It’s November, which means it’s not only time to celebrate Thanksgiving but also diabetes awareness. The yearly observance of Diabetes Awareness Month provides a chance to shed light on one of our nation’s most prevalent chronic diseases. While the focus for the month has largely been to bring attention to how to live healthy with diabetes, now more than ever, it should also draw awareness on how a population health approach can reduce its impact.
In recent years, the healthcare community has pushed to shift the focus of the diabetes type 2 conversation away from management and towards prevention through diet and exercise. Just this year, Medicare approved a model that incentivizes providers to help obese, at-risk patients join diabetes prevention programs that teach them to cultivate healthy lifestyles.
As one of the Medicare-approved organizations, YMCA is empowering its locations across the country to take a community-based approach to prevention. In San Antonio, where one in seven adults has been diagnosed with diabetes, the local YMCA has partnered with a city health agency to provide a free, group-based program for both individuals and families to teach how to eat healthy and exercise properly.
Multiple programs, like the one at the YMCA, exist to educate on healthy eating and exercise. But a person’s ability to develop a healthy lifestyle is also largely impacted by the physical environment in which they live. Many people remain vulnerable due to food insecurity or a sedentary lifestyle, or because of the establishments and infrastructure of their neighborhoods. In many areas across the country, a dearth of parks, gyms or safe streets can make physical activity challenging. And in many areas, especially urban and rural low-income areas, obesity rates have risen due to a decline of fresh food options. If people cannot get nutritious food or adequate exercise, then expecting them to develop healthy lifestyles may be unrealistic.
A true population health approach to diabetes prevention has to expand beyond education to meet practical, environmental needs.
In New Orleans, where diabetes is the second leading cause of death after homicide, a $7 million citywide program called the Fresh Food Retailer Initiative (FFRI) was established to address access to healthy options and food insecurity. The program provides loans to finance new supermarkets and full-service grocery stores in underserved communities, known as “food deserts”. Grocers that receive funding are required to dedicate “significant shelf space” to fresh fruits and veggies. By promoting fresh foods and making them more accessible, New Orleans is empowering its residents to live healthier.
On a national scale, The Robert Wood Johnson Foundation uses its Communities Creating Healthy Environments program to empower minority communities, typically at higher-risk for diabetes, to change their own environments from within. Residents have been able to affect more than 70 changes in policy to put fresh food in school lunches, build safe parks and trails, and cut down on pollution.
Making healthy habits feasible for vulnerable populations is the key to sustaining them for more effective diabetes prevention. And empowering them to help themselves is even better. By addressing physical environment and other social determinants of one’s risk for diabetes, we can not only reduce their chances of diagnosis, but improve their overall health.