1. Through Our Own Lens… Culturally Aware Diabetes Programs Jandel T. Allen-Davis, MD Vice-president, Government, External Relations and Research Kaiser Permanente Colorado Region Women in Government 18 th Annual Western Regional Conference May 14, 2015

2. 2| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 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

3. 3| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 Diabetes: The opportunity — Martin Luther King, Jr.  “ Of all the forms of inequality, injustice in health care is the most shocking and inhumane. ”

4. Getting grounded in terms…

5. Glossary of terms  Determinants of health  Health equity  Health disparities 5| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 http://www.communityview.ca/infographic_SHR_health_equity_2014.html

6. 6| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 Health disparities: The numbers

7. 7| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 Health disparities: The numbers

8. 8| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 Health disparities: The numbers

9. Diabetes and health inequities…

10. 10| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 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

11. 11| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 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 7 th 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

12. 12| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 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

13. Through our lens… 13| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015

14. The obesity connection…yet another perfect tsunami

15. 15| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015

16. 16| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 Prevalence of Self-Reported Obesity Among Whites, Blacks and Hispanics, BRFSS, 2011-2013 Non-Hispanic Whites Non-Hispanic Blacks Hispanics

17. 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 17| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 Obesity and Diabetes in Vulnerable Populations: Reflection on Proximal and Distal Causes Lucy M. CandibLucy M. Candib, MD Ann Fam Med. 2007 Nov; 5(6): 547–556.

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

19. 19| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 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)

20. 20| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 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

21. 21| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 Recommendations Community  Leverage assets  Provide time, talent, treasure and testimony as resources  Identify the “truth tellers”  Get as “upstream: as possible Health System

22. 22| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.September 5, 2015 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