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.

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.