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Diabetes in the Pacific Rim: Taking a Systems Approach to the Epidemic

The three U.S. territories, together with Federated States of Micronesia, the Republic of Palau, and the Republic of the Marshall Islands, make up the U.S. Affiliated Pacific Island Jurisdictions. Diabetes hits residents of our Pacific territories much harder than those who live in the contiguous United States. Age-adjusted diabetes rates per 100,000 people approach 40 in Guam and a staggering 166 in American Samoa, compared to the U.S. average of 25.

The disease rate is related to a regional obesity epidemic fueled by increased imports and consumption of high-fat, high-energy foods; reduced opportunities for physical activity; and cultural norms that view larger body size as a sign of well-being and beauty. The result is a skyrocketing rate of both diabetes and obesity. Polynesian groups also have a higher percentage than Caucasians of microvascular complications from diabetes, such as foot sepsis.

Our Pacific territories represent a unique opportunity for health systems research and planning due to their size and expansive geography. Jurisdictional systems must work together across this area to maximize the health of residents by leveraging limited public dollars and finding innovative ways to address health disparities. Equally important, federal agencies and organizations like Altarum Institute must reach out to our Pacific communities and join them in this work.

To jump-start this needed cooperation, the first-ever Pacific Summit on Diabetes took place in September. My colleague Sheryl Mathis and I traveled more than 8,000 miles to the Commonwealth of the Northern Mariana Islands (CNMI) to facilitate this summit, sponsored by the U.S. Department of Interior and several Department of Health and Human Services Agencies, including the National Center on Minority Health and Disparities at the National Institutes of Health, the Health Resources and Services Administration, and the Office of Global Health Affairs.

The summit provided a unique opportunity for Centers for Disease Control and Prevention (CDC)-funded Diabetes Prevention and Control Program Coordinators in the jurisdictions to take a fresh look at the burden of diabetes in the Pacific and new practices to address the disease. The jurisdiction coordinators, public health officials, politicians, consumers, and medical and community-based providers participated in a five-day conference featuring two days of intensive work sessions to develop their action plans. I facilitated Guam’s work sessions and Ms. Mathis facilitated the CNMI work sessions, resulting in the development of task-based, time-specific action plans.

Strengthening local jurisdiction diabetes plans is the first step in the development of a Pacific Regional Comprehensive Diabetes Control Plan. This effort will be modeled on the CDC’s Comprehensive Cancer Control model used by the Cancer Council of the Pacific Islands/Pacific Cancer Initiative. Taking a systems approach, each group adapted their existing diabetes control plans to be more comprehensive and inclusive of multiple stakeholders and communities. Acknowledging the complexity of diabetes in Pacific Island communities, jurisdiction teams strategically discussed the “research, risk, response and redirection of efforts in the trans-disciplinary approaches to diabetes prevention and control,” said Dr. Stevenson Kuartei, Palau’s public health director.

The NIH National Center on Minorities and Health Disparities is coordinating a 2009 follow-up summit for stakeholders to do more action planning, focusing specifically on diabetes health disparities within subpopulations in each jurisdiction. Altarum hopes to continue to be involved in this important health disparities systems work by facilitating future meetings. We believe that the summit in September is a perfect example of what can be accomplished with cross-jurisdictional cooperation and a systems approach to health care and health disparities. By working together in a cooperative way, we may finally be able to tackle the epidemic of diabetes in the Pacific Basin territories.

 

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This post is filed under Chronic Disease Management, Community Health, Health Disparities and Intercultural Health, Health Policy Analysis, Obesity. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.