Large outdoor garden

Reversing prediabetes together

Poor nutrition and lack of physical activity are two significant drivers of prediabetes, a medical condition that fuels type 2 diabetes and other chronic diseases. About 30% of Oregon adults live with obesity. More than one in 3 have prediabetes. The good news: We can reverse prediabetes before it becomes diabetes. But we can’t do it with doctor’s visits and diets. Instead, everyone has a role to play in redesigning our communities to enable more Oregonians to make healthier choices about what to eat and how much to move.


How place matters to our health

  • Social conditions

    Many working Oregonians don’t earn enough to pay for basic needs. After rent and utility bills, some don’t have enough left to buy fresh and less-processed foods, which can cost more.

    Education, income,
    discrimination and structural
    racism are among the social conditions that can limit or
    expand a person’s ability to live a healthy life.

    Three people standing on boxes trying to grab apples from a tree. First person is the tallest with the shortest box. Second person is at middle length with the middle length box. Third person is at the shortest length with the highest box. All three people are able to grab apples from the tree.
  • Physical settings

    Some research suggests that living in a walkable neighborhood makes it less likely you will live with obesity or develop diabetes.

    The locations where we live,
    work, learn, play or age, such as
    our homes, neighborhoods, workplaces, schools, parks,
    senior centers and public spaces, help determine how healthy we
    can be.

    A neighborhood showing a house next to an apartment building next to an office building.
  • Industry practices

    Sugary drink companies target specific communities. African American kids and teens see more than twice as many TV ads for sugary drinks compared with their white counterparts.

    Companies sell things—they always have. But today, kids are surrounded by marketing that pushes harmful products, while low-income adults and communities of color are specifically targeted.

    An outdoor billboard showing a sugary drink advertisement for
  • People power

    Enabling people to use federal nutrition assistance (like food stamps) at farmers markets helps lower-income Oregonians eat a healthier diet with more fruits and vegetables.

    Governments, communities and voters can change policies and environments in ways that make
    it easier or harder to make healthy choices.

    A group of diverse people speaking up at a forum


  • Open Video Modal

    Michelle Jenck:
    We attracted not only our health care partners who were already obviously part of doing that kind of work in the community, but we brought in other community partners that were in the food systems or in providing community programming around health and wellness, like the YMCA and OSU Extension. We also attracted private business and other organizations and sectors like the schools. Everybody wanted to be part of it and they all stepped up in some way, shape or form to participate at some level.

    The decision to focus on prediabetes was largely centered around the fact that the same community health indicators, the same health behaviors, the same health equity concerns and the same social determinants of health influence a lot of chronic diseases, whether they be diabetes, cancer, heart disease, stroke. 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. So, the effort that we identified as a priority in our community was really intended to address the fact that there is this huge disconnect between what we know we should be doing and what we are doing, and how could we as a community step up and fill that gap?

    Lauren Sorg:
    Our community members are facing so many barriers on top of barriers, on top of barriers that access to food gets lowered down on the priority list for parents that are trying to keep their lights on or that have other bills to pay.

    We provide these spaces for consumers to come in and access the food. So, like our farm table store front, we have a farm share program so that is a weekly subscription box that anyone could sign up for. We’ve got three local farms that deliver the products to our storefront and then the community member signs up their family and themselves and they come on a once a week basis and pick up their food. We’ve expanded that program to meet the needs of low-income community members by providing a hundred dollars off for SNAP families to be able to have a farm share box.

    Curt Shelley:
    So, in Tillamook the school is the focal point of the larger community. And when I say that, what I mean is that there are so many things that go on here and it’s a great opportunity for us to promote wellness, to promote health, to promote emotional and physical wellness. And it’s really nice, the support and the collaboration that we get from other organizations around community.

    Health means something different to all people. And for some people it’s weight loss or some people it’s healthy cooking, for some people it’s socialization, and so it’s different for all people. And so we’ve put as many things together that we could put together to allow people to become involved and participate.

    Michelle Jenck:
    Behavior change is heavily influenced organically. What people see and observe around them is what they tend to do. It’s just how we’re wired. And so creating the conditions in the community that influence behavior in that organic way is really what we strive to do.

    Curt Shelley:
    So we’ve noticed that when you’re well you want to come to work and we’ve also noticed that we have less absences on Wednesdays, and we would like to think that that might be because of some of the Wellness Wednesday things that we have going on and motivational things through wellness.

    Michelle Jenck:
    Encouraging people to understand how changing their relationship with food, changing their relationship with being active, changing their relationship with how they interact with each other in their family unit, at work, in the community can be done in a way that’s health promoting. And an extension of that is that they are likely to lose some weight and they are likely to experience some potentially significant improvements in their health indicators as a result of that.

    Lauren Sorg:
    I couldn’t think of any better work. I mean, food is life. I mean, food and water, you need those things. And so to be able to work in community food systems and work with students, babies all the way up into senior citizens, you’re providing this opportunity for them to really grow and love in the community that they belong to.

    Michelle Jenck:
    To connect people in ways that might not seem obvious to them that they are health promoting, and that’s really the goal. We want this to be something that is a natural extension of their day to day life, it becomes their default because it’s just the way that the community is shaped, it’s how people here live.

    Partners create a healthier Tillamook County

    Nearly 1 in 3 people in Tillamook County are living with obesity. Nearly 1 in 4 have diabetes or prediabetes. To reverse these trends, 40 community partners are working to reshape food, school and other important systems that affect people’s everyday lives. They believe a healthy community is the responsibility of the community, not just the individual.

  • Open Video Modal

    Dr. Catherine Livingston:

    Between having normal blood sugar control and having diabetes, where you no longer are able to well control your blood sugar, is this phase called prediabetes. This is when we know that you are certainly at risk for diabetes, and without some sort of intervention, it’s very likely you’re going to develop diabetes in the coming years. This is really a critical opportunity to be able to intervene and help prevent somebody from developing diabetes.

    The exciting thing about prediabetes is that you can definitely reverse it. If people start to make lifestyle changes, really significant ones, in the prediabetes phase, they may be able to prevent diabetes, at least for a few years, or forever.

    For so long, obesity, diabetes, and prediabetes, although people are less familiar with it, has been really thought of as a problem of the individual. And while individuals are making daily choices, this goes way beyond that. This is a problem of the community. This is a problem of how we make choices about what’s available in terms of physical activity opportunities. It’s about making choices about what kind of foods people have access to, what kind of foods are affordable, and what kind of foods are in different areas. I think really taking the blame, certainly, and the focus off the individual, and really thinking about how we can work on this from a population setting is extraordinary.

    It’s really important that we figure out what works for diabetes and also what works to help prevent prediabetes. Diabetes is incredibly expensive for health care plans and for insurance companies and for the population in terms of the health burden, and so really making sure that Medicaid is covering the things that work is critically important.

    When someone comes into the clinic and I diagnose them with prediabetes or diabetes, we have a really great 20-minute conversation. That’s probably not going to be enough. In fact, I know that’s not going to be enough. There’s no way, even if I’m a fantastic doctor and even if I do such a good job in that 20 minutes, there is no way that that’s going to last throughout the whole year, because people have to make this decision about what they’re going to eat and how they’re going to exercise every day, multiple times a day.

    We really need to think about, how can we affect that decision outside of just the doctor’s office, but really in the community setting, where people work, where people go to school, where they socialize. We need to make sure that the places that people work, live, and play all offer healthy choices, that they support healthy choices. That way, when people are making their daily decisions, it becomes easier to make the better choice for themselves and their families.

    For one, making it pleasant to go do physical activity outside. That might mean that there have to be sidewalks, which is not true in all neighborhoods, that there are parks that are safe and desirable to go to. We really need to figure out how to build physical activity into our lives every day on a daily basis.

    I think that there are a lot of different roles that different bodies can play. My clinic has a certain role in terms of treating patients and connecting people to community resources. A health system, such as a network of clinics or a hospital system, has a different role, which might involve getting people connected into community-based resources, offering food supplementary programs, and things like that. And we think about education, which has a lot to do in terms of improving children’s health. Finally, the insurers. What is their role in terms of covering effective prevention and treatment?

    One of the really exciting things about coordinated care organizations is that they’re able to spend money in innovative ways. A lot of other Medicaid agencies across the nation aren’t really able to do this, but in Oregon, we’ve made it so that we can invest in the things that are nontraditional. The Diabetes Prevention Program is a year-long program that takes place in people’s communities that’s really working on building healthy lifestyle changes, so eating well, exercising, to really help prevent the progression of prediabetes to diabetes. The fact that Oregon has moved ahead and started to cover this makes us one of the leaders in the nation.

    About a million people in Oregon have Medicaid, and a significant proportion of those have prediabetes. When we think about the fact that Medicaid is now covering the Diabetes Prevention Program, there’s such an opportunity to reach a large number of people. There’s also a tipping point, if you will, where if we get a lot of people into these programs in their communities where they’re making active lifestyle change with others who are also having the same experience, we’re actually having a really significant population impact.

    How places cause and solve prediabetes

    The places where we eat and live affect who gets prediabetes and who doesn’t. Reducing obesity and prediabetes will require less blame on individuals. It’s up to all parts of our communities to make changes that support healthy eating and physical activity. These include health systems, coordinated care organizations, businesses and schools.

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  • Tillamook shows how a community can address chronic disease

    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…

    Read the full story
    a tub of fresh vegetables from a food coop

Time to get involved

Whether you have one minute or a full day, we all can play a role in making healthier Oregon communities.

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Personal stories show how communities shape our collective health. Share the story of Tillamook County partners helping their neighbors live healthier lives.

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Share the facts

Statistics prove how place matters to the health of our communities. Download and share web-friendly facts about prediabetes and diabetes in Oregon.

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Get to know a partner

The American Diabetes Association of Oregon & SW Washington works to educate people about how to prevent diabetes and support those living with the disease.

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Key factors shape the health of communities but aren’t easy to see. These PowerPoint slides reveal how drivers of health affect the risk of obesity and diabetes.

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