REACH 2010 Seattle & King County Cheza Collier, PhD, MPH, MSW Public Health - Seattle & King County University of Washington School of Public Health and Community Medicine, Social and Behavioral Sciences Program (January 2004)

Acknowledgment Mike Smyser, MS, Epidemiologist Epidemiology, Planning & Evaluation Public Health – Seattle & King County

OBJECTIVES  Review diabetes disparity information  Learn the six health priority areas targeted by REACH  Learn the primary Seattle & King County REACH community interventions.

Definition of Health Disparities  Health Disparities describe the disproportionate burden of disease, disability and death among a particular population or group when compared to the proportion of the entire population.  Source:Washington State Board of Health

NATIONAL HEALTH DISPARITIES DATA  Disease Prevalence, Compared to White Americans or to Average Rate: –Diabetes: Nearly 3 times higher among Native Americans than the average rate; 70% higher among African Americans

Persons with diabetes and end-stage renal disease, United States Year 2010 target 78 per 1 million persons

Lower extremity amputations in persons with diabetes (age adjusted to the year 2000 standard population), United States

WASHINGTON STATE DIABETES DEATH RATES BY RACE AND AGE Rates are per 100,000 population Source: Washington Center for Health Statistics

KING COUNTY DIABETES DEATH RATES BY RACE AND GENDER

Eliminating Health Disparities What will it Take? Access to Health Services Economic Opportunity and Equity Reduced Stress due to Social Factors Mental Health and Social Support Trust in Health System and Research Educational Opportunity Respect for Language and Other Cultural Factors Lower Environmental Risks Freedom from Discrimination Promotion of Healthy Behaviors

REACH 2010 Racial and Ethnic Approaches to Community Health –National Goal: By the year 2010, eliminate disparities in health status experienced by racial and ethnic minority populations –Funding through the Centers for Disease Control and Prevention

6 REACH PRIORITY AREAS  Cardiovascular Health  HIV/AIDS  Immunizations  Infant Mortality  Breast and Cervical Health  Diabetes 25 REACH 2010 Communities Nationally

REACH 2010 SEATTLE & KING COUNTY  MISSION –“The mission of the REACH Coalition is to reduce diabetes health disparities experienced by communities of color. Through strong partnerships, we will support the empowerment of individuals, families, and communities, and create sustainable long-term approaches to prevention and control of diabetes utilizing all appropriate community resources in King County.”

MULTIPLE CULTURES WORKING TOGETHER TO REACH FOR HEALTH REACH COALITION African American Asian American/ Pacific Islander American Latino/Hispanic European American

LOCAL REACH HISTORY  PHASE I ACTIVITIES  –Coalition Development –Community Assessment –Community Action Plan

REACH PHASE II  (and beyond?)  Continued Coalition Development  Implementation of Community Action Plan (CAP)  Evaluation, Feedback, Revisions and Reporting

REACH COALITION DEVELOPMENT  Multi-Cultural Focus  Attention to membership – over 70 agencies and individuals  Training  Bi-Monthly meetings  Coalition Structure

Coalition Challenges and Solutions  Multiple Cultures and Languages  Differences of Opinion  Distribution of Funds  Authority Hierarchy  7 Languages, Hire Bilingual/Bicultural Staff, Listen and Learn  Consensus Decision Making; Bring Concerns back to the Coalition - (Ops)  Coalition Selection Committee  Process Discussion; Take Backseat

REACH STAFFING  REACH Coalition Members  Principal Investigator (PI)  Program Manager  Community Liaisons  Peer Educators  Evaluation Manager  Evaluator Interviewers  Researchers  Case Coordinators  Administrators and Administrative Support  Expert presenters and Interpreters

COMMUNITY ACTION PLAN ELEMENTS  Interventions conducted by sub- contracting community agencies  Support Groups  Education Classes  Self Management Classes  Enhanced Diabetes Registry use  Case Coordination  Community Campaigns  Evaluation

SUPPORT GROUPS  Emotional Support  Shared Experiences  Shared Resources  Dealing with discrimination  Tips for talking about diabetes –family –providers –friends –each other

EDUCATION CLASSES  Physical Activity  Nutrition  Marketing  Weight Management  Glucose testing  Other topics

SELF MANAGEMENT CLASSES  Self care focus  Increasing self-efficacy  Increasing provider- patient communication by patient initiative

ENHANCED DIABETES REGISTRY USE  Tracking of –HbA1c –blood pressure –eye exams –foot exams –urine tests –referrals

CASE COORDINATION  Complete diabetes registry  Communicate with providers  Communicate with patients about recommended procedures for them  Refer patients to community activities and resources

COMMUNITY INTERVENTIONS  Grocery Stores  Restaurants  Faith Settings  Pharmacies  Work Sites  Media

EVALUATION  Coalition Member Interviews  Participant Surveys  Focus Groups  Key Informant Interviews  Community Documentation

REACH CULTURAL COMPETENCE  Coalition Membership  Staffing  Listening to Participants  Language Capacity  Literature and Training  Community Feedback

REACH LIMITATIONS  Only King County  Only Diabetes  Native Americans Not Participating  Limited Language Capacity  Limited Geographic Scope

SUSTAINABILITY  Integrate activities into existing service system –Registry –Groups and Classes  Train peer educators and encourage continued work  Community network establishment  Seek additional funding  REACH may be instituted as ongoing CDC program

HOPES AND PLANS  Focus on Healthy Families/Healthy Communities  Continue Diabetes Work  Expand to Other Chronic Disease Prevention, Environment Focus  Convince Funding Agencies and Policy Makers to Support Efforts  Reduce/Eliminate Health Disparities Over Time

AVOID COMPLICATIONS Neuropathy / Amputations Kidney Disease / Renal Failure Heart Disease Blindness

ELIMINATE RACIAL/ETHNIC DIABETES HEALTH DISPARITIES INCREASE HEALTH AND WELL BEING

WHAT MIGHT YOU DO TO INCREASE YOUR CULTURAL COMPETENCE AND HELP TO ELIMINATE HEALTH DISPARITIES?  Open your empathetic heart to humans of other hues  Recognize power differences and how they affect you  Learn what your own biases are and channel them in a positive direction  Discuss racism with friends/family, & how to prevent discrimination  Speak out against discrimination when you see it  Make your health/wellness practice one that welcomes all and/or targets the disenfranchised  Join a local coalition or community group with relevant goals  Be willing to learn