The catastrophic ways chronic disease — especially diabetes — fueled COVID deaths and complications should by now have compelled the nation to widely implement proven strategies known to prevent and control such conditions. But despite all the official talk about “health disparities,” the American Recovery Plan does not require states to address chronic disease in any way. And so, states are just widely letting these diseases — with their terrible impact on low-income and working-class communities — continue to fester.
Consider: In the first COVID surge, New York City sustained a staggering 356% increase in diabetes deaths, the most in the nation and the largest increase of any state. The city has had $4 billion in recovery funds since May, now raised to $5.9 billion, and the state has $12 billion, but neither has spent a recovery penny to bring proven diabetes prevention and self-care education to neighborhoods that need this help so badly.
Instead, in March 2020, just as the pandemic struck, New York State revoked promised funds which would have continued the only community diabetes self-care program in the Bronx’ 15th Congressional District, which Rep. Torres represents and where Norwood’s Health People is based — a district with the worst health disparities of New York’s 62 counties.
The Diabetes Self-Management Program (DSMP), as the six-session course is known, is documented to help people with type 2 diabetes lower their blood sugar and avoid multiple complications through strategies to improve their nutrition — such as reading labels to avoid the extraordinary levels of sugar in the American food supply. Studies from around the world have shown that when people with diabetes did contract COVID, having lower blood sugar slashed their deaths and complications, yet the state hasn’t restored this life-saving program in our district.
The fight against chronic disease begins with diabetes because it is both the most widespread disease in the United States (34 million people are known to have it) and the gateway to the nation’s massive ill health. Diabetes worsens heart disease and high blood pressure, increases the risk of Alzheimer’s, and drives almost half of kidney failure requiring dialysis. The defunded self-management program, among other things, reduces new cases of kidney disease by 90% in the first year among participants.
And diabetes is a disease singularly improved by good patient education that low-income communities can rapidly and effectively provide. Health People trained low-income people to become peer leaders who engaged almost 2,000 Bronx Medicaid recipients in sites like public housing, churches, shelters and food pantries before being defunded. At homeless shelters, the New York City Department of Health found that emergency room visits for participants fell by 45% in six months.
The systematic racism and classism that drives these huge failures are too clear, but there is something else at work. The American medical industry seems to almost regard sick low-income people as commodities. Huge industries have been built off them. Dialysis alone is a $35 billion annual industry, with lobbyists protecting its interests.
More people, especially Black and Brown and poor people, are sicker than ever in the wake of COVID lockdowns, isolation and stress-eating. Medical centers around the nation are now reporting that, during COVID, diabetes-related lower limb amputations have increased anywhere from 50 to 1000%. But neither Medicaid or Medicare will pay for any of the more than 20 community-based strategies and education protocols shown to help lower blood sugar. They will pay the $70,000 to $250,000 a major amputation can cost but not $900 to educate patients in self-care practices that can save their feet.
Why not?
And while children aren’t supposed to get “adult-onset” Type 2 diabetes, hospitals in Washington and New Orleans saw new cases of Type 2 diabetes for patients under age 20 double, citing pandemic lockdowns and restrictions on youth activity. They reported these kids are sicker than “normal” — so sick that standard medications often don’t work.
The federal government must focus recovery monies on fighting diabetes on every front, providing better access to exercise and nutritious food, improved clinical care and proven preventive education for all who want it. And it must stop subsidizing soda and sugary drinks — the worst sources of sugar — via its indefensible policy of paying billions annually for them through the Supplemental Nutrition (SNAP) program.
We are encouraged that Mayor-elect Eric Adams, who lost weight, changed his diet and reversed his diabetes when faced with the prospect of losing his eyesight, understands that the fight must begin by enabling community groups in diabetes-stricken neighborhoods to train and field local educators who have the credibility — and determination — to reach thousands of people who have almost given up hope that improved health is possible for them.
Torres represents Bronx’ 15th Congressional District. Norwood is the executive director of Health People, based in Torres’ district.
