This paper examines diabetes as both a growing global epidemic and a designated Healthy People 2020 priority area. Drawing on research by Davis (2008), Cunningham-Myrie et al. (2015), and Tabish (2007), it argues that poor diet and physical inactivity are primary drivers of the disease and that public health leaders should focus on root-cause prevention rather than symptom management. The case of the Marshall Islands — where a return to traditional diet and activity eliminated a diabetes outbreak — is presented as a model for the kind of community-based leadership needed in the United States. The paper concludes with an annotated resource list covering epidemiology, genetics, clinical guidelines, and global management of type 2 diabetes.
Diabetes is a community health problem and a Healthy People 2020 priority area. Tabish (2007) has cited it as a growing epidemic occurring all over the world. Because diabetes has been linked to obesity, poor diet, and lack of exercise, it is reasonable to conclude that if people ate better and exercised more, the rising spread of diabetes could be reversed. This is the contention of researchers such as Davis (2008) and Cunningham-Myrie, Theall, Younger, et al. (2015). In short, diabetes is impacting everyone. All who consume "fast food" type diets are at risk of developing diabetes, according to these studies.
The public health leadership problem related to this health issue is that public health leaders appear all too willing to simply treat the symptoms of diabetes instead of attacking the causes of the disease. Better leadership in this area would resemble what Davis (2008) did in the Marshall Islands, when he guided the native population back to their traditional, healthy diet and away from the pre-packaged, manufactured food items they had been importing from the West.
Within a year, diabetes — which had become remarkably prominent in the Islands, unlike any period before — was gone, thanks entirely to the traditional diet and the physical activity that came from producing one's own food, as had always been the custom in the Islands before the importation of Western food products. If this approach worked in the Marshall Islands, it should be transferable elsewhere. The kind of leadership needed in the United States is leadership that will inspire such a direction — a genuine change in the way people eat, live, and think about the impact of their diets on long-term health outcomes.
This problem connects directly to the Healthy People 2020 priority areas, as diabetes is identified as one of the 42 topic areas for the program by the Centers for Disease Control and Prevention (Healthy People, 2015). It is therefore considered a serious area of concern that demands sustained public health attention and targeted intervention strategies.
Almeida-Pititto, B., et al. (2015). Type 2 diabetes in Brazil: epidemiology and management. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 8, 17–28.
Billings, L., & Florez, J. (2010). The genetics of type 2 diabetes: what have we learned from GWAS? Annals of the New York Academy of Sciences, 1212, 59–77.
Cunningham-Myrie, C., Theall, K., Younger, N., et al. (2015). Associations between neighborhood effects and physical activity, obesity, and diabetes: The Jamaica Health and Lifestyle Survey, 2008. Journal of Clinical Epidemiology, 68(9), 970–978.
Davis, B. (2008). Defeating diabetes: Lessons from the Marshall Islands. Today's Dietitian, 10(8), 24.
"Diabetes among 42 CDC priority topic areas"
"Annotated references on diabetes epidemiology and management"
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