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National Agenda for Public Health Action:
A National Public Health Initiative on Diabetes and Women’s Health
A National Agenda for Action
Ten priorities are recommended for improving the health and well-being of women
with or at risk for diabetes. For each recommendation, strategic actions are
proposed as the means by which the Initiative's goals will be achieved expeditiously.
Some actions can be implemented immediately and accomplished in a relatively
short time (6-12 months); others require a more extensive investment of time
and/or resources.
The vast majority of the recommendations and strategies apply to all life stages.
However, some life stages have unique needs that require special approaches
to truly have a positive impact. These variations are noted where appropriate.
Regardless of life stage, strategies must respect and reflect racial, ethnic,
religious, geographic, and cultural needs. Also, although the focus of these
recommendations is to improve the health and well-being of women, adopting many
of the recommendations will also benefit men and families.
Implementing the priority actions requires strong leadership bolstered by true
collaboration among multiple partners. Vital roles and shared responsibility
must be assumed by public and private health care organizations; business and
industry; education and environment; communication and media; and policy makers
at local, state, and federal levels. Our hope is to enlist the help and support
of a broad spectrum of organizations and individuals in translating this thoughtful
national agenda into tangible and effective action.
1. Strengthen advocacy on behalf of women with or at risk
for diabetes.
- Create, support, and mobilize both existing and new innovative partnerships
and coalitions for the improved health and well-being of women.
- Educate key stakeholders and consumers (women, men, and families) about
the issues, challenges, and opportunities for improving the lives of women
with or at risk for diabetes. The principles of cultural competency should
be respected in all educational messages.
- Advocate for and support more public health research on diabetes and women's
health, including identifying measures of quality of care.
- Develop policies and programs to support community health.
- Establish policies that support culturally competent messages and services
for women at risk for diabetes while also developing stronger links to culturally
competent personal health care services for women and health care providers
trained in the principles of cultural competency.
2. Expand community-based health promotion education, activities,
and incentives for all ages in a wide variety of settings—schools,
workplaces, senior centers, churches, civic organizations, and other locations
where women live, learn, work, and play.
- Support and encourage the development of a coalition of grassroots women's
groups.
- Develop a core health promotion message for women, such as
- Complications from diabetes are more serious for women.
- Families are essential partners in promoting health and managing diabetes.
- You may be able to prevent diabetes.
- Diabetes is manageable and treatable.
- The devastation of diabetes does not have to happen.
- Honor the gift of life, eat to be well, and get moving.
- Everyone is at risk for diabetes.
- Diabetes prevention saves money and improves quality of life.
- Design a social marketing campaign that integrates current diabetes-related
messages aimed at women and their families regarding nutrition, cardiovascular
disease, smoking, and physical activity.
- Work with and through business, industry, and media partners to reach women
and influence them to adopt healthy behaviors.
- Identify and develop links with community agencies that interface with
women at greatest risk in all life stages, including those in non-health-related
sectors (e.g., historically black colleges and universities, fraternal organizations,
civic organizations, social organizations, professional organizations, beauty
and nail salons, faith-based organizations, and community centers).
- Design and conduct a national campaign based on nontraditional methods
of advertisement, such as pay stubs, grocery store receipts, and other retail
vehicles.
Especially for the adolescent years (10-17 years)
Structure and deliver educational messages to encourage female
adolescents with and at risk for diabetes to engage in regular physical activity,
make good nutritional choices, and avoid or stop smoking.
- Raise awareness and knowledge about the importance of regular physical
activity among adolescent girls.
- Increase awareness of the benefits of making healthy food choices, the
existence of simple methods for preparing healthy foods, and the negative
effects of regularly eating fast food and snacks and drinking soda instead
of water or milk.
- Identify the most appropriate messages for teens at risk—particularly
teens with a genetic history of diabetes, and pregnant and/or obese teens.
- Encourage positive messages about self-care and self-respect.
- Raise awareness about the comorbidity of diabetes and depression.
Create positive, rewarding forums that promote healthy eating
and physical activity among adolescent females at risk for type 2 diabetes.
- Conduct focus groups and other forms of qualitative research with adolescent
women to help design the structure, content, and delivery channels of forums.
- Involve youth representatives in the planning and design stages.
- Partner with nonprofit organizations, government agencies, universities,
businesses, and media outlets to deliver forums on a national basis.
- Develop incentive-based systems to attract and retain participants in forums.
Especially for the reproductive and middle years (18-64 years)
Educate women and providers to increase their awareness about diabetes, its
risk factors, its preventability where applicable through lifestyle choices,
and its association with other chronic diseases (for example, cardiovascular
disease).
- Assess and evaluate existing messages, programs, and campaigns.
- Increase the awareness of women and providers about the positive impact on
both the quality and length of life for women with diabetes through preventing
and delaying heart disease.
- Develop an effective social marketing campaign, using focus groups or other
qualitative methods.
- Design and test messages and determine dissemination strategies for specific
population subgroups.
Especially for the older years (65 years and older)
Educate seniors and promote lifestyle changes that prevent
and treat diabetes, including physical activity, healthy eating, and relieving
depression. Emphasize the relationship of diseases of old age to diabetes (for
example, heart disease and diabetes).
- Develop and disseminate diabetes prevention messages for senior women with
diabetes through National Diabetes Education Program partners.
- Inform consumers and providers about recent changes and updates to Medicare
coverage for diabetes self-management and medical nutrition therapy.
Expand intergenerational programs and activities to reduce
social isolation among older women.
- Encourage relationships among women across the life span through participation
in diabetes prevention and treatment activities.
- Define the optimal parameters of intergenerational programs and activities.
- Identify barriers and enabling factors among older women to participation
in intergenerational programs.
- Identify existing successful programs and activities in urban/rural areas
and different ethnic/cultural groups through qualitative and quantitative
public health research.
- Summarize findings, share them with state and local organizations, and
promote their use in program designs.
- Partner and build community coalitions that involve the elderly and address
their unique needs.
- Use schools, churches, and other key venues within communities to create
activities and occasions for women of all generations to congregate.
3. Encourage and support diabetes prevention and control programs
in state health departments to develop prevention programs for all women and
establish efficient links for women at risk for type 2 diabetes.
- Enhance financial support and resources to state health agencies to establish
and maintain leadership on behalf of women with or at risk for diabetes.
- Support strong leadership to facilitate organized and consistent efforts
between and among the various departments of state and local public health
agencies addressing issues of diabetes and women's health.
- Encourage state and local coalitions and other consortiums to coordinate
plans, policies, and activities through regular communication and priority-setting
processes.
- Document results of ongoing demonstration projects and share models for
widespread use.
- Evaluate existing communication and education programs to identify effective
strategies for motivating and sustaining behavioral change in women.
- Evaluate existing data from research to extract lessons learned, and identify
effective diabetes prevention and management strategies in a range of settings
for all life stages.
- Examine best practices of managed care and other health care organizations
regarding chronic disease management.
- Compile information on "best practices" for diabetes prevention
and management, and promote policies to support these practices.
4. Fortify community programs for women with sufficient funding,
training, tools, and materials.
- Explore more efficient and effective ways to use existing resources at
national, state, and community levels.
- Enhance funding streams through public-private partnerships.
- Develop a comprehensive resource guide for lay women based on existing
information on best practices for diabetes prevention and management.
- Establish "train the trainers" programs to facilitate rapid translation
of new knowledge into practice.
Especially for the older years
Increase the priority of federal, state, and local funding
for (a) diabetes management training and education for elderly women and their
families, caregivers, and health care providers; (b) prescription drugs, health
insurance coverage, and prevention; and (c) grassroots and community programs.
- Engage area agencies on aging, state and local programs, American Association
of Retired Persons, advocacy organizations, coalitions on aging, geriatric
education centers, and the National Conference of State Legislatures in developing
a broad policy statement supporting increased diabetes funding.
- Seek funding from the private, not-for-profit sector.
- Educate extended care facilities about diabetes management.
- Highlight effective training based on models that have been demonstrated
to work.
- Link with Medicare drug benefit groups to coordinate policy and programs.
- Identify and solicit sponsors to establish a fund for advocacy and program
development.
5. Expand population-based surveillance to monitor and understand
- variations in the distribution of diagnosed and undiagnosed diabetes and
of impaired glucose tolerance within and among groups; and
- the factors—cultural, racial, ethnic, geographic, demographic,
socioeconomic, and genetic—that influence the risk for diabetes and
complications among women at all life stages.
- Examine the capacity of existing surveillance systems to collect data on
disease distribution and risk factors.
- Design appropriate expansions and/or adaptations in existing systems, and
create new systems where necessary.
6. Educate community leaders about diabetes and its management
and about the value of healthy environments.
- Increase diabetes awareness programs and materials in workplaces, health
care settings, (such as drug stores, pharmacies, and health clinics), the
media, and the community (such as recreational centers, schools, churches,
barber shops, and beauty shops).
- Develop a web-based clearinghouse of science-based diabetes information
and programs targeting women and the general public.
- Develop and implement a diabetes education and communication program in
schools, workplaces, community health centers and other health care settings,
and government social program offices. Programs should focus on nutrition,
physical activity, and smoking cessation for all women, and they should include
weight loss management and breast-feeding education for women in their reproductive
years.
- Advocate for expansion of parks, sidewalks, playgrounds, and other public
recreational areas.
Especially for the adolescent years (10-17 years)
Educate school system personnel
- Build partnerships and dialogue among relevant constituents, including
boards of education, diabetes experts, school nurses, teachers, counselors,
administrators, community health experts, food service providers, parents,
and students.
- Design and expand coordinated school health programs for diabetes.
- Conduct demonstrations in schools for prevention of diabetes among female
students at risk and for managing diabetes among those diagnosed with diabetes.
- Develop and disseminate a guide for school personnel, including sex-specific
components, when appropriate.
7. Encourage health care providers to promote risk assessment,
quality care, and self-management for diabetes and its complications in their
practice settings.
Because the types of health care issues and providers vary by life stage, recommendations
and strategies presented below are age specific.
Especially for the adolescent years (10-17 years)
- Develop and disseminate best practice guidelines for providers in various
clinical and nonclinical settings.
- Disseminate the model of multidisciplinary teams for diabetes management
and encourage its use in clinical settings.
- Empower families to become informed advocates for improved diabetes care.
- Identify or develop risk assessment and diagnostic tools geared to adolescents.
- Conduct health services research to determine the usefulness of tools,
patient satisfaction with those tools, and their relative cost-effectiveness.
- Assess Health Plan Employer Data and Information Set measures for adolescents
and propose revised or new measures.
- Review and tailor self-management guidelines to adolescent years.
- Bolster training and continuing education for health care providers and
diabetes community health workers.
- Promote various strategies to increase self-esteem among adolescent women
with diabetes.
Especially for the reproductive years (18-44 years)
Promote expansion of routine physical exams to include risk
assessment and appropriate follow-up for diabetes among reproductive-aged women.
- Develop practical and useful screening tools, such as assessment questions,
appropriate physical activity, diet, hip and waist measurement, and body mass
index, and incorporate them into standard health assessments.
- Train health personnel to conduct and use these assessments.
- Promote the use of tools among various health associations in clinical
settings.
- Market the need for expanding routine exams to purchasers, health plans,
and payers.
- Train future health professionals about women's health and diabetes to
ensure that they are able to communicate with women and address their unique
concerns.
Especially for the middle years (45-64 years)
As recommended by the American Diabetes Association, integrate
diagnostic testing for type 2 diabetes with Pap tests, mammography, and other
routine procedures.
- Increase provider awareness of the need for and value of integrated testing.
- Increase provider awareness about the seriousness of diabetes as well as
strategies to prevent complications through continuing education, journal
articles, and advertising.
- Empower women to become informed advocates and to create demand for integrated
diagnostic testing.
8. Ensure access to trained health care providers who offer
quality services consistent with established health care guidelines.
Like the previous recommendation, access to care presents a unique challenge
all life stages and is particularly important in rural areas. Recommendations
and strategies presented below are age specific.
Especially for the adolescent years (10-17 years)
- Integrate diabetes messages and programs into the education and health
care services that adolescents already receive.
- Conduct focus groups and other types of qualitative research with adolescent
women to elicit what they know about diabetes and how they best receive messages
from service providers.
- Develop and market information resources, such as interactive games, so
that children and adolescents know who their health providers are and what
they do.
Especially for the reproductive years (18-44 years)
- Develop and integrate culturally appropriate diabetes messages into education
and services that reproductive-aged women already receive, focusing on high-risk
and racial/ethnic groups.
- Ensure appropriate pre- and perinatal monitoring and health care for women
who develop gestational diabetes.
- Ensure access to follow-up and ongoing care for women who develop gestational
diabetes and therefore are at increased risk for type 2 diabetes.
- When available, use health care providers at the work site to provide diabetes
care.
- Encourage occupational health personnel to develop and use risk assessment
tools for diabetes.
Especially for the middle years (45-64 years)
- Capitalize on health care visits for other family members by making links
and referrals for self-care that include risk factor reduction advice and
testing for diabetes.
- Use health care providers at the work site to provide diabetes care.
Especially for the older years (65 years and older)
- Take advantage of health care visits for other family members by making
links and referrals for self-care that include risk-factor reduction advice
and testing for diabetes.
- Use and expand mobile health care programs and education services with
vans, immunization units, and other delivery vehicles at convenient venues
such as churches, senior centers, and shopping malls.
9. Encourage health care coverage and incentives for recommended
diabetes prevention and management practices by
a. Promoting partnerships between insurers and workplaces or labor communities
and encouraging employers and employees to discuss needed diabetes benefits
in offered health packages
- Identify the appropriate range of benefits based on "best practices."
- Educate employers, employees, and labor union representatives about their
role in ensuring health benefits to prevent and manage diabetes.
- Conduct a pilot demonstration on a sex-specific health care benefits package
that includes prevention, management, and treatment.
- Analyze Medicaid and other data on the costs and benefits of early prevention.
- Meet with key stakeholders to get buy-in on the need for reimbursement
of diabetes risk assessment as a part of routine exams.
b. Working with health insurers and policy makers to expand coverage and reimbursement
policies to include prevention services for women throughout their lives
- Promote federal laws and programs so that all women have adequate coverage
for preventive and other services.
- Work with health plans and purchasers of care to help them appreciate the
cost of diabetes and encourage the addition of preventive services to coverage
plans.
- Extend diabetes collaboration among relevant federal agencies to provide
health services to uninsured and underinsured women.
- Identify efficient reimbursement policy models and use them to promote
improved coverage.
c. Increasing health coverage and promoting purchasing cooperatives including
small business
- Conduct an inventory of existing model programs of health coverage and
purchasing cooperatives.
- Develop and disseminate a toolbox of model programs, including nontraditional
health care coverage options.
- Promote collaboration on model programs.
- Market programs to individuals and include education on using the health
care system.
- Advocate for policies to increase comprehensive care coverage for the underinsured
and uninsured.
Especially for the middle and older years (45 years and older)
- Expand WISE WOMAN (acronym for Well Integrated Screening and Evaluation
for Women Across the Nation) throughout the United States.
- Design, fund, and conduct an actuarial study on the impact of diabetes
on Medicare costs.
10. Conduct public health research on the following questions
to further our knowledge about the epidemiologic, socioenvironmental, behavioral,
translational, and biomedical factors that influence diabetes and women's health.
- What do we know about diabetes prevention and intervention, among women
across all life stages, based on existing research data and findings, and
what are the implications of this knowledge for future programs and policies?
- To what extent can type 2 diabetes and its complications in women be prevented
or delayed by changes in diet, physical activity, psychosocial stress, work
conditions, or pharmacology, taking into account specific biological and maturational
changes (for example, endocrinological, physiological, psychological, and
social) at each life stage?
- What is the impact of depression on the lives of women across the life
stages with or at risk for diabetes?
- What are the determinants of the characteristics of effective diabetes-related
prevention and intervention services among women at different life stages?
- What is the extent of health care provider knowledge, beliefs, and practices
related to risk factors, diagnoses, clinical, and preventive care of type
1, type 2, and gestational diabetes among women across all life stages?
- What is the societal cost of diagnosed and undiagnosed diabetes among women
throughout the life course?
Especially for the adolescent years (10-17 years)
- What strategies can most effectively minimize the obstacles (independent
of normal development and specific to diabetes) to help adolescents adopt
and maintain appropriate health behaviors, prevention, and/or management of
diabetes?
- Which environmental factors, if maintained or modified, would have a positive
effect on preventing diabetes or improving diabetes outcomes for adolescents?
What strategies can best lead to environmental change?
Especially for the reproductive years (18-44 years)
- What are the effects of changes in weight, diet, and physical activity
during and after pregnancy on the risk of developing gestational diabetes
type 1 diabetes, and type 2 diabetes and the risk of diabetes in the offspring?
What systems and infrastructure are needed to support those changes?
- What are the most cost-effective interventions for preconception planning
among women with type 1 and type 2 diabetes to prevent diabetes anomalies
in their offspring?
Especially for the middle years (45-64 years)
- What are the developmental characteristics of women in the middle years
that affect or influence the risk for diabetes diagnosis, complications, and/or
treatment?
- What interventions will have the best effect on long-term outcomes and
improved quality of life?
- How can the delivery of preventive care, building on the existing system,
be improved for women in the middle years?
Especially for the older years (65 years and older)
- To what extent does use of multiple medications, including over-the-counter
drugs, influence quality of life and affect women's ability to manage diabetes?
- What developmental characteristics of women in the older years affect or
influence the risk for diabetes, diagnosis, complications, and/or treatment?
- What interventions are most effective in promoting and sustaining healthy
behaviors in the older years?
- What features of improved care, including community supports, can be efficiently
implemented at home, in assisted living facilities, and in other settings
for women in the older years?
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Page last modified: December 20, 2005
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
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