Through Our Own Lens… Culturally Aware Diabetes Programs Jandel T. Allen-Davis, MD Vice-president, Government, External Relations and Research Kaiser Permanente

Through Our Own Lens…Culturally Aware Diabetes Programs

Jandel T. Allen-Davis, MDVice-president, Government, External Relations and Research

Kaiser Permanente Colorado RegionWomen in Government 18th Annual Western Regional Conference

May 14, 2015

2 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.April 19, 2023

Agenda Slide

Grounding in terms

Diabetes and health equity by the numbers

Obesity and Diabetes: The perfect “tsunami”

Toward a national agenda: “It takes a village.”

Discussion


Diabetes: The opportunity

— Martin Luther King, Jr.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Getting grounded in terms…

Glossary of terms

Determinants of health

Health equity

Health disparities


http://www.communityview.ca/infographic_SHR_health_equity_2014.html


Health disparities: The numbers





Diabetes and health inequities…


Diabetes: The facts

There is an emerging global epidemic of diabetes that can be traced back to rapid increases in overweight, obesity and physical inactivity.

Total deaths from diabetes… Type 2 diabetes is much more common than type 1 diabetes… Reports of type 2 diabetes in children … In 2005, 1.1 million people died from diabetes. 80% of diabetes deaths are now occurring in low- and middle-income countries. Lack of awareness …can lead to complications such as blindness, amputation and kidney

failure. Diabetes can be prevented.

http://www.who.int/features/factfiles/diabetes/10_en.html


Diabetes: The facts

Prevalence: In 2012, 29.1 million Americans, or 9.3% of the population Undiagnosed: Of the 29.1 million, 21.0 million were diagnosed, and 8.1 million were

undiagnosed. Prevalence in Seniors: The percentage of Americans age 65 and older remains high, at

25.9%, or 11.8 million seniors (diagnosed and undiagnosed). New Cases: The incidence of diabetes in 2012 was 1.7 million new diagnoses/year; in 2010 it

was 1.9 million. Prediabetes: In 2012, 86 million Americans age 20 and older had prediabetes, a condition in

which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with prediabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke; this is up from 79 million in 2010.

Deaths: Diabetes remains the 7th leading cause of death in the United States in 2010, with 69,071 death certificates listing it as the underlying cause of death, and a total of 234,051 death certificates listing diabetes as an underlying or contributing cause of death.

» http://www.who.int/features/factfiles/diabetes/10_en.html


Diabetes: The risk factors

Modifiable

– Weight

– Fat distribution

– Inactivity

– Weight

– Age

– Pre-diabetes

– Gestational Diabetes

– Polycystic Ovary

Non-modifiable

– Age

– Race and ethnicity– Gender

– Family History

Through our lens…


The obesity connection…yet another perfect tsunami



Prevalence of Self-Reported Obesity Among Whites, Blacks and Hispanics, BRFSS, 2011-2013

Non-Hispanic Whites

Non-Hispanic Blacks

Hispanics

The convergence of many factors and the epidemic of diabetes in vulnerable populations

Fetal and maternal explanations The thrifty genotype The nutritional transition The health impact of urbanization and immigration Social attributions and cultural perceptions of increased weight The impact of globalization on nutrition


Obesity and Diabetes in Vulnerable Populations: Reflection on Proximal and Distal CausesLucy M. Candib, MD

Ann Fam Med. 2007 Nov; 5(6): 547–556.

Toward a national agenda: “It takes a village.”


Recommendations

Awareness Leadership Health System

Meet people where they are: culture is just as local as politics!

The enormity of the issue(s) cannot be underestimated and are largely unknown to many sectors, including the communities

“Health in All Policies”

Community grass roots leadership essential: coalitions

There is strength in P3!

The System: opportunities for cross collaboration

Medical education: demonstrate cultural “proficiency”

Address social determinants (Clinic Community Integration

Health access is still an issue (and will be)


Recommendations

Cultural Competency

Growing in importance as demographics evolve

Behavioral, social, financial and clinical implications

Data, Research and Evaluation

Effectiveness: Know what works, share it

The Scale Challenge: From Pilots to Programs

Join and create opportunities for shared learning

Health System

A word about implicit bias

Workforce challenges: concordance drives adherence


Recommendations

Community

Leverage assets

Provide time, talent, treasure and testimony as resources

Identify the “truth tellers”

Get as “upstream: as possible

Health System


Getting upstream from health care: The opportunity

There are five issues that make a fist of a hand that can knock America out cold. They're lack

of jobs, obesity, diabetes, homelessness, and lack of

good education.

will.i.am

Documents

Through Our Own Lens… Culturally Aware Diabetes Programs Jandel T. Allen-Davis, MD Vice-president, Government, External Relations and Research Kaiser Permanente