by Qing Qing Miao, 2014 Summer Intern, Health Law and Policy Clinic
In continuation of its efforts to provide comprehensive policy recommendations for the prevention and management of type 2 diabetes, the Harvard Law School Center for Health Law and Policy Innovation (CHLPI) recently launched its 2014 North Carolina State Report: Providing Access to Healthy Solutions (PATHS) – The Diabetes Epidemic in North Carolina: Policies for Moving Forward. The launch took place in Raleigh, North Carolina and began with a Diabetes Leadership Dinner on May 29th followed by a Strategy Forum on May 30th. Similar to its counterpart New Jersey report released earlier in March, the North Carolina report provides detailed coverage of the current landscape of diabetes care and offers both broad and specific policy initiatives to strength federal, state and local efforts to improve type 2 diabetes care.
Funded by the Bristol-Myers Squibb Foundation through the organization’s Together on Diabetes Initiative, the report comprises the second phase of PATHS’ state-level policy reform initiatives in New Jersey and North Carolina. Selected for their opportunities to receive and implement federal-level recommendations, these pilot states possess both the momentum and infrastructure to sustainably implement findings from the report.
The North Carolina report is the final product of the efforts of the CHLPI Clinical Fellows, Maggie Morgan and Sarah Downer and the clinical student Tiffany Lopinsky. Developed over the course of 18 months, the report incorporates extensive interviews with over 90 key stakeholders and community partners, who shared insights into the barriers involved in mitigating the health impacts of diabetes.
The PATHS report provides both the contextual and structural analysis of institutional systems currently installed within North Carolina and recommends policy to help the state move forward with its health initiatives. Touching upon the social, legal, environmental, and financial dimensions of diabetes care, the report underscores two broad areas of policy: disease prevention and disease management. Detailed recommendations spanned the following topics: increasing economic access to healthy foods for the underserved; improving the food retail and transportation infrastructure to help individuals access healthy foods; implementing early childhood interventions through school food and wellness programs; embracing community resources to build a social support network for patients; implementing a coordinated system of whole-person care involving primary and special care, self-management education, community health workers; and increasing access to health care providers.
CHLPI initiated its launch with a Diabetes Leadership Dinner, inviting key interviewees and other notable partners such as Patti Doykos, the Director of the Bristol-Myers Squibb Foundation. Opening the event with warm introductions was Robert Greenwald, the Director & Clinical Professor of Law at CHLPI. Greenwald introduced the mission of the Center to improve health outcomes and reduce health disparities, highlighted the strategic legal moves and actionable recommendations underlying the report, and put forth the “whole-person patient centered” treatment approach that PATHS advocates. In closing, he emphasized the imperative for community and state support in steering the trajectory of diabetes care as it changes within a rapidly transforming health landscape.
Following Greenwald’s introduction was a keynote address presented by Dr. John Buse, Chair of the National Diabetes Education program. In his presentation titled “A Clinician’s Perspective of Diabetes Priorities in North Carolina,” Dr. Buse underscored studies supporting the efficacy of lifestyle interventions on decreasing the incidence of comorbid diseases. Unfortunately, the populations most vulnerable to diabetes complications are minority groups, which are disproportionately affected by the disease. In North Carolina, diabetes is twice as likely to affect minorities. According to Dr. Buse, segregation and income are the two most prominent factors for health disparities. To eliminate this health gap, he proposed a three-pronged approach of expanding insurance coverage, helping individuals access diabetes self-management education, and developing community health workers & peer support.
The Strategy Forum hosted on May 30th allowed CHLPI to present its report to the North Carolina Diabetes Advisory Council (NCDAC), which directly advises the state government on diabetes prevention and management. The forum served a dual function as a platform for the attendees – public health officials, health care professionals, community health workers, and other stakeholders of the state – to prioritize action items surrounding diabetes prevention and management.
Formal events started with the CHLPI team’s presentation of its report before the Diabetes Advisory Council (DAC). Afterwards, the team welcomed the arrival of significant contributors to the Strategy Forum. Patti Doykos and Robert Greenwald led the introductions and directed the audience attention to the final iteration of CHLPI’s presentation. Following the PATHS presentation was the keynote speech given by Dr. Ann Albright, the Director of the Division of Diabetes Translation for the Centers for Disease Control and Prevention. Detailing the trends of diabetes within the last few decades and the trajectory of the disease in the future, Dr. Albright emphasized the importance of evidence-based Diabetes Prevention Programs (DPP) implemented at the state level and scaled at the national level. After presenting the CDC’s own DPP research trial, she made a forceful case for lifestyle change interventions – mediated by the installation of trained health workers – in helping to prevent diabetes and managing pre-diabetes.
The full breadth of current state efforts to prevent and manage diabetes was encapsulated by the four panelist presentations given after the keynote. The last of the panelists, L’Tanya Gilchrist, shared a compelling story of her motivations for working as a clinical assistant health provider at the Durham County Health Center. She recounted her father’s experience with diabetes: at the height of his disease, his complications had necessitated that he receive several amputations. At the climax of her story, Gilchrist determinedly asserted that no patient should ever have to experience what her father had. She described her role as a community health coach – how she is able to assist patients with literacy barriers in providing diabetes self-care and how she connects them to their healthcare providers.
The Forum culminated with a strategy session, an incubator exercise for the different health and policy professionals to distill their ideas about moving forward with diabetes prevention and management. A sense of excitement and reserved optimism characterized the tone of the collaborative work as each group detailed their priorities for diabetes-related policy reform. Themes pervading the exercise ranged from improving the built environment, community zoning involving the partnership of urban planners, and methods to increase community social support. Although conversations about diabetes prevention and management touched on various subjects, the issue of reimbursement for pre-diabetes care was especially prominent, as Medicaid currently does not reimburse for the identification and management of pre-diabetes. This issue guided the forum’s final discussion as multiple attendees highlighted the imperative to expand the health focus to include pre-diabetes.