The financial costs and suffering caused by diabetes are increasing rapidly in New Jersey and nationwide, and a new report says a wide range of legislative actions and social changes are needed to ensure that fewer people become diabetic or experience serious health complications from the disease.
About 700,000 state residents, or 9 percent of the population, have diabetes, according to a reportby Harvard Law School’s Center for Health Law and Policy Innovation. The disease is being diagnosed with increasing frequency, with 9.1 new cases per 1,000 people in 2010 compared to 4.6 per 1,000 in 1996.
State Senate President Stephen Sweeney, who was diagnosed with diabetes when he was 50, noted that the report projects the number of state residents with the disease will double by 2025, at an eventual cost of $14.5 billion a year, including lost productivity.
“This is a really tough disease,” Sweeney, 54, said at the PATHS New Jersey Diabetes Leadership Forum held in Trenton last week. “Those are real numbers, and it impacts the economy. The fact that there’s a focus on this now is critical because the clock’s ticking and more and more people every year are diagnosed.”
Diabetes is a disorder of blood-sugar regulation that can increase the risk of heart attacks and strokes and cause vascular damage that results in blindness, kidney failure, and foot and leg infections that lead to amputation. It is a leading contributor to rising healthcare costs.
Gov. Chris Christie signed a measure in August requiring studies of the impact of diabetes on state programs and recommendations for changes from the Department of Health. But the authors of the new report, Amy Katzen and Allison Condra of the CHLPI, say that much more must be done to stem the disease.
Their recommendations include giving more staff and funding to the departments of Health, Education, and Children and Families to address diabetes; making it easier for poor residents to get food assistance, particularly to buy fruits and vegetables; improving access to farmers markets and stores that sell healthy foods; insurance reforms; weight-loss programs; and improving school lunch programs and health screenings.
The report, which was sponsored by the Bristol Meyers Squibb Foundation, also says the state should boost support for farmers, promote Complete Streets efforts that encourage towns to make it easier for residents to walk and bike, encourage towns to offer physical activity programs, and work to increase health-insurance enrollment.
Katzen and Condra acknowledged that getting more funding and making changes in so many areas — farming, public education, medicine, Medicaid, transportation, streetscapes and the retail grocery business, among others — will take years, but they said the conference aimed to help people who already work on these issues see their common goals and help them begin lobbying for improvements.
“We’re hoping they’ll be able to use the report to identify priorities,” Condra said. “Also, we’re hoping they’ll begin to recognize ways that they as a community can move forward on this.”
Link between disease and diet
One topic discussed by conference participants was helping poor families get better access to healthy food, since people with healthy diets have lower rates of diabetes and experience fewer of the adverse consequences.
Reforms could include expanding the number of people eligible for SNAP, the federal food-stamp program, to include those with incomes of up to 200 percent of the poverty level, as well as expanding SNAP office hours and funding incentive programs that make SNAP benefits worth more at farmers markets, the report says.
Currently only 60 percent of eligible state residents participate in SNAP and WIC, another federal food program, according to the report. New Jersey has 25 percent fewer supermarkets than any other state. And there are only 1.5 farmers markets per 100,000 residents, the lowest rate in the mid-Atlantic region, with many of them located far from public transportation.
Efforts to improve diet and health are already under way in some towns, including Camden, where Campbell Soup Co. is spending $10 million over 10 years on an effort to reduce childhood obesity and hunger and develop methods that can be used elsewhere.
“We’re working on a pretty in-depth program of several strategies, specific to food, physical activity, nutrition education, public will — educating the public — and then we’ll take our program to our other hometown communities around the country,” Kim Fremont Fortunato, director of Campbell Healthy Communities, said during a panel discussion.
The effort in Camden is already seeing some successes, including a program that brings fruits and vegetables to 30 corner stores and seems to be improving business at the stores, she said. The initiative is also adjusting to setbacks, such as low interest in mobile produce trucks, and working on a number of complicated questions such as how to make urban gardens financially viable, how to get their produce into stores, and how to make parks safe for kids seeking physical activity.
In the broad area of diabetes management, Katzen said it is critical that state residents have health insurance and praised Christie’s decision to accept an expansion of Medicaid to cover more people.
She also outlined a number of ideas that should be used more widely, including a weight-loss regimen that helps prevent at-risk individuals from getting diabetes, self-management education to teach people to control the disease, face-to-face care management for patients with multiple diseases, and bigger roles for pharmacists and community health workers.
Katzen cited one specific problem that makes managing diabetes difficult — insurance companies frequently change the brands of glucose strips they cover. Katzen said some diabetics must check their blood-sugar levels several times a day, but they often find that their insurer has changed which company’s testing system is covered.
“People will come in to their doctor with a bag of strips and meters and they have no idea which one goes with what because the covered brand changes so many times, so they’re just lost. That seems so unnecessary,” she said. “We’re very interested in working to identify ways to reduce the frequency of those changes.”
Katzen and Condra said they planned to ask conference participants, who represented a variety of state and local agencies, healthcare providers and nonprofit organizations, to identify a subset of priorities with the goal of pushing to make changes in those areas in the next year.
The Center for Health Law and Policy Innovation will also be issuing a similar diabetes report for North Carolina this year, and will later put out two reports on state “best practices” and recommendations at the federal level, they said. The center will continue to work in New Jersey, providing technical and research assistance to organizations working on diabetes issues.