09/06/2013 03:23 pm ET Updated Nov 06, 2013

Diabetes and Development: A New Approach for Community Health

Much has been written about poverty and its effects on diabetes and obesity. Just a few weeks ago, Mark Hyman, MD, tackled this issue in a cohesive and informative discussion entitled, "The Link between Poverty, Obesity & Diabetes." Several years ago government and health care professionals warned that diabetes and obesity would reach alarming proportions. They were right! It has reached epidemic proportions and is now predominately a disease of "poverty."

Dr. Hyman suggested initiatives and ideas that "may help shift the tide of poverty and disease" are sensible and should be acted upon. The challenge, in my view, is finding the path to get there. The answer could very well be community activism -- the same strategy that gave us the civil rights movement.

Eighteen months ago, I took my first steps to becoming a community health care 'activist' when I joined a conversation called New Performances of Diabetes Development. It was conceived by community activist, Lenora Fulani, PhD, Dean of the multi-faceted learning center UX, and co-chair Susan Massad, MD, a primary care physician and community health activist. UX -- an initiative of the All Stars Project, Inc., (ASP), is a non-traditional university center for learning and development. Its guiding principle is that everyone can develop and learn new things. All classes are free.

Many of those participating have diabetes or know someone who does. We listened in rapt attention as Dr. Spyros Mezitis, well-known New York City diabetes specialist, painted a frightening, depressing, and seemingly hopeless picture for diabetes and obesity. Unfortunately, his canvas showed that the disease manifested at epidemic proportions among the poor.

Like Dr. Hyman, Dr. Mezitis outlined the reasons, and offered some solutions. "Yet," he noted, "despite significant advances in research, clinical academic circles and the pharmacological industry, the epidemic progresses unabated." However, there was a glaring omission -- the community that's impacted the most -- poor people. The challenge was getting this group to participate in a conversation about an issue that disproportionately affects their health and lives. A paradigm shift was crucial if we wanted to see change.

Both Dr. Fulani and Dr. Massad emphasized the only way the community could become effective was through learning and development. Dr. Massad noted that people with diabetes don't see an epidemic but views it as an individual issue because it's something they've done wrong. As such, they don't want to talk about it because "it's my problem." There was a discrepancy -- while everyone sees the disease as a medical issue, it's really "a disease of the community."

This was a significant insight for me. For several years I worked on community health projects funded by the public and private sectors to reach people in underserved communities. My team used traditional and non-traditional marketing techniques to educate our target audiences. Community access and involvement were strategies we used successfully given our limited resources. Now, I was intrigued by the concept of learning and development to effect lasting change. My decision to become an active participant in New Performances of Diabetes Development was easy.

Along with fellow "performers" we're creating a 'development' strategy that would ask hard questions such as:

  • what do people need to develop as better eaters and better movers to make healthier choices in their lives?
  • how is the activity of groups of people playing a more active role in shaping their own lives and that of their communities developmental?
  • how is participating in changing the conditions of health and illness in our communities developmental?

Our monthly meetings give people with diabetes a 'safe' place to share their struggles. One poignant moment stands out in my mind. Jesse admitted that she craved sugary donuts as snacks. Her husband convinced her not to succumb to the bad habit by providing a healthier alternative. Another person teams up with a neighbor for morning walks. Imagine communities around our city organizing to help each other become healthier.

Development underscores the learning process on group outings. At ASP/UX we encourage people to leave their comfort zones in order to have new experiences. That's why on a cold, rainy Saturday morning about 15 of us met at the American Museum for Natural History. We were there to tour the exhibit -- Our Global Kitchen: Food, Nature, and Culture.

A few weeks later, about 20 of us boarded Metro North for an outing to Mt. Kisco, a bedroom community outside of New York City. Our hostess, an UX board member designed an itinerary that included a visit to a farmer's market. Most of the day was spent at a Child Care Center with an innovative approach to learning and development. Their Feed Me Fresh Nutrition Program is a year-round garden to table nutrition program offering the children a hands-on approach to healthy eating and nutrition education. With the help of a team of nutritionists, farmers and chefs, the center has created a curriculum that builds a natural appreciation for fresh, whole food.

While there, our group feasted on a healthy meal made with organic produce from local farms. One of the local farmers was on hand to answer questions, and offer tips on how to find healthy, affordable food.

One might ask -- what does all this have to do with the treatment of diabetes? For one thing, we're experiencing our world as bigger, more interesting and exciting than many had originally imagined. It's a world of wonder that offers endless possibilities.

Already, we're seeing changes in our group. Participants are exposing new people to our monthly meetings. Many had complained about finding fresh, produce in their communities. Others are sharing locales to find farmer's markets close to their homes. Many have begun walking.

This is reminiscent of the civil rights movement that started with one woman. She helped change the nation. Imagine what we can accomplish as we continue to learn, grow and develop together. We'll have a voice to make demands for what's best for our communities!

As Dr. Massad points out, "We cannot expect, wait for or count on the powers that be, for example, the government to take care of this. It is a question of the people putting pressure from the bottom-up to create change. This is what Performing and Developing beyond Diabetes is all about."

For more information on the program, Performing and Developing beyond Diabetes, UX and THE ALL STARS PROJECT, please visit us at