Interim Report:
Proposed Recommendations for Action

A National Public Health Initiative on Diabetes and Women's Health

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Executive Summary

Diabetes is a serious public health issue affecting more than 17 million Americans, more than half of whom are women. With the increasing life span of women and the rapid growth of minority racial and ethnic populations in the United States (who are hardest hit by the diabetes burden), the number of women at high risk for diabetes and its complications will continue to increase, placing added demands on the health care delivery system and on other sectors of society. The estimated cost of diabetes to the United States for direct health care and other indirect expenditures is about $100 billion annually.

In 2000, the Centers for Disease Control and Prevention (CDC) established the National Public Health Initiative on Diabetes and Women’s Health, which has three phases. In Phase I, Diabetes & Women’s Health Across the Life Stages: A Public Health Perspective was prepared. This report, published in 2001, examines the issues that make diabetes a serious public health problem for women; analyzes the epidemiologic, psychosocial, socioeconomic, and environmental dimensions of women and diabetes; and discusses the public health implications. In Phase II, the information contained in the Phase I report was converted into an interim report containing recommendations for needed strategies, policies, disease tracking, and research to improve the lives of women diagnosed with or at risk for diabetes. Phase III will involve preparing and implementing the National Public Health Action Plan on Diabetes and Women’s Health. This final phase of the Initiative will translate the recommendations into concrete operational programs and policies for relevant agencies and organizations.

This interim report culminates Phase II and was prepared jointly by four cosponsoring organizations: CDC, the American Diabetes Association (ADA), the American Public Health Association (APHA), and the Association of State and Territorial Health Officials (ASTHO). The purpose of this report is to offer priority recommendations for responding to diabetes as a prominent public health issue for women and to garner the attention of policy makers, public health professionals, other advocates for women’s issues, researchers, and the general public. In particular, this document provides recommendations for persons charged with making decisions and affecting policies related to diabetes and women’s health.

This interim report outlines the vision and goals for the National Public Health Initiative on Diabetes and Women’s Health, guiding principles, a public health framework, and a life stage approach for addressing diabetes and women’s health. These life stages are the adolescent years (ages 10-17 years), the reproductive years (ages 18-44 years), the middle years (ages 45-64 years), and the older years (ages 65 years and above). Many of the recommendations for public health action pertain to all women, regardless of life stage; others are life stage-specific. While the emphasis is specifically on women’s health, adopting and implementing many of the recommendations will improve the health and well-being of men and families as well.

The ultimate vision is a nation in which:

• diabetes among women is prevented whenever possible,
• early diagnosis and appropriate management of diabetes among women is promoted across the life stages,
• the occurrence of complications from diabetes among women is prevented, delayed, or minimized, and
• women at risk for diabetes are provided the family and community support needed to prevent diabetes and its complications.

The underlying principles support:

• a public health approach,
• collaboration within and between multiple sectors of society,
• consideration for the unique needs of different life stages among racial, ethnic, religious, and cultural groups,
• full engagement of women and grassroots organizations,
• shared accountability by state and community leaders,
• actions based on sound research,
• measurable outcomes with which to evaluate progress, and
• sustainability of strategies and policies over time.

Several key strategy and policy recommendations pertaining to women of all ages call for:

• strengthening advocacy on behalf of women with or at risk of diabetes,
• increasing awareness among the general public about the seriousness and preventability of diabetes in women,
• expanding community-based health promotion education, activities, and incentives for women of all ages in a wide variety of settings, such as schools, workplaces, senior centers, churches, civic organizations, and others,
• integrating diabetes messages and prevention activities within the larger context of chronic disease prevention and health promotion,
• enhancing community development policies and practices (including “smart growth” initiatives and empowerment zones) that promote safe environments for physical activity,
• increasing availability and access to healthy food choices for all sectors of the population,
• supporting policies and programs in schools and workplaces that respect the health-related needs of their female students and employees, particularly women with or at risk for diabetes,
• increasing the capacity of community programs to develop and disseminate “best practices” and lessons learned,
• assuring access to trained health care providers who offer quality services to prevent and manage diabetes among women of all ages, and
• expanding public and private health insurance packages to provide adequate coverage for preventive care, including health promotion, health and nutritional education, physical activity, self-management, and screening for complications among women diagnosed with diabetes.

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