The National Program to Eliminate Diabetes Related Disparities in Vulnerable Populations. Keri L. Norris, PhD, MPH Health Scientist, DDT/PEB

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1 The National Program to Eliminate Diabetes Related Disparities in Vulnerable Populations Keri L. Norris, PhD, MPH Health Scientist, DDT/PEB

2 DDT Strategic Plan & Health Disparities Four Goals Goal One: Prevent Diabetes (we are NOT working in this area) Goal Two: Prevent complications, disabilities, and burden associated with diabetes Goal Three: Eliminate diabetes-related health disparities Goal Four: Maximize organizational capability to achieve DDT goals

3 Purpose The purpose of the program is to reduce morbidity, premature mortality, and eliminate health disparities associated with diabetes. Mobilize community partners Assist them to effectively plan, develop, implement, and evaluate community-based interventions to reduce the risk factors that influence the disproportionate burden of diabetes in vulnerable populations

4 Social Ecological Model

5 Recipient Activities Convene, coordinate, and mobilize existing local partnerships/coalitions to address multiple factors contributing to diabetes-related disparities in the region, within at least three distinctly defined communities Lead/facilitate a community strategic planning process to identify specific actions to be undertaken and specific outcomes to be achieved related to reducing diabetes-related disparities in each of the three proposed communities.

6 Recipient Activities Implement interventions in each of the three communities in collaboration with community partners, based on the action plan developed through the strategic planning process with the coalition/partnership. Lead/facilitate a community strategic planning process to identify specific actions to be undertaken and specific outcomes to be achieved related to reducing diabetes-related disparities in each of the three proposed communities.

7 Recipient Activities Learning community: In collaboration with CDC and other grantees, participate in a learning community to regularly share lessons learned and compile, document and disseminate best/ promising practices. CDC Work Groups Partner to support efforts of the National Diabetes Education Program and National Diabetes Wellness Program Sharing population-specific expertise with the DDT-funded Diabetes Training and Technical Assistance Center (DTAC) Attend required meetings: Attend CDC-sponsored meetings/ training activities

8 Organization Communities Target Population DPCP Connection Association of American Indian Physicians Association of Asian Pacific Community Health Organizations Louisiana (Houma) SE Michigan (Native Americans) Kansas (Kickapoo) Native Americans AN- NHOPI Ebeye, RMI CA (B) Waimanalo, Oahu, HI HI (B) Los Angeles CA (B) Center for Appalachian Philanthropy Appalachian (rural) OH (A) Kentucky Regional Planning Development Agency KY/OH Region1 VA/WV Region2 MS Region3 Older Adults & Low SES OK LA MI KS CA KY (A) OH VA (C) WV MS (A) KY (A) Bullitt Cty KY Henry Cty KY Shelby Cty KY National Alliance for Hispanic Health Hispanics DC/VA (C) National Kidney Foundation of Michigan Phoenix Rio Rancho Watsonville Detroit (NW) Flint Inkster African Americans (Low SES) AZ (B) NM (C) CA (B) MI (A) MI MI MI

9 AAIP The Association of American Indian Physicians (AAIP) is a national, non-profit that works to reduce the widely acknowledged health disparities facing American Indian and Alaska Native (AI/AN) people. The AAIP was established in 1971 by a group of 14 American Indian physicians dedicated to improving health outcomes in Native communities. Today, the AAIP has 383 AI/AN physician members and over 3,400 national partners. The AAIP mission is, "to pursue excellence in Native American health care by promoting education in the medical disciplines, honoring traditional healing principles and restoring the balance of mind, body, and spirit". The vulnerable population that the Association of American Indian Physicians will address is the American Indian/Alaska Native (AI/AN) population residing in three communities: the Kickapoo Tribe of Kansas Diabetes Coalition (KPC), SE Michigan Native Americans United to Prevent and Defeat Diabetes Coalition (MNC), and the United Houma Nation of Louisiana Diabetes Coalition (HNC). The goal of the AAIP is to reduce the morbidity, premature mortality, and to eliminate diabetes-related health disparities in American Indian communities by collaborating with, mobilizing, and guiding three community coalitions to effectively plan, develop, implement, and evaluate community-based environmental, policy, and systems change intervention strategies.

10 AAPCHO AAPCHO will collaborate with 3 AA&NHOPI-serving CHCs (LaVentura, Waimanalo, and Ebeye) and their state DPCPs to strengthen existing coalitions to address diabetes through the following objectives: 1. Convene, strengthen and evaluate local coalitions in 3 distinct AA&NHOPI communities to address multi-level factors contributing to diabetes in AA&NHOPI subgroups; 2. Develop and implement a regional strategic, action and evaluation plan in a multi-level approach to reducing diabetes disparities in AA&NHOPIs; 3. Participate in learning communities and attend CDC meetings for information-sharing, increased collaboration and coordination to optimize resources and avoid duplication; 4. Share program findings and increase promotion and education of strategies; 5. Develop and implement the program s evaluation plan AAPCHO and the community coalitions will review tools, select relevant approaches to respond to community needs, and adapt strategies to be culturally and linguistically appropriate for each AA&NHOPI community.

11 KIPDA The lead agency on this project, the Kentuckiana Regional Planning and Development Agency (KIPDA) aims to reduce the diabetes related inequalities in vulnerable populations, specifically older adults and persons of lower socio-economic status, in the rural counties of Bullitt, Henry and Shelby (Kentucky). (KIPDA), will use their extensive coalition building skills to develop a county-specific coalition comprised of representatives from formal health promotion agencies (e.g. Health Department) and informal county-specific natural helpers (e.g. community organizer) to explore the individual, interpersonal, community, institutional and societal influences on the prevalence of diabetes. Initially, the coalition will design a comprehensive needs assessment which will include 1) a health status survey, 2) a photovoice project, 3) an observational study of the number and types of county-specific services which promote social interaction among the community members (e.g. churches, senior centers), services which directly impact the health needs among community members (e.g. pharmacies, hospitals, exercise facilities, parks, fast food venues) and services which adversely affect the reputation of the county (e.g. liquor, pawnbrokers), and 4) a review of supportive and nonsupportive healthy living, economic and school policies. All of these will inform their strategic plan, priority setting, intervention choice and evaluation plan.

12 The Alliance (NAHH) The Mobilizing Communities to Reduce Diabetes (MCRD) program will mobilize and strengthen the capacity of three underserved communities in the West-Southwest region of the United States to raise diabetes awareness, and improve access to effective diabetes prevention and management services among Hispanic adults through the implementation of evidence-based interventions. This will focus on the communities of Phoenix, Arizona; Rio Rancho, New Mexico; and Watsonville, California. The Alliance will serve as the national coordinator of the MCRD program and be responsible for organizing efforts in the three communities to 1) convene and mobilize multi- sectoral partners, 2) conduct a year-long needs assessment and strategic planning process to assess their community s current state of diabetes-related needs, 3) deliver training and technical assistance services on evidence-based interventions to raise awareness of, prevent, and improve the management of diabetes, and 4) build sustainable regional capacity to continually address diabetes-related disparities. This strategic planning process will follow the Mobilizing for Action through Planning and Partnerships (MAPP) framework, a community-driven strategic planning tool developed by the National Association of County & City Health Officials (NACCHO) for improving community health. The strategic planning process is designed to identify gaps and barriers at the individual, interpersonal, organizational, community, and societal levels in the ecological model, and culminate with the implementation of sustainable evidence-based interventions tailored to meeting the needs of each community s defined public health priorities.

13 NKFM Through innovative partnerships and community-specific planning, this project positively impacts the social determinants of health, therefore reducing diabetesrelated health disparities in three Michigan communities: Flint, Inkster and Northwest Detroit. Each of these communities has significant rates of diabetes and large African American populations. The residents of these communities have high rates of unemployment, low socioeconomic status and low education levels. The long-term goal of the project is to decrease diabetes related morbidity and mortality through the mobilization and creation of community resources in the selected regions. This objective will be reached through an extensive and coordinated approach that employs policy and environmental change to transform the three communities into places that address social determinants of health while promoting healthy lifestyle choices to those people living with or at-risk of diabetes.

14 AppaPhil The Center for Appalachian Philanthropy (AppaPhil) will lead a collaborative effort to reduce morbidity and premature mortality, as well as contribute to eliminating health disparities associated with diabetes in rural Appalachian communities. AppaPhil will partner with experienced teams from existing diabetes coalitions, Marshall University and Ohio University, to address the problem of diabetes in this economically distressed region, which has some of the nation s highest rates of diabetes. Through the support of the CDC, this team will use its skills and experience to mobilize existing community partners and assist them to effectively plan, develop, implement, and evaluate community based interventions to reduce the risk factors that influence disproportionate burden of diabetes for the vulnerable populations in rural Appalachian regional communities. The purpose of the proposed project is to identify and decrease personal, social, and environmental determinants linked with the morbidity, premature mortality, and diabetes-related health disparities in rural Appalachia. The beneficiary population for this proposal is three clusters of counties(communities) that straddle five Appalachian states: #1 Elliot County, Morgan County, Wolfe County in KY with Scioto County, OH; #2 Buchanan County, Russell County, Wise County in VA with McDowell County, WV; #3 Kemper, Noxubee, and Winston Counties in MS. It is anticipated that this project will reach 27,500 participants over five years. The program will draw upon the strength of existing coalitions to act as a collaborative network that mobilizes and empowers local citizen actions in the distinct rural Appalachian counties.

15 Questions Keri L. Norris, PhD, MPH (770) Alexis Williams, MPH, CHES (770)