An Early Warning Sign: Diabetes Deaths in California Legislative In Assembly Districts, diabetes death rates adjusted for age …
an early warning sign
Diabetes Deaths in California Legislative Districts
WHAT
An Early Warning Sign: Diabetes Deaths in California Legislative Districts 2004 examined diabetes death rates by both California Senate and Assembly Districts
fact
SHEET
key findings
There is considerable variation in diabetes death rates between legislative districts, and districts that have higher diabetes death rates also tend to have higher prevalence of overweight and unfit children Legislative districts in three regions — Los Angeles County, the Central Valley, and southwest San Bernardino County — have the highest diabetes death rates Three racial/ethnic groups — African Americans, Latinos and American Indians/ Alaska Natives– have the highest burden of diabetes deaths Diabetes death rates are increasing
WHY
The study suggests that environments may be as significant in predicting susceptibility to chronic diseases as personal health choices and behaviors Unless something is done to fundamentally improve community environments, California families and businesses will face unparalleled increases in human suffering and costs related to increasing rates of diabetes
WHEN
This report is
based on data from the California Multiple Cause of Death Files for the five-year period between 1996 and 2000 The data was analyzed in 2003 and released in February 2004
HOW
The California Center for Public Health Advocacy utilized data derived from the California Multiple Cause of Death Files from 1996 to 2000 Dr Chi Kao of the University of California, San Francisco, San Franciscos Institute for Health Policy Studies, and Richard Cohen of the Public Health Institute conducted data management and analysis Deaths for which diabetes was reported as either the underlying cause or as one of multiple causes were included in the analysis The CCPHA correlated the findings from this analysis with the findings from their previous reports on the prevalence of overweight and unfit children by state legislative district
WHO
The study was conducted by the California Center for Public Health Advocacy, with funding from The Robert Wood Johnson Foundation
an early warning sign
Diabetes Deaths in California Legislative Districts
Diabetes death rates are strongly correlated with the prevalence of overweight and unfit children in legislative districts
In both Assembly Districts r075, p00001 and
Senate Districts r073, p00001 diabetes death rates and the prevalence of overweight children were positively correlated In both Assembly Districts r068, p00001 and Senate Districts r064, p00001 diabetes death rates and the prevalence of unfit children were positively correlated
key findings
Findings by race — three racial/ethnic groups — African Americans, Latinos and American Indians/Alaska Natives — have the highest burden of diabetes deaths
African Americans have the highest death rate for all ethnic groups in 95 of Assembly Districts and 100 of Senate Districts Latinos have a higher death rate than Whites in 69 of Assembly Districts and 75 of Senate Districts, and a higher rate than Asians/Pacific Islanders in 85 of Assembly Districts and 95 of Senate Districts Statewide, American Indians/Alaska Natives, African Americans Latinos also have the youngest average age of death due to diabetes American Indians/Alaska Natives die from the disease an average of 64 years younger than Whites, while African Americans die an average of 55 years younger, and Latinos die an average of 45 years younger than Whites However, even for a given racial/ethnic group, there are differences in
diabetes-related death rates across legislative districts that cannot be attributed to age differences For example, Whites have the largest proportional variation in age-adjusted diabetes death rates between Assembly Districts, ranging from 382 to 1614 per 100,000–more than a four-fold difference Other ethnic groups have at least a two-fold variation between the legislative district, with the highest rate and the district with the lowest rate
There is considerable variation in diabetes death rates throughout California that cannot be attributed to age and racial/ethnic differences between legislative districts
In Assembly Districts, diabetes death rates adjusted for age and race/ethnicity range from 406 per 100,000 to 1584 per 100,000–nearly a four-fold difference In Senate Districts, age- and race-adjusted diabetes-related death rates range from 525 per 100,000 to 1402 per 100,000–nearly a three-fold difference
Legislative districts in three regions — Los Angeles County, the Central Valley, and southwest San Bernardino County — have the highest diabetes death rates
ANGELES COUNTY LOS ANGELES COUNTY has 10 of the 16 Assembly Districts with the highest rates, and three of the
eight Senate Districts with the highest rates CENTRAL VALLEY THE CENTRAL VALLEY has three of the 16 Assembly Districts with the highest rates, and three of the eight Senate Districts with the highest rates SAN BERNARDINO COUNTY SOUTHWEST SAN BERNARDINO COUNTY has three of the 16 Assembly Districts with the highest rates, and two of the eight Senate Districts with the highest rates
Diabetes death rates are increasing Over the fiveyear period under study, the age- and race/ ethnicity-adjusted death rate due to diabetes rose annually, from 790 per 100,000 in 1996 to 836 deaths per 100,000 in 2000, an increase of 58 percent
an early warning sign
Diabetes Deaths in California Legislative Districts
The diabetes epidemic will not be solved by calling for individual behavior change alone Instead, policymakers must address the community and environmental factors that perpetuate it Policies must be established that employ the following strategies to reduce diabetes-related deaths in California:
keyrecommendations
SPECIFIC RECOMMENDATIONS INCLUDE: Every legislator should convene a district forum to address the epidemics of diabetes and obesity locally Educate health care providers
about diabetes primary prevention and clinical management practices proven to be successful with individuals at high risk for diabetes Develop and implement a coordinated statewide plan for simultaneously addressing the epidemics of diabetes and overweight/obesity Improve access to health care in order to prevent, delay, manage and treat diabetes Improve school environments: o Implement SB 19 nutrition standards in grades K-12 o Enforce state law mandating 200-400 minutes of physical education every 10 days in grades 1 12 o Utilize in-service funds to train teachers in physical education Improve community environments: o Require chain restaurants to provide nutrition information on display boards and menus o Design communities in ways that promote healthy eating and physical activity o Restrict marketing and advertising of unhealthful foods and beverages to children o Establish zoning regulations that prohibit the sale of unhealthful food near schools Conduct research to determine the specific conditions in communities that contribute to high diabetes-related death rates and high percentages of overweight and unfit children Retain the diabetes-related benefits currently provided
by public and private health insurance plans
Prevent and delay diabetes, and ensure access to health care to prevent, treat, and manage the disease Create healthy nutrition and physical activity environments Place special emphasis on racial/ethnic and geographic communities experiencing the greatest burden of disease
an early warning sign
Diabetes Deaths in California Legislative Districts
study
spokespersons
list
regional
development
spokespersons
Harold Goldstein, DrPH Executive Director California Center for Public Health Advocacy 5302976000 hg@publichealthadvocacyorg Daniel Hackman Policy Analyst California Center for Public Health Advocacy 5302976000 dh@publichealthadvocacyorg Stefan Harvey Assistant Director California Center for Public Health Advocacy 5302976000 sh@publichealthadvocacyorg Sarah Samuels, DrPH President Samuels and Associates 5102716799 sarah@samuelsandassociatescom
SACRAMENTO COUNTY
MELISSA GUAJARDO Nutrition Project Coordinator Health Education Council 9165563348
BAY AREA
TRESS STEWART Public Health Nurse Southeast Health Center, San Francisco City Health Department 4156717039
CENTRAL VALLEY
DR ED MORENO Director Fresno County Health
Department 5594453202 edmoreno@cofresnocaus DR PHYLLIS PRECIADO Faculty Research Fellow Latino Center for Medical Education and Research, UCSF-Fresno 5592416575
state diabetes
spokespersons
DR ANN ALBRIGHT Chief Diabetes Prevention and Control Program, California Department of Health Services 9164254081 cell aalbrigh@dhscagov aalbright2@osophsdhhsgov DR FRANCINE KAUFMAN Head of the Center for Diabetes, Endocrinology Metabolism, Childrens Hospital of Los Angeles; Past President, American Diabetes Association 3236694606 3107012780 cell fkaufman@chlauscedu
SANTA BARBARA COUNTY
SUSAN KLUCKER Public Health Nutritionist Santa Barbara County Project LEAN 8053468456 sklucke@cosanta-barbaracaus
an early warning sign
Diabetes Deaths in California Legislative Districts
regional
spokespersons
list
SAN BERNARDINO COUNTY
ELAINE MCFADDEN Public Health Nutritionist San Bernardino Health Department 9096484234 cell sem7419@yahoocom SONIA VEGA Public Health Nutritionist San Bernardino Health Department 9093879193 svega@dphsbcountygov
spokespersons
LOS ANGELES COUNTY
JACQUELINE DOMAC Teacher Los Angeles Unified School District 3107137070 ihearrain@aolcom JEANETTE FLORES Team Leader: 57th
Assembly District California Center for Public Health Advocacy 6268516365 6263478397 cell jeanettevflores@kporg MARIANNE FOUST Team Leader: 54th Assembly District California Center for Public Health Advocacy 5624308754 7149436849 cell mfoust@socalrrcom DR BILL RELEFORD Founder Diabetes Amputation Prevention Foundation 3104120183 breleford@aolcom ROSA SOTO Regional Director California Center for Public Health Advocacy 6269611179 6266887468 cell ccphasoto@earthlinknet
SAN DIEGO COUNTY
NAOMI BUTLER Food on the Run Coordinator San Diego County Project LEAN 7605051831 7607441831 cell naomib@coxnet CHRIS WALKER Director Clinical and Community Programs, Whittier Institute for Diabetes and Endocrinology and Project Dulce 7604453774 cell walkerchris@scrippshealthorg
Bilingual Spanish If you would like to contact your local legislators, you can locate their contact information for both their Sacramento and district offices via the link below For Senators, use the first link; for Assembly Persons, the second link http://wwwsencagov/newsen/senators/rosterhtp http://wwwassemblycagov/acs/acsframeset7htm
ORANGE COUNTY
DR AMERICA BRACHO President and CEO Latino Health Access 7142738013 cell
7145427792 americab@latinohealthaccessorg tish1@latinohealthaccessorg
an early warning sign
Diabetes Deaths in California Legislative Districts
WHAT IS DIABETES?
Diabetes is characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both Diabetes manifests itself in two forms, known as Type 1 and Type 2 diabetes; neither can be cured
diabetesfact
SHEET
types of diabetes
TYPE 1 DIABETES:
may account for 5 to 10 percent of all diagnosed cases of diabetes usually strikes children and young adults, who need several injections a day or an insulin pump to 
survive previously called insulin-dependent diabetes mellitus IDDM or juvenile-onset diabetes
TYPE 2 DIABETES:
may account for about 90 to 95 percent of all diagnosed cases of diabetes increasingly being diagnosed in children and adolescents is largely preventable or can be delayed risk factors include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity African Americans, Latinos, American Indians/ Alaska Natives, and some Asian Americans and Pacific Islanders are at a
particularly high risk for Type 2 diabetes previously called non-insulin-dependent diabetes mellitus NIDDM or adult-onset diabetes
an early warning sign: Diabetes Deaths in California Legislative Districts
diabetes
132 BILLION
Estimated cost in the United States of direct medical and indirect expenditures attributable to diabetes in 20021
by the
NUMBERS
18 MILLION
Number of adults in California not diagnosed with diabetes 82 who are at significant risk for developing diabetes because they are sedentary in conjunction with being overweight or obese5
40 BILLION
Estimated economic loss to the US economy in 2002 due to the higher rates of lost work time, disability, and premature mortality associated with diabetes1
100
20
Projected percentage increase, nationally, in the number of Latinos and other minority populations diagnosed with diabetes between 2002 and 20201
Amount per dollar spent in the US on health care for people with diabetes this includes costs attributable to diabetes as well as non-diabetes-related costs1
50
24
Projected percentage increase, nationally, in the number of African Americans diagnosed with diabetes between 2002 and 20201
Number of times
greater medical expenditures in the US are for those with diabetes than for those without, after adjusting for differences in age, sex, and race/ethnicity1
27
213,062
Projected percentage increase, nationally, in the number of Whites diagnosed with diabetes between 2002 and 20201
Estimated number of deaths attributable to diabetes in the US in 20032
51
19
Number of times more likely American adults with diabetes aged 35 64 years were to report a history of coronary heart disease during 1999 2001 than those without the disease6
Estimated percentage of all deaths in the US for which cardiovascular disease is listed as the primary cause of death attributed to diabetes1
49 24 31
times more likely to report a history of stroke6 times more likely to report another heart condition6 times more likely to report at least one of these conditions than adults of similar age without diabetes6
2
Number of times greater the risk of death is for people in the US with diabetes than for those without the disease3
60
Percent of nontraumatic lower-limb amputations in the US that occur among people with diabetes3
67
33
Percentage of boys born in 2000 who will develop diabetes if
current trends continue7
Percent increase in diabetes among Californians between 1990 and 19984
1 MILLION
39
Percentage of girls born in 2000 who will develop diabetes if current trends continue 7
Number of people in the US, aged 20 years and older, diagnosed with diabetes each year3
American Diabetes Association: Economic Costs of Diabetes in the US in 2002 Diabetes Care 26:917-932, 2003 [Abstract] Center for Disease Control: National Diabetes Fact Sheet 2003 American Diabetes Association: National Diabetes Fact Sheet 4 Mokdad, AH, et al, Diabetes Care 2000; 239: 1278-1283 5 Diabetes in California: Findings from the 2001 Health Interview Survey 6 From the Center for Disease Controls Morbidity and Mortality Weekly Report, November 7, 2003/Vol 52/No 44 Self-Reported Heart Disease and Stroke Among Adults With and Without Diabetes United States, 1999 - 2001 7 Narayan, KM, et al, JAMA 2003; 29014: 1884-1890
2 3
1
an early warning sign: Diabetes Deaths in California Legislative Districts
Shaping Community Environments
100
Percent increase in obesity rates in adults over the last twenty years1
at the
a look NUMBERS
70
65
Percent of American adults who are overweight or
obese1
Percent increase over the last two decades of meals and snacks from restaurants and other food-service establishments from 16 of meals and snacks in 1978 to 27 in 19953
226
Number of times more supermarkets per capita in middle- and upper-income neighborhoods than in low-income neighborhoods4
200
Percent increase in obesity rates in teens over the past two decades2
26
Percent of their food dollars Americans spent on restaurant meals and other foods prepared outside their home in 19703
95
Percentage of California schools that sell fast foods5
26 Billion
Amount spent on food advertising promotional expeditures in 20006
46
Percent of food dollars spent on awayfrom-home foods in the US today3
1 Billion
Amount spent on television advertising aimed at children in 1997, a tenfold increase from 19837
92
Percent increase in the amount of calories children consume when they eat a meal at a restaurant 770 calories versus at home 420 calories3
22
Percentage of food advertising that is for fruits, vegetables, grains beans8
Flegal KM, Carroll MD, Ogden CL, Johnson CL Prevalence and Trends in Obesity Among US Adults, 1999-2000 Journal of the American Medical Association 2002,
vol 288, pp 1723-1727 Ogden CL, Flegal KM, Carroll MD, Johnson CL Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000 Journal of the American Medical Association 2002, vol 288, pp 1728-1732 Center for Science in the Public Interest: Anyones Guess, The Need for Nutrition Labeling at Fast-Food and Other Chain Restaurants 4 Amanda Shaffer, The Persistence of LAs Grocery Gap, Center for Food and Justice, 2002 at 43 5 2000 California High School Fast Food Survey 6 Elitzak H Food Marketing Costs at a Glance Food Review 2001, vol 24, no 3, pp 47-48, cited in CSPIs Pestering Parents report 7 Lauro PW Coaxing the Smile that Sells New York Times, November 1, 1999, p C1, cited in CSPIs Pestering Parents report 8 Marion Nestle, Food Politics
1 2 3
an early warning sign
Diabetes Deaths in California Legislative Districts
The California Center for Public Health Advocacy convened a panel of diabetes experts including:
scientific
PHYLLIS PRECIADO, MD, RN
PA N E L
ANN ALBRIGHT, PHD, RN
UCSF the California Department of Health Services Diabetes Prevention and Control Program Albright is the Chief of the Diabetes Prevention and Control Program
Latino Center for
Medical Research, UCSF Preciado is a Faculty Research Fellow at the University of California at San Francisco-Fresno Latino Center for Medical Education and Research In February of 2003 Preciado initiated a community-based comprehensive diabetes management program in Fresno
BILL RELEFORD, JR, MD
Diabetes Amputation Prevention Foundation Releford is the founder of the Diabetes Amputation Prevention Foundation, an organization dedicated to reducing the amputation rate associated with diabetes Releford is a past president of the African Chapter of the American Diabetes Association
DEBRA COHEN, MD
Kaiser Permanente Santa Theresa Medical Center Cohen is a pediatric endocrinologist
GUADALUPE HEREDIA, RN, CDE
Clinica De Salud, Brawley Heredia is a Certified Diabetes Educator
JOE SOLOWIEJCZK, RN, MSW, CDE
Texas Diabetes Institute Soloweijczk, a diabetes nurse educator and family therapist, worked with the Oakland Unified School District in 2002
ALKA KANAYA, MD
UCSF Kanaya, an assistant adjunct Professor of Medicine, Division of General Internal Medicine at UCSF, has conducted research on diabetes
TRESS STEWART, RN
Southeast Health Center, San Francisco Stewart is a public health
nurse with the San Francisco Department of Public Health
FRANCINE KAUFMAN, MD
Keck School of Medicine Kaufman is the Head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital of Los Angeles and is on the faculty of the Keck School of Medicine at USC Kaufman is the immediate past president of the American Diabetes Association and was the chair of the Los Angeles County Task Force on Youth Obesity
CHRIS WALKER, MPH
Whittier Institute for Diabetes and Endocrinology Walker is the Executive Director of Project Dulce, a communitybased diabetes management services program that operates at health centers throughout San Diego County, and is the Director of Clinical and Community Programs for the Whittier Institute
an early warning sign
Diabetes Deaths in California Legislative Districts
organizational
backgrounds
The Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation, based in Princeton, New Jersey, is the nations largest philanthropy devoted exclusively to health and health care It became a national institution in 1972 with receipt of a bequest from the industrialist whose name it bears, and has since made more than 2 billion in grants The
Foundation concentrates its grantmaking in three areas: to assure that all Americans have access to basic health care at reasonable cost; to improve the way services are organized and provided to people with chronic health conditions; and to reduce the personal, social, and economic harm caused by substance abuse–tobacco, alcohol, and illicit drugs
California Center for Public Health Advocacy
The California Center for Public Health Advocacy CCPHA raises awareness about public health issues and mobilizes communities to promote the establishment of effective health policies Established in 1999 by Californias two public health associations–Southern California Public Health Association and California Public Health Association-North–the CCPHA is an independent, nonpartisan, nonprofit organization The CCPHA uses tools of public health–health education, social marketing, epidemiology, and grassroots organizing–to design policy solutions to address public health challenges facing California today The CCPHAs strength lies in their unique approach of working simultaneously with facets of public health that are rarely combined The CCPHA uses both scientific expertise and grassroots
means to effect change at the community and state level, focusing not only on specific public health issues but the general well-being of all Californians Building on the historic strength of Californias two Public Health Associations the CCPHA provides leadership in California in the field of public health, focusing their efforts on the following priority areas: Prevention The CCPHA encourages the establishment of policies and programs that support community-based health promotion and disease prevention, paying particular attention to addressing health disparities; Public Health Constituency Building The CCPHA works toward expanding and strengthening the constituency for public health by acting as a catalyst and convener of different types of people–both professional and lay–and organizations interested in promoting community health; Information Transfer The CCPHA encourages others to learn from their experience, sharing the lessons they learn through training programs and by publicizing their findings at local and national conferences and in professional publications The CCPHA receives funding from The California Endowment, The Robert Wood Johnson Foundation, The California
Wellness Foundation and Kaiser Permanente
