PHAdvocates' Harold Goldstein: Reining in California's Skyrocketing Diabetes Epidemic
By Harold Goldstein, Executive Director, Public Health Advocates.
Have you ever heard that if you put a frog in cold water and slowly turn up the heat, the frog will never jump out? It turns out that's not true. Frogs sense the slowly changing temperature and jump out long before they are scalded.
But what about us humans? If a change comes gradually, do we notice soon enough to act quickly and avert disaster? I've been thinking a lot about this as it relates to California's diabetes epidemic. Diabetes rates have tripled in the last 30 years, and yet compared to other epidemics, our collective reaction has been mostly to sit in the water as it gets hotter and hotter.
This response is remarkably different from other issues. Take polio, for example. In 1952, there were 58,000 new diagnoses, 3,145 related deaths, and 21,269 cases of polio-induced paralysis. Ten years later, after a massive and coordinated nationwide vaccination drive, the number of new polio diagnoses dropped to 910. Compare that to diabetes. Here in California, 2.4 million people have type 2 diabetes. Each year, 8,000 Californians die from the disease, 13,000 have a foot or leg amputated, and thousands more go blind or suffer kidney failure, requiring dialysis treatment. And what are we doing about it?
Earlier this year, with support from the California Health Care Foundation, Public Health Advocates and the UCLA Center for Health Policy Research released the first statewide study about the prevalence of prediabetes in California counties. The results were shocking.
Headed for Trouble
Prediabetes is, as it sounds, a condition in which someone's elevated blood sugar levels put them on track to develop diabetes within a few years. It is estimated that 15% to 30% of people with prediabetes will have type 2 diabetes in five years; 70% will have diabetes later in their lives.
According to the study, 55% of California adults now have either diabetes or prediabetes. Almost one-quarter of teens now have diabetes or prediabetes. Low-income populations and communities of color are the hardest hit. We estimate that diabetes rates will increase another 80% over the next five years. In California, we'll have 1.9 million more people with diabetes by 2020.
Why? With limited availability of healthy food in low-income communities, a preponderance of soda and junk food marketing, and urban neighborhoods lacking safe places to play, we have slowly, quietly, and inadvertently created a world in which diabetes is the natural consequence.
The childhood obesity epidemic of the past few decades has matured. Our state's young adults will soon be forced to cope with a new reality: The growing diabetes epidemic is going to cost us — and cost us big — both financially and in human suffering.
Diabetes is already the leading cause of high health care costs in the US. Annual medical expenses for people with diabetes are, on average, $7,900 more than for people without diabetes, adding up to more than $100,000 in a lifetime. Devastating conditions like blindness, amputations, kidney failure, nerve damage, heart disease, and related complications drive these costs.
Diabetes costs the people of California about $24.5 billion each year. This could rise another $15 billion by the middle of our next governor's first term. Remarkably, California spends only three cents per person each year on diabetes prevention — all federal funds. That's less than any other state.
Chasing New York
Fortunately, there are simple fixes we can make to turn down the heat. At minimum, we can catch up to other large states like New York, which invests 42 cents per capita per year. With California's population, that rate would raise many millions of dollars for diabetes prevention programs that make living a healthy life easier and more affordable.
There is much we can and must do, particularly in low-income communities and communities of color where diabetes rates are highest: improve school food, expand the availability of nutrition education and support, help more farmers markets get electronic benefit transfer (EBT) machines to accept food stamp dollars, invest in walkable sidewalks, create more public bicycle systems, and expand access to safe parks. But not everything can be done with what the state budget allows, so it is also vital to ensure a sustainable funding source for this important work, such as through statewide soda taxes. A tax of two cents per ounce could raise more than $2 billion a year for diabetes prevention.
If we truly want to demonstrate that we take this problem seriously, we need to make a major investment in an equity-focused diabetes prevention campaign on par with the state's tobacco control program. Even $100 million to fight diabetes would be a drop in the bucket compared to what Medi-Cal is already paying to treat the disease and how much more it will cost only five years from now.
We can also make it easier and less costly for people to access and participate in the US Centers for Disease Control and Prevention diabetes prevention program. This program is a structured lifestyle modification regimen that helps people eat less and exercise more to bring down blood-sugar levels. Currently, Medi-Cal and most private insurers don't reimburse for the program, even though it's been clinically proven effective 58% to 70% of the time and can cost as little as a couple hundred dollars per year. A small change in state or national regulations could fix this, and providers are beginning to line up to fill the impending demand.
Finally, we need to make sure that our children have the opportunity to get off to a healthy start. We need to encourage children to drink water instead of sugar-sweetened beverages, and we need to make sure that every child has quality physical education. If we start with these few simple strategies, we can turn down the heat on diabetes and save ourselves and our children. Prediabetes is completely reversible. It is time to make it a top statewide priority.
This article was originally published on the California Health Foundation's online blog on August 23, 2016.