-877-CDC-DIAB

Internet: www.cdc.gov/diabetes or for more information about the Initiative:

http://www.cdc.gov/diabetes/projects/women.htm