REACH 2010 Seattle & King County

Cheza Collier, PhD, MPH, MSWPublic Health - Seattle & King County

University of Washington School of Public Health and Community Medicine,

Social and Behavioral Sciences Program(January 2004)

Acknowledgment

Mike Smyser, MS, EpidemiologistEpidemiology, Planning & EvaluationPublic Health – Seattle & King County

OBJECTIVES

Review diabetes disparity informationLearn the six health priority areas

targeted by REACH 2010.Learn the primary Seattle & King County

REACH community interventions.

Definition of Health Disparities

Health Disparities describe the disproportionate burden of disease, disability and death among a particular population or group when compared to the proportion of the entire population.

Source:Washington State Board of Health

NATIONAL HEALTH DISPARITIES DATA

Disease Prevalence, Compared to White Americans or to Average Rate:– Diabetes: Nearly 3 times higher

among Native Americans than the average rate; 70% higher among African Americans

Persons with diabetes and end-stage renal disease, United States

Year 2010 target 78 per 1 million persons

Lower extremity amputations in persons with diabetes (age adjusted to the year

2000 standard population), United States

WASHINGTON STATE DIABETES DEATH RATES BY RACE AND AGE

0

200

400

600

800

1000

1200

1400

1600

1800

0-44 45-64 65-74 75+ All Ages

White, non-Hispanic

African descent, non-hispanic

AmericanIndian/Alaska Native

Asian American /Pacific IslanderAmerican

Hispanic, any race

Rates are per 100,000 populationSource: Washington Center for Health Statistics

KING COUNTY DIABETES DEATH RATES BY RACE AND GENDER

White - M

African Am - M

Asian - M

Hispanic - M

White - F

African Am - F

Asian - F

Hispanic - F

0

5

10

15

20

25

30

35

40

458

0-8

4

81

-85

82

-86

83

-87

84

-88

85

-89

86

-90

87

-91

88

-92

89

-93

90

-94

91

-95

92

-96

Ag

e-A

dju

ste

d R

ate

pe

r 1

00

,00

0

Eliminating Health

DisparitiesWhat will it Take?

Access to Health

Services

EconomicOpportunityand Equity

ReducedStress due to SocialFactors

Mental Healthand Social

Support

Trust in HealthSystem andResearch

EducationalOpportunity

Respect forLanguage andOther Cultural

Factors

LowerEnvironmental

Risks

Freedom fromDiscrimination

Promotion of Healthy

Behaviors

REACH 2010

Racial and Ethnic Approaches to Community Health

– National Goal: By the year 2010, eliminate disparities in health status experienced by racial and ethnic minority populations

– Funding through the Centers for Disease Control and Prevention

6 REACH PRIORITY AREAS

Cardiovascular Health

HIV/AIDS Immunizations

Infant MortalityBreast and

Cervical HealthDiabetes

25 REACH 2010 Communities Nationally

REACH 2010 SEATTLE & KING COUNTY

MISSION– “The mission of the REACH Coalition is to

reduce diabetes health disparities experienced by communities of color. Through strong partnerships, we will support the empowerment of individuals, families, and communities, and create sustainable long-term approaches to prevention and control of diabetes utilizing all appropriate community resources in King County.”

MULTIPLE CULTURES WORKING TOGETHER TO REACH FOR HEALTH

REACH COALITIONAfrican AmericanAsian American/Pacific Islander AmericanLatino/HispanicEuropean American

LOCAL REACH HISTORY

PHASE I ACTIVITIES1999 - 2000

– Coalition Development– Community Assessment– Community Action Plan

REACH PHASE II

2000 - 2007 (and beyond?)Continued Coalition DevelopmentImplementation of Community

Action Plan (CAP)Evaluation, Feedback, Revisions

and Reporting

REACH COALITION DEVELOPMENT

Multi-Cultural FocusAttention to membership

– over 70 agencies and individuals

TrainingBi-Monthly meetingsCoalition Structure

Coalition Challenges and Solutions

Multiple Cultures and Languages

Differences of Opinion

Distribution of Funds Authority Hierarchy

7 Languages, Hire Bilingual/Bicultural Staff, Listen and Learn

Consensus Decision Making; Bring Concerns back to the Coalition - (Ops)

Coalition Selection Committee

Process Discussion; Take Backseat

REACH STAFFING

REACH Coalition Members Principal Investigator (PI) Program Manager Community Liaisons Peer Educators Evaluation Manager Evaluator Interviewers Researchers Case Coordinators Administrators and Administrative Support Expert presenters and Interpreters

COMMUNITY ACTION PLAN ELEMENTS

Interventions conducted by sub-contracting community agencies

Support GroupsEducation ClassesSelf Management ClassesEnhanced Diabetes Registry useCase CoordinationCommunity CampaignsEvaluation

SUPPORT GROUPS

Emotional SupportShared ExperiencesShared ResourcesDealing with discriminationTips for talking about diabetes

– family– providers– friends– each other

EDUCATION CLASSES

Physical ActivityNutritionMarketingWeight ManagementGlucose testingOther topics

SELF MANAGEMENT CLASSES

Self care focusIncreasing self-efficacyIncreasing provider-

patient communication by patient initiative

ENHANCED DIABETES REGISTRY USE

Tracking of– HbA1c– blood pressure– eye exams– foot exams– urine tests– referrals

CASE COORDINATION

Complete diabetes registryCommunicate with providersCommunicate with patients about

recommended procedures for them

Refer patients to community activities and resources

COMMUNITY INTERVENTIONS

Grocery StoresRestaurantsFaith SettingsPharmaciesWork SitesMedia

EVALUATION

Coalition Member InterviewsParticipant SurveysFocus GroupsKey Informant InterviewsCommunity Documentation

REACH CULTURAL COMPETENCE

Coalition MembershipStaffingListening to ParticipantsLanguage CapacityLiterature and TrainingCommunity Feedback

REACH LIMITATIONS

Only King CountyOnly DiabetesNative Americans Not ParticipatingLimited Language CapacityLimited Geographic Scope

SUSTAINABILITY

Integrate activities into existing service system– Registry– Groups and Classes

Train peer educators and encourage continued work

Community network establishmentSeek additional fundingREACH may be instituted as ongoing

CDC program

HOPES AND PLANS

Focus on Healthy Families/Healthy Communities

Continue Diabetes WorkExpand to Other Chronic Disease

Prevention, Environment FocusConvince Funding Agencies and Policy

Makers to Support EffortsReduce/Eliminate Health Disparities

Over Time

AVOID COMPLICATIONS

Neuropathy / Amputations

Kidney Disease / Renal Failure

Heart Disease

Blindness

ELIMINATE RACIAL/ETHNIC DIABETES HEALTH DISPARITIES

INCREASE HEALTH AND WELL BEING

WHAT MIGHT YOU DO TO INCREASE YOUR CULTURAL COMPETENCE AND HELP TO ELIMINATE

HEALTH DISPARITIES?

Open your empathetic heart to humans of other hues

Recognize power differences and how they affect you

Learn what your own biases are and channel them in a positive direction

Discuss racism with friends/family, & how to prevent discrimination

Speak out against discrimination when you see it

Make your health/wellness practice one that welcomes all and/or targets the disenfranchised

Join a local coalition or community group with relevant goals

Be willing to learn