San Francisco Burden of Disease & Injury Study:
Determinants of Health
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Diabetes: What Can Be Done?

The burden of diabetes in San Francisco can be reduced by preventing obesity and overweight. Obesity and overweight can be prevented by addressing physical inactivity and poor diet. Tobacco smoking is an independent risk for diabetes.

For those who have already become diabetic, the burden of diabetes-related complications can be reduced most effeciently by applying evidence-based approaches such as those outlined in the CDC's Guide to Community Preventive Services.

Some specific interventions, drawn from HHS's Steps to a HealthierUS initiative, are as follows (please send suggestions for interventions in SF):

HHS Recommendations, Steps to a HealthierUS San Francisco Interventions or Resources
Educate health plans and providers regarding standards for preventive health care practices and how to fully implement them. Kaiser, CHN, SF Health Plan
Conduct community-wide campaigns to implement a diabetes risk assessment questionnaire (e.g., American Diabetes Association’s Are You at Risk?) at multiple points of contact such as grocery stores, pharmacies, family planning clinics, senior centers, churches, and department stores, etc. local chaper ADA
Conduct media campaigns promoting diabetes risk-assessment with the message to see a health care provider if the individual is at risk.  
Promote diabetes literacy among the public. Dean Schillinger and others at SFGH Primary Care have been doing seminal research in this area. See recent papers in Arch Intern Med or in JAMA
Increase the likelihood that physicians develop treatment plans for diagnosed [diabetic] patients and follow accepted standards of care.  
Provide and train health care professionals on office-based procedures for referrals, follow-up, and patient reminders [for diabetic patients].  
Provide a process for referrals [of diabetics] to community facilities for physical activity, nutrition education, and tobacco cessation.  
Ensure participation of federally funded health centers in comprehensive diabetes plans. SF Community Clinic Consortium & CHN Primary Care
Form diabetes support groups to improve self-management practices in people with diabetes and to support lifestyle changes.  
Provide family and caretaker education for people with diabetes to support change/maintenance of behavior in patients with pre-diabetes and diabetes.  
Support faith-based outreach services to offer their resources (e.g. transportation, meeting space, designated diabetes awareness activities) to the elderly, disabled, and socially isolated members of the community.  
Provide training to school staff to respond to diabetes emergencies, assist in diabetes care/self-management, and provide education to other students regarding diabetes. See also, school health
Develop community support groups for persons with diabetes.  
Also see tobacco, poor diet, physical inactivity, and school health  





Contribution to overall disease burden in SF

Downstream (health consequences)

Upstream causes

What can be done?

Web resources

MEDLINE strategies

Updated May 28, 2003

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