1. The Public Health Perspective: The National Diabetes and Women’s Health Action Plan Michelle D. Owens, PhD Centers for Disease Control and Prevention

2. 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: 5 th leading cause of death

3. 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

4. Sedentary Lifestyles and Obesity Lifestyle factors: type 2 diabetes Obesity and weight gain Physical inactivity

5. Sedentary behaviors Public health campaigns to reduce obesity and type 2 diabetes Impact of sedentary behaviors  Television watching and eating behaviors study (Hu, Li, Colditz et al, 2003)  Males: 29 hours per week of television  Females: 34 hours per week

6. Television Watching TV watching: lower metabolic rate Exposure to food advertising Hu study with women:  Assessed average weekly time watching TV  Amount of time on average: physical activity  50,277 women in final analysis

7. 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

8. 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

9. 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

10. 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

11. Diabetes: Priority health issue for DHHS Requires collective energies National Public Health Initiative on Diabetes and Women’s Health

12. 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

13. Phase III

14. 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

15. Public Health Vision Prevent or delay diabetes Provide women support Promote appropriate care Prevent, delay, minimize complications

16. The National Agenda for Public Health Action Collaboration among many partners Mobilizing diverse organizations

17. 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

18. Diabetes and Women’s Health Across the Life Stages

19. 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

20. Challenges: The Reproductive Years Barriers to self-care: impact of multiple roles Limited time for physical activity and healthy eating Weight gain and pregnancy

21. 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

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

23. Strategy Areas of the Action Plan Advocacy and Policy Services and Programs Communication and Education Research and Surveillance

24. Ten Major Steps to Action: The Recommendations 1. Strengthen advocacy 2. Expand community-based health promotion 3. Encourage and support diabetes prevention and control programs 4. Fortify community programs

25. Ten Major Steps to Action: The Recommendations 5. Expand population-based surveillance 6. Educate community leaders 7. Encourage risk assessments, quality care in health care settings 8. Ensure access to quality services

26. Ten Major Steps to Action: The Recommendations 9. Encourage health care coverage 10. Conduct public health research

27. Call to Action Conference: Update October 2003 Call-to-Action Conference  Implementation of National Agenda

28. Implementation Will require multiple partnerships Develop coalitions, ways to collaborate Build upon existing resources Identify gaps

30. American Diabetes Association www.diabetes.orgwww.diabetes.org 800-342-2383 American Public Health Association www.apha.orgwww.apha.org 202-777-2534 Association of State and Territorial Health Officials www.astho.org 202- 371-9090www.astho.org

31. Centers for Disease Control and Prevention/Division of Diabetes Translation Toll-free number: 1-877-CDC-DIAB Internet: www.cdc.gov/diabetes orwww.cdc.gov/diabetes for more information about the Initiative: http://www.cdc.gov/diabetes/projects/wom en.htm http://www.cdc.gov/diabetes/projects/wom en.htm