REACH 2010 Seattle & King
County
Cheza Collier, PhD, MPH, MSW
Public 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, Epidemiologist
Epidemiology, Planning & Evaluation
Public Health – Seattle & King County
OBJECTIVES
 Review diabetes disparity
information
 Learn 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
1800
White, non-Hispanic
1600
1400
African descent, nonhispanic
1200
1000
American
Indian/Alaska Native
800
600
Asian American /
Pacific Islander
American
400
200
Hispanic, any race
0
0-44
45-64
65-74
Rates are per 100,000 population
Source: Washington Center for Health Statistics
75+
All Ages
KING COUNTY DIABETES DEATH
RATES BY RACE AND GENDER
45
African Am - M
African Am - F
35
30
Hispanic - M
25
20
15
White - M
Hispanic - F
Asian - M
White - F
Asian - F
10
5
92-96
91-95
90-94
89-93
88-92
87-91
86-90
85-89
84-88
83-87
82-86
81-85
0
80-84
Age-Adjusted Rate per 100,000
40
Freedom from
Discrimination
Trust in Health
System and
Research
Promotion of
Healthy
Behaviors
Eliminating
Health
Disparities
Access to
Health
Services
Mental Health
and Social
Support
Reduced
Economic
Stress due
Opportunity
to Social
and Equity
What will it Take?
Factors
Lower
Respect for
Educational
Environmental
Language and
Opportunity
Risks
Other Cultural
Factors
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
25 REACH 2010 Communities Nationally
 Cardiovascular
Health
 HIV/AIDS
 Immunizations
 Infant Mortality
 Breast and
Cervical Health
 Diabetes
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 COALITION
African American
Asian American/
Pacific Islander
American
Latino/Hispanic
European American
LOCAL REACH HISTORY
PHASE I ACTIVITIES
1999 - 2000
– Coalition Development
– Community Assessment
– Community Action Plan
REACH PHASE II
2000 - 2007 (and beyond?)
Continued Coalition
Development
Implementation of Community
Action Plan (CAP)
Evaluation, Feedback, Revisions
and Reporting
REACH COALITION
DEVELOPMENT
Multi-Cultural Focus
Attention to membership
– over 70 agencies and individuals
Training
Bi-Monthly meetings
Coalition 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 Groups
 Education Classes
 Self Management Classes
 Enhanced Diabetes Registry use
 Case Coordination
 Community Campaigns
 Evaluation
SUPPORT GROUPS
 Emotional Support
 Shared Experiences
 Shared Resources
 Dealing with discrimination
 Tips for talking about diabetes
– family
– providers
– friends
– each other
EDUCATION CLASSES
Physical Activity
Nutrition
Marketing
Weight
Management
Glucose testing
Other topics
SELF MANAGEMENT
CLASSES
Self care focus
Increasing self-efficacy
Increasing 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 registry
Communicate with providers
Communicate with patients
about recommended procedures
for them
Refer patients to community
activities and resources
COMMUNITY INTERVENTIONS
Grocery Stores
Restaurants
Faith Settings
Pharmacies
Work Sites
Media
EVALUATION
Coalition Member Interviews
Participant Surveys
Focus Groups
Key Informant Interviews
Community Documentation
REACH CULTURAL
COMPETENCE
Coalition Membership
Staffing
Listening to Participants
Language Capacity
Literature and Training
Community Feedback
REACH LIMITATIONS
Only King County
Only Diabetes
Native Americans Not
Participating
Limited Language Capacity
Limited Geographic Scope
SUSTAINABILITY
 Integrate activities into existing
service system
– Registry
– Groups and Classes
 Train peer educators and encourage
continued work
 Community network establishment
 Seek additional funding
 REACH may be instituted as ongoing
CDC program
HOPES AND PLANS
 Focus on Healthy Families/Healthy
Communities
 Continue Diabetes Work
 Expand to Other Chronic Disease
Prevention, Environment Focus
 Convince Funding Agencies and
Policy Makers to Support Efforts
 Reduce/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
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DIABETES HEALTH DISPARITIES AND CULTURAL …