November marks National Diabetes Month. For most of my career, the better part of 25 years or so, I have worked in programs focused on diabetes prevention and management. This disease is infuriating and no matter how many resources we seem to throw at it, it continues to rage on in our communities. What is most heartbreaking and frustrating about diabetes is how it ravages communities of color. African Americans are 60% more likely to be diagnosed with diabetes and are twice as likely to die from it. In Philadelphia, 17% of adults with diabetes are African American, while overall prevalence is 12% (Health of the City 2020, Department of Public Health, City of Philadelphia). Poor social conditions caused by systemic racism, such as poverty, lack of access to healthy food, and unsafe housing contribute to poorer outcomes.
While many of the programs I have been involved in throughout my career were noble in their efforts to improve prevention and management, they didn’t strike at some of the systemic issues that plague communities and cause diabetes in the first place. For the first time, however, I feel hope that there is a way to combat diabetes. With an “it takes a village approach,” HCIF’s Cities Changing Diabetes – Philadelphia program engages multiple stakeholders in addressing diabetes in innovative ways. What feels palpably different about this program is that it embraces the most vulnerable of communities, including recently incarcerated citizens, individuals living with disabilities, and other overlooked or underserved populations. The authentic engagement of these communities is how we embody our values and commitment to equity. Additionally, the program helps to integrate fundamental social determinants of health issues into diabetes prevention and management.
I have thought a lot about diabetes and equity recently. When you read about healthcare disparities in journal articles, it doesn’t quite hit home until you realize that people who you know are impacted by diabetes due to longstanding inequities. In trying to learn more about diabetes and disparities, I stumbled across the American Diabetes Association website and learned that they recently developed a Health Equity Bill of Rights: https://www.diabetes.org/healthequitynow
One of the rights impacted me the most:
#8: The right to a built environment that does not put you at greater risk for getting diabetes.
This is something that many of us take for granted – access to clean air, clean water, safe places to exercise and play, and access to healthy food. To address these issues, it will take a village to create innovative solutions and a community-based approach. I am comforted that a program like Cities Changing Diabetes exists and am hopeful that in another 25 years when I look back, it will serve as a model for how we can improve outcomes and decrease disparities in chronic conditions in cities across the country.