Diabetes as a Public Health Issue: Community Action Plans

Introduction to Diabetes: Types and Public Health Stakes

Diabetes is a metabolic disease in which the body does not produce enough insulin or cannot properly use the insulin it does manufacture. "Insulin is a hormone that is needed to convert sugar, starches and other food into the energy needed for daily life" ("All about diabetes," ADA, 2007). Diabetes may be easy to define, but it is a terrible and complex disease — one which the public and even modern medicine has trouble fully understanding.

There are two different kinds of diabetes: Type I and Type II. Type I Diabetes is mainly genetic in its origins and is usually diagnosed in children and young adults. In this form of the disease, the body stops producing insulin ("Type I Diabetes," ADA, 2007). Treatment typically requires the patient to use synthetic insulin for most of his or her adult life and to follow a special diet to control spikes or rapid drops in blood sugar.

In Type II Diabetes, by contrast, the body either does not produce enough insulin or the cells ignore the insulin the body does produce. Type I Diabetes was once called juvenile diabetes because Type II typically occurred in older, sedentary, and overweight adults. Sadly, because of increased rates of obesity in America, younger and younger children are being diagnosed with what was once called adult-onset diabetes. "Children today may be the first generation in America that have shorter life expectancies than their parents" if current trends in childhood weight gain and physical inactivity continue, and one of the primary reasons for this shortened expected lifespan is the epidemic of Type II Diabetes (Livingston 2004: 2). The long-term risks of diabetes include damage to the sufferer's eyes, kidneys, nerves, and heart ("Type II Diabetes," ADA, 2007).

Childhood Obesity and the Solano County Crisis

One important distinction between the two types is that, unlike Type I Diabetes, Type II is preventable. It can even be contained if diagnosed early, or ideally if at-risk populations who are overweight and sedentary change their lifestyles. It should be noted that there is still a genetic component to Type II Diabetes, as it is more common among African Americans, Latinos, Native Americans, Asian Americans, and Pacific Islanders ("Type II Diabetes," ADA, 2007). Nevertheless, rates of Type II diabetes are increasing across all ethnic groups because of rising obesity rates and declining levels of physical activity throughout society.

Nationally, one in five children is overweight — placing them at the highest risk for developing Type II Diabetes in the future. Solano County in California has a higher rate of overweight children and youth than the state of California as a whole, and California already has a higher rate of overweight children than the national average (Livingston 2004: 1). The statistics for Solano County are grim: over 31 percent of Solano children ages 2–5 are overweight or considered significantly at risk based on their Body Mass Index (BMI). Among children and teens ages 5–20, 38 percent are overweight or significantly at risk for becoming overweight. Compounding the problem, fifty percent of overweight children and teens will remain overweight as adults.

The Children and Weight Coalition: A Community-Based Response

To take proactive community action against the health risks threatening future generations, Solano County developed an organization known as the Children and Weight Coalition of Solano County (CWCSC), comprising over 75 agencies and individuals committed to developing and implementing effective solutions. The organization encourages parents, educators, and community organizations to promote healthy, noncompetitive physical activities, reduce the availability of junk food to students, and foster a healthy lifestyle overall (Livingston 2004: 2). At the time of the plan's development, 30 percent of Solano County youth did not engage in any physical activity. A preventative strategy is best, and these initiatives can also help children who are already overweight, obese, or living with diabetes — though exercise and healthy eating are not a replacement for medical attention when necessary (Livingston 2004: 1).

The CWCSC developed a strategic plan with action steps not only on a countywide basis but also tailored to the specific needs of each community within the county: Benicia, Dixon, Fairfield-Suisun, Rio Vista, Vacaville, and Vallejo. "Four strategic directions were identified as having the greatest impact on children and their environments: Home and Family Environment, School Environment, Community Environment, and Health Care Systems" (Livingston 2004: 3). An ecological model was adopted that addressed the obesity and Type II diabetes crisis from legislative, media, government, food supply, health care, community, school, family, and child-centered perspectives.