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Poverty impacts chronic disease

Wellness program aims to tackle illness early on


Low income people with diabetes who have trouble paying for food, shelter, medicine and other basic needs have the most difficulty managing their medical condition, a new study reports in the Journal of the American Medical Association.

In fact, according to the researchers at Massachusetts General Hospital in Boston and Harvard University, nearly half of these individuals who struggle with basic needs are not properly managing their diabetes.

In the study, researchers collected data from 411 people with diabetes at clinics and health centers in Massachusetts from June 2012 through October 2013. While most of the participants had health insurance, about 40 percent reported issues with access to food, medicine or other necessities.   

For instance, nearly 28 percent reported not taking their medication because they could not afford the drugs. Nearly 20 percent said they did not have reliable access to food and 14 percent were struggling to pay utilities.

“This not surprising at all,” said Dr. Jerome Williams Jr., a cardiologist at Mid-Carolina Cardiology in Charlotte, North Carolina, who was not involved in the study.  “When you talk about diabetes management, it is expensive to eat healthy and in certain neighborhoods, there are limited supermarkets. If you have to walk 5-10 miles to a supermarket, are you going to do it? Probably not. Sometimes people have to make a choice, eat healthy or have a roof over my head.”   

Williams said that some of the same problems exist in the Charlotte community as described by the Harvard study. “It really depends on the demographics,” he said. “It depends on someone’s ability to afford their medication and have the bus fare to get to a doctor’s office, which may be burdensome for a person who is working two jobs to put food on the table.”

Williams argues that studies like these cut to the heart of wellness. “The health of the community is not just access to health care, it involves engaging in social situations,” he said.

The policy debate on using limited resources has two options: do you intervene early and reduce medical problems in the long run or treat the disease once the health problem arises?

“We’re out of the gate early as it relates to raising awareness and educating people in the community about making healthy decisions,” said Williams, referring to Novant Health’s wellness initiative known as Remarkable You. As part of the effort, the hospital system has pledged to stamp out high blood pressure, prediabetes and obesity through a multi-year screening and wellness program.

Launched in early 2014, Novant Health’s wellness initiative committed to screening 500,000 people for chronic conditions where they live and work. By discovering undiagnosed conditions sooner, the goal is to prevent damaging and potentially life-threatening health effects among the general public.

Williams often takes his message about preventing hypertension to churches, barbershops and gymnasiums. “We can’t expect them to come to us,” he explained. “And it’s a captive audience.”

By informing the community at these events, Williams said people become engaged and spread the word throughout their own neighborhoods, thereby getting more people to participate at the next screening session.

The Centers for Disease Control and Prevention estimates more than 29 million Americans have diabetes and as many as 8 million of those cases are undiagnosed. Additionally, 86 million people in the U.S. have prediabetes, or elevated glucose levels.

For those at risk, diabetes prevention is proven, possible and powerful, according to the National Diabetes Education Program. Studies show that just losing 5-7 percent of one’s body weight can prevent or delay the onset of the disease.

Novant Health’s goal is to screen half a million people in inpatient, outpatient and community settings to assess their personal risk factors and the hospital system anticipates providing more than 25,000 A1C blood tests for diabetes.

The health assessments are meant to identify and help the most at-risk population in the community. For information on the next health screening in the community, visit NovantHealth.org/RemarkableYou.





Published: 1/15/2015