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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

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reach 2010 seattle king county

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
Acknowledgment

Mike Smyser, MS, Epidemiologist

Epidemiology, Planning & Evaluation

Public Health – Seattle & King County

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

Year 2010

target 78

per 1 million

persons

slide7
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
WASHINGTON STATE DIABETES DEATH RATES BY RACE AND AGE

Rates are per 100,000 population

Source: Washington Center for Health Statistics

eliminating health disparities what will it take
Eliminating HealthDisparitiesWhat will it Take?

Freedom from

Discrimination

Promotion of

Healthy

Behaviors

Access to

Health

Services

Trust in Health

System and

Research

Mental Health

and Social

Support

Reduced

Stress due

to Social

Factors

Economic

Opportunity

and Equity

Lower

Environmental

Risks

Educational

Opportunity

Respect for

Language and

Other Cultural

Factors

reach 2010
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 Mortality

Breast and Cervical Health

Diabetes

6 REACH PRIORITY AREAS

25 REACH 2010 Communities Nationally

reach 2010 seattle king county13
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.”
slide14

MULTIPLE CULTURES WORKING

TOGETHER TO REACH FOR HEALTH

REACH COALITION

African American

Asian American/

Pacific Islander

American

Latino/Hispanic

European American

local reach history
LOCAL REACH HISTORY
  • PHASE I ACTIVITIES
  • 1999 - 2000
    • Coalition Development
    • Community Assessment
    • Community Action Plan
reach phase ii
REACH PHASE II
  • 2000 - 2007 (and beyond?)
  • Continued Coalition Development
  • Implementation of Community Action Plan (CAP)
  • Evaluation, Feedback, Revisions and Reporting
reach coalition development
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

Coalition Challenges and Solutions
reach staffing
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
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
SUPPORT GROUPS
  • Emotional Support
  • Shared Experiences
  • Shared Resources
  • Dealing with discrimination
  • Tips for talking about diabetes
    • family
    • providers
    • friends
    • each other
education classes
EDUCATION CLASSES
  • Physical Activity
  • Nutrition
  • Marketing
  • Weight Management
  • Glucose testing
  • Other topics
self management classes
SELF MANAGEMENT CLASSES
  • Self care focus
  • Increasing self-efficacy
  • Increasing provider-patient communication by patient initiative
enhanced diabetes registry use
ENHANCED DIABETES REGISTRY USE
  • Tracking of
    • HbA1c
    • blood pressure
    • eye exams
    • foot exams
    • urine tests
    • referrals
case coordination
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
COMMUNITY INTERVENTIONS
  • Grocery Stores
  • Restaurants
  • Faith Settings
  • Pharmacies
  • Work Sites
  • Media
evaluation
EVALUATION
  • Coalition Member Interviews
  • Participant Surveys
  • Focus Groups
  • Key Informant Interviews
  • Community Documentation
reach cultural competence
REACH CULTURAL COMPETENCE
  • Coalition Membership
  • Staffing
  • Listening to Participants
  • Language Capacity
  • Literature and Training
  • Community Feedback
reach limitations
REACH LIMITATIONS
  • Only King County
  • Only Diabetes
  • Native Americans Not Participating
  • Limited Language Capacity
  • Limited Geographic Scope
sustainability
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
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
AVOID COMPLICATIONS

Heart Disease

Blindness

Neuropathy / Amputations

Kidney Disease / Renal Failure

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

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