Tillamook shows how a community can address chronic disease

a tub of fresh vegetables from a food coop

Quick Summary

In Oregon, 1 in 3 adults has prediabetes, based on CDC estimates. That’s more than one million people across our state. Clearly, something bigger is going on than a few people making unhealthy choices. Addressing it will require something bigger, too. That’s exactly what’s happening right now in Tillamook County, where local partners are reshaping their community so it’s easier for people who live there to lead healthy lives.

We tend to equate a diagnosis of prediabetes or diabetes with a lack of knowledge or willpower. There’s too much shame and blame when people talk about diabetes, a serious and life-altering chronic disease. We make it so personal.

Prediabetes and type 2 diabetes are too widespread in our state and nationally to be chalked up to individual “failings.”

In Oregon, 1 in 3 adults has prediabetes, based on CDC estimates. That’s more than one million people across our state. Add to that 287,000 adults who already have type 2 diabetes. Clearly, something bigger is going on around us, in our communities, than a few people making unhealthy choices.

A graph showing the percentage of Oregon adults living with obesity versus diabetes from 1990 to 2010. The graph shows obesity has been increasing alongside diabetes, with obesity at a higher rate.
Type 2 diabetes is tied to obesity. Since 1990, both have more than doubled in Oregon.
Source: Oregon Diabetes Report Jan. 2015

One way to approach this challenge is to look at who in Oregon has—or doesn’t have—access to healthy and safe food, parks and housing, plus a good education and the opportunity to earn a decent paycheck. And what has led to lack of access to these key factors for good health? Our racist systems and policies, discrimination and targeting by industry have all contributed to Black, Indigenous, tribal communities and people of color in Oregon experiencing disproportionately higher rates of diabetes and obesity.

Students at Tillamook Junior High School practicing corn hole during P.E.

Addressing it will require something bigger than looking at one or two factors at a time. Fortunately, that is exactly what’s happening right now in Tillamook County.

In this part of Oregon’s North Coast, rich with beaches, forests and dairy farms, more than 40 local partners have come together to change their community in fundamental ways. To reduce the number of residents who live with prediabetes and diabetes, this coalition is reshaping Tillamook County so it’s easier for people who live there to lead healthy lives.

“We’ve long understood what we need to be doing differently to be healthier, and for a variety of reasons, it’s been really hard to actually achieve those goals,” said Michelle Jenck, wellness coordinator for Tillamook County Community Health Centers.

Tillamook decided that the priority for their community would be to address the “huge disconnect between what we should be doing and what we are doing,” Jenck said. “How could we as a community step up and fill that gap?”

A leading risk factor for diabetes and other chronic diseases is obesity, which affects nearly 30% of Oregonians. Obesity is driven by poor nutrition and a lack of physical activity. To reduce diabetes and other chronic diseases in our families and communities, we have to make sure more people have the opportunity to eat better and move more every day.

In Tillamook, partners are expanding those opportunities by working together to improve basic societal systems that shape people’s everyday lives. Partners include businesses, schools, government agencies and other organizations.

For example, Food Roots, a nonprofit, is strengthening the local food system to make it more affordable and convenient for residents, especially those with lower incomes, to make fresh vegetables and fruit a regular part of their diet.

In the school system, leaders at Tillamook School District #9 are promoting and supporting wellness efforts for teachers and staff, which also benefits the students in their care. (See more of their story in this video.)

And those examples are just the start.

It’s important, especially if you have a risk factor, to get tested for prediabetes. But the Tillamook partners recognize that it’s not enough to tell people to take a test, eat better and move more. Not when so many Oregonians face barriers to health in the places where they live, work, learn, play and age. Our communities must change, too.

That means making sure that all people have access to the basic components of health: Not just healthy food and nearby parks, but also safe housing, clean air, health care, good education and the opportunity to earn an income that can support a family. It’s all connected, and it all connects to our health.

So much of what people read and hear about diabetes, online and even in doctors’ offices, leaves them feeling guilty and ashamed. That’s not fair. A diabetes diagnosis is not a statement about someone’s moral character. It’s a reflection of how hard it can be to be healthy in our own communities. Tillamook County is showing us that communities, working together, can also make it easier.

Dr. Catherine Livingston checking a patient's blood pressure
Dr. Catherine Livingston from OHSU’s Richmond Primary Care Clinic checking her patient’s blood pressure.

Learn more:

Kaitlyn Lyle, MA, is the diabetes program coordinator for the Oregon Health Authority’s Health Promotion and Chronic Disease Prevention section.


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