The Consensus of Ideas
d16: Executive Innovation Lab on Diabetes and Obesity, Powered by The diaTribe Foundation
By Kelly Close, Christie Auyeung, Nicole Kofman, and Alexander Wolf
The diaTribe Foundation hosted its inaugural d16: Executive Innovation Lab on Diabetes and Obesity from January 13–15, 2016 in Palo Alto, CA. d16 engaged leaders across diverse sectors to produce innovative, systems-level solutions that could reduce the societal burden of diabetes, heighten the urgency and need for action around the epidemic, and bring a new way of thinking into the diabetes ecosystem.
d16 was co-facilitated by innovation experts Heather McLeod Grant, Alexa Cortes Culwell, and Lisa Kay Solomon. Heather and Alexa are leaders in scalable social impact and Co-Founders/Managing Directors of Open Impact, a strategic advisory firm partnering with exceptional social change leaders to envision, design, and accelerate their impact. Lisa Kay Solomon is a leading design innovation strategist and author focused on building the leadership required to ignite change and create lasting impact. Using elements of “design thinking,” the facilitators guided participants through collaborative workshops to generate innovative solutions to the most pressing challenges in type 2 diabetes.
Forty-two participants attended d16, including prominent medical professionals, entrepreneurs, manufacturing leaders, policy-oriented healthcare experts, academics, tech leaders, government decision makers, educators, media experts, food and nutrition scholars, and philanthropists. Participant biographies are available at d16.diatribe.org.
d16: Executive Innovation Lab Participants:
Jennifer Aaker, John Agos, Becky Bausman, Savi Baveja, Adam Brown, Kelly Brownell, Curtis Carter, Paul Ciechanowski, Andy Cunningham, Abdallah Daar, Dave deBronkart, Sean Duffy, Esther Dyson, Faith Foreman, James Gavin, Phil Gilbert Sr., Kevin Hagan, Jennifer Hahamian, Jeff Halpern, Brad Harmon, Lee M. Kaplan, Christopher Kay, Orville Kolterman, Bon Ku, Allison Kurian, Niels Lund, Kate McLean, Sarah Mummah, David Napier, Shepard Nevel, Riccardo Perfetti, Rita Nguyen, Branden Powell, Kathleen Regan, Joni Saylor, Alex Slater, Laura Schmidt, David Strasberg, Virginia Valentine, Terry Vance, Michael Warburg, Richard Wood, and John Yee.
Filling an Urgent Need in the Community
Recent data revealed that one in seven US adults has diabetes, two in five US adults have prediabetes, and eight in 10 seniors have diabetes or prediabetes.
More than 30 million people are at risk of major health complications.
And these largely preventable diseases are costing the US nearly $245 billion per year in direct and indirect healthcare costs. Indeed, one in five healthcare dollars in the US is spent on diabetes.
How could we as a society have failed at combatting the largest public health crisis of our time while spending such astronomical sums on it each year? Part of the reason, in our view, is that too many of the funds invested in addressing this epidemic have been used to relieve symptoms, focusing on treatments and reactionary “Band-Aid” solutions, rather than prevention, behavior change, and proactive, cross-sector solutions.
We need more holistically-designed approaches that identify root causes of the diabetes epidemic and offer innovative, scalable solutions. At d16, we responded to that need: after breaking down the diabetes ecosystem into seven key fields and examining the causes of diabetes in each of these areas, d16’s group of experts identified patterns across the board and ideated new solutions that could be impactful, scalable, and investable.
At d16, we analyzed the diabetes ecosystem and identified bright spots and gaps: what is currently successful in diabetes, what needs improvement, and what could be scalable? Many of the ideas below are not new. What is new is the way of thinking regarding how they are connected to other approaches, and how various components of the diabetes ecosystem can work together to implement and scale the ideas. These innovative solutions address the underlying causes of diabetes across the ecosystem, beginning the conversation on how to break down the silos that have long stunted progress in diabetes. We hope the result will be greater impact, which includes both a strong return on investment for funders, and the improved health of our communities.
IDEO and Introduction to Design Thinking:
d16 kicked off on Wednesday, January 13, 2016 at IDEO, the premiere design firm based in the heart of Silicon Valley. Dennis Boyle, co-founder of IDEO and the head of its healthcare practice, led a tour of IDEO to demonstrate the value of design thinking and its applications to healthcare and diabetes. He followed the tour with a design thinking workshop, where he led attendees through IDEO’s approach to generating ideas for diabetes prevention initiatives.
System Analysis and Idea Generation
This introductory activity prompted attendees to discuss the biggest challenges, as well as key areas of opportunity, in diabetes.
2) Understanding the System
This exercise helped give participants a better understanding of the scale of the problem and the components of the diabetes ecosystem, which was organized into seven broad areas: (i) food and beverage, (ii) built environment, (iii) media, culture, and mindsets, (iv) healthcare delivery and payment, (v) technology and data, (vi) research and development science, and (vii) individual factors and behaviors. Within small groups, participants analyzed some of the largest factors influencing the diabetes epidemic in each area. Participants then reconvened as a full group to identify patterns and points at which where there might be opportunities to intervene.
3) Bright Spots
Teams worked to identify “bright spots” in the diabetes ecosystem. “Bright spots” refer to efforts that have demonstrated impact and are replicable, innovative, solutions-focused, and results-driven. This exercise served to identify what is already working and what is scalable with additional investment.
4) Idea Generation
Diverse groups of participants generated ideas for programs and initiatives to reduce the societal burden of diabetes. Participants used design thinking to generate both “moonshot” ideas as well as “small bets” that could be implemented on a smaller scale in the near term. After each group presented their top moonshot and small bet ideas, participants chose a set of ideas to analyze further. The final session included discussion of next steps for implementing ideas generated by the participants.
The following sections outline some of the insights and ideas that generated the most enthusiasm at d16.
KEY INSIGHTS, THEMES, AND “AHA” MOMENTS
There were several key insights, or “Aha” moments, into the diabetes ecosystem that influenced the later ideas:
American healthcare is designed for acute care.
An underlying theme participants identified is that the American healthcare delivery system is designed to most effectively address cases of acute disease care, and it has failed to adapt to the growing need for chronic disease management. Reimbursement and payment policies provide perverse incentives to providers and other medical professionals that result in the focus on treating symptoms instead of underlying causes of disease and prevention. This system of perverse incentives also creates silos within the provider community as opposed to encouraging team-based care, a model that has proven to be effective in diabetes and other chronic conditions. With people living longer, coupled with the rapid emergence of type 2 diabetes and obesity in the US over the last several decades, there is an urgent need to enhance the way care is delivered to those with chronic conditions. This shift in how healthcare is delivered will require changes in reimbursement in areas across the system.
Information does not equal insight.
Individuals have access to more information than ever before through electronic health records, genome sequencing, and mobile health apps. In the diabetes field, patients can receive enormous amounts of data through devices such as continuous glucose monitors, glucose tracking mobile apps, and more. Access to data is no longer the problem, but information itself does not improve patient outcomes. Individuals and patients must have the tools to translate and interpret that data, and the information contained in the data must be leveraged to drive insights into an individual patient’s behavior or into trends within a population to develop effective interventions or prevention strategies.
Root causes of diabetes are directly connected to many disease areas.
Several d16 attendees noted that two of the fundamental underlying factors behind type 2 diabetes and obesity — diet and physical activity — are also major risk factors for a host of other medical conditions, including cancer, heart disease, and even Alzheimer’s. Strategies and initiatives to prevent and alter the course of diabetes will have a direct impact in these other disease areas. Thus, members of the diabetes community have a lot to gain from partnering not only across diabetes, but also across other disease areas. This recognition creates tremendous opportunities to involve both a larger patient population and practitioners across disease areas, and to chip away at the stigma that significantly impacts the quality of life of people diagnosed with type 2 diabetes.
Overcoming stigma requires a large-scale societal movement
According to the Institute of Medicine, diabetes is one of the most stigmatized diseases. Diabetes stigma arises out of misplaced blame on patients for causing their own diabetes. This stigma leads patients to feel as if they failed or have created an undue burden on the healthcare system, when in reality they are succumbing to increasingly unavoidable trends that subject us to significantly increased risk of diabetes.
This stigma plays a direct role in many of the key factors influencing diabetes outcomes, including poor dietary habits, lack of exercise, therapy adherence, and the lack of type 2 diabetes patient voices in policy and regulatory conversations. In designing and implementing strategies to overcome stigma, there is much to be learned from the experiences within other disease communities, such as the HIV/AIDS and epilepsy communities: two diseases in which stigma was and/or is also a defining characteristic. HIV/AIDS activists, in particular, were able to create a movement, the core elements of which included public awareness, proposed solutions to identified problems, leadership (from patients, policymakers, and regulators), and a core group of patients who became smart enough to propose solutions and to sit at the table with decision makers to discuss them and hold them accountable. To this day, there are ongoing efforts to reduce the stigma associated with a diagnosis of HIV/AIDS. A similar movement is needed to reduce the significant stigma that is attached to type 2 diabetes: one that is bigger than just those with the disease. And it begins with broad-based education and awareness.
Conceptual Initiatives, Pilots, and other Brainstorms Generated at d16
Summarized below are the twelve ideas that came out of d16 that we believe are the most investible, scalable, and impactful. They are not finalized project proposals, and we welcome any and all feedback to further develop and improve upon them.
Working Title: National Diabetes “Show Up” Day
Summary: The majority of people with diabetes experience stigma related to their disease, and this contributes to many negative consequences, including: patients ‘hiding’ their diabetes from their friends, family, peers and employers; the perpetuation of this stigma in the media; an absence of type 2 diabetes advocates or a strong patient voice to influence policy and funding; and negative psychosocial impacts that affect quality of life and patient outcomes.
The LGBT community, in particular, offers many lessons in how to address stigma from which the diabetes community can learn. d16 participants created the concept of National Show Up Day, inspired by the LGBT rights movement’s “Coming Out” Day. This day is about a sea change in public perception, behavior, and conversation about type 2 diabetes. It is about providing a safe place for people with diabetes to talk about their disease and about demonstrating that they are not alone. It is an annual day set aside each year for individuals to speak publicly or to their family and friends as people living with type 2 diabetes and for their community — loved ones, employers, caregivers, government, nonprofits, and shops and restaurants — to show people with type 2 diabetes that they are supported in all areas of their lives. This day would be coupled with mechanisms to keep the conversation ongoing, from small efforts like design icons for vendors and restaurants to display to show their support, to larger details like an annual awards program to recognize businesses and individuals who have truly “shown up.” It is backed with a sound partner strategy (i.e., Nike creates a custom “Show Up” shoe, Walgreens gives free A1c tests on Show Up Day, etc.) and a go-to-market plan. While the movement may start with a single “Show Up” day, over the long-term it could evolve into a broader movement surrounding health and wellness in our day-to-day lives.
System Impact: d16 identified “stigma” and the lack of a strong, visible type 2 diabetes patient advocacy community as root causes influencing and perpetuating the scope of the epidemic. When patients and their communities don’t talk to each other about type 2 diabetes:
- Misinformation is more easily spread;
- Patients feel more isolated, which can lead to cycles of poor mental health and health behavior;
- Businesses, researchers, government officials, and others do not understand the urgency, breadth, depth, and nuances of the problem, and how it impacts their constituents, and;
- Communities will continue to blame patients for their disease, failing to rally to address the root causes of the diabetogenic environment.
National Show Up Day mobilizes the entire type 2 ecosystem to “show up” together to combat the root cause of stigma, help eliminate the shame associated with diabetes, put the need to address diabetes at the forefront of people’s minds, and encourage those with type 2 diabetes to become advocates. In addition to addressing stigma, National Show Up Day would aim to transform the conversation to focus on the root causes of the epidemic and free people from self-blame and shame.
Working Title: Anthology of Bright Spots (“What’s Working”)
Summary: Various efforts throughout the US and abroad have been shown to significantly improve outcomes related to diabetes, but many of these models have not been scaled or replicated on a systemic level, due in part to a lack of information-sharing. An opportunity identified at d16 was to create an accessible “anthology” of existing work that has been demonstrated to be effective in improving outcomes for people with type 2 diabetes. The size and scope could be expanded over time. Such an anthology could also include insights from other disease areas that could be applied to diabetes. This could be an evolving anthology with regular updates, and it could be available through multiple platforms (an annual report, a website, etc.). The anthology could include resources for each model including primary contacts, accessible publications or data reports, and other information to help people replicate successful efforts in other networks. On a broader scale, the Anthology of Bright Spots could further highlight those efforts that have impacted the field of diabetes through an awards program or through a national convening event to connect those interested in either contributing resources, scaling existing projects, or in learning about those models.
System Impact: The diabetes ecosystem is fragmented, resulting in a lack of knowledge sharing across people in different sectors. These include those involved with academia, local grassroots efforts, policy initiatives, clinical research, and more. There are several consequences to this fragmentation:
- Resources are wasted when leaders in the field cannot effectively learn from each other;
- Models of success on the local level are not replicated or scaled to the fullest extent they could be;
- Different stakeholders in diabetes remain working in silos;
- And potential funders do not have information about how to invest their philanthropic dollars in ways that will have the greatest impact.
An Anthology of Bright Spots would serve to increase transparent information sharing in diabetes, highlight successful efforts in diabetes that can be scalable, and allow for cross-sector collaboration.
Working Title: Diabetes Screening — Meeting Patients Where They Are
Summary: Of the more than 29 million people with diabetes in the US, over eight million of them are undiagnosed. Moreover, 90% of the 86 million Americans with prediabetes don’t know they have it. Early diagnosis of diabetes and prediabetes allows for early intervention, treatment, and prevention efforts, hopefully lowering the rates of diabetes complications and significantly altering the patient journey that can often result from prolonged hyperglycemia.
d16 participants examined the underlying causes of this problem. Part of the challenge is a lack of education, and another factor is that screening has not been integrated into mainstream society. Once again, the diabetes community can learn from successful efforts in other areas such as annual flu shots, blood pressure cuffs in super markets, regular mammograms, and regular STI testing. Contributing factors to these examples resulted from public and provider education about the impact of these efforts, guidelines from professional societies, and partnerships with industry groups.
System Impact: Inadequate screening for diabetes and prediabetes has several consequences for the healthcare system:
- Treatment for diabetes is delayed, with many patients requiring medication therapy at the time of diagnosis (as opposed to only requiring diet and exercise changes for those diagnosed at very early stages of progression).
- Complications of diabetes — including retinopathy, neuropathy, nephropathy, and more — are more common, as patients have sustained hyperglycemia for longer periods of time. In addition to the health consequences of complications, the financial consequences are significant, as 53% of the lifetime medical costs to treat diabetes are due to complications. Moreover, the US spends over $69 billion annually on the indirect costs of diabetes: loss-of-productivity costs, work absenteeism, etc.
- A healthcare environment that does not stress proper screening reinforces the social perception of diabetes not being an urgent crisis.
This program would not only enable more diagnoses of diabetes and prediabetes, allowing for earlier intervention, but it would also raise awareness of the critical need to “know your number” and to be regularly screened for diabetes.
Working Title: A “Carbon Taxes” Health Code for Food Distributors
Summary: How might we create a standard set of nutrition guidelines for all food distributors (manufacturers, restaurants, vending machines, etc.) with a corresponding score or “award” for those who meet the guidelines? The idea stems from carbon taxes, in which the government will decide what the threshold for nutritional foods offered must be for any given food distributor, and those who meet that threshold would receive some form of tax reduction or other financial incentive. Moreover, these places would also receive a very visible, easy-to-understand stamp of approval. For instance, restaurants who meet the threshold would have to put a green stamp on all their menus (and perhaps are also then rewarded financially, i.e. tax subsidies), those who are middle-tiered would put a yellow stamp, and those that very poorly address the guidelines receive a red stamp (and perhaps are also then punished financially, i.e. increased taxes).
System Impact: Across the diabetes ecosystem, many incentives currently in place enforce a “diabetogenic” environment. As one d16 participant said, American culture and society have created a “perfect storm” for creating a diabetes epidemic. By providing financial incentives for food distributors to offer more nutritious foods, the quality of food commercially available will be more likely to improve, thus making “the healthy choice the easy choice.”
The goal of this program would be to incentivize food distributors to offer increased selections of healthier food, and to provide a clear and visible marker for consumers as to where they can eat that provides nutritional foods.
Working Title: A Nationwide Tax on Sugar-Sweetened Beverages
Summary: Sugar-sweetened beverages, or SSBs, include soda, sweet tea, sports drinks, juices, and other beverages with high levels of added sugar. These drinks are high in calories but low in nutritional value, and have been estimated to be the number one source of added sugar and excess calories in the American diet, accounting for 7% of all calories consumed on average. The average American drinks 44.7 gallons, or nearly 500 cans, of carbonated soft drinks every year. And one Gallup poll found nearly half of Americans drink at least one soda a day, with 7% drinking over four cans daily. Sugary drink intake has been linked to weight gain, obesity, and type 2 diabetes. This nationwide tax would be designed to discourage the production and sale of SSBs and reduce overall sugar consumption by people in the US.
Such taxes have already been passed on a national level in Mexico in 2013, which reduced purchases of sugary drinks by 12 percent in one year, with the biggest reductions among low-income populations. In addition, purchases of untaxed beverages increased 4% (36 ml/capita/day), which was mainly driven by growth in the purchases of bottled water.
In 2016, Britain announced plans to enact its own soda tax, with the hopes of instating the tax by 2018. In November 2014, Berkeley, CA became the first city in the US to approve a soda tax, and San Francisco and Philadelphia are actively working to have a soda tax passed as well. In Berkeley, early positive reports show a 16% reduction in sugar-sweetened beverage consumption post-tax. Scaling the SSB tax effort up on a national scale is one example of a “quick win” using policies that can affect a lot of people in a short period of time and at a relatively low cost.
System Impact: Passing a nationwide tax on sugar-sweetened beverages would help to address our current “diabetogenic” society on a systems level by focusing on the environmental factors that perpetuate the development and progression of diabetes and its complications, increasing awareness and shifting public perceptions of the harmful health effects of sugar-sweetened beverages, and could open the door to move aggressive policies down the road once public support has increased. In the past, taxes on cigarettes have been successful at reducing smoking among Americans, and the hope is that a nationwide tax on SSB can also reduce soda consumption and move the needle on public health.
Such policies could have a large-scale impact on prevention of not only type 2 diabetes, but also obesity, high blood pressure, heart disease and strokes. Scientists at UCSF estimated that a nationwide penny-per-ounce tax on sugar-sweetened beverages would prevent nearly 10,000 cases of heart disease, 8,000 strokes, and 26,000 deaths over the next decade, as well as 240,000 cases of diabetes per year. It would save $17 billion over the next decade on healthcare spending related to diabetes and obesity and its complications, and would generate $13 billion per year in direct tax revenue that could be further invested in other areas such as prevention or education.
Some opponents of SSB tax efforts claim that it would disproportionately affect low-income consumers economically. As Dr. Tom Farley, author of Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives stated in the New York Times, however, “…the poor are disproportionately suffering from obesity and type 2 diabetes as a consequence of sugary drinks. They drink more sugary drinks now than people who have more money. Because people with lower incomes are more price-sensitive, they will disproportionately benefit from efforts to reduce sugary drink consumption.”
*Note: Three members of The diaTribe Foundation (Kelly Close, Christie Auyeung, and Nicole Kofman) are currently enrolled in an online class through the Harvard Kennedy School of Public Policy called “Leadership, Organizing and Action: Leading Change.” With a focus on community organizing and leading social change, the class is helping The diaTribe Foundation strengthen its understanding of successful movements and putting its leadership skills to practice. The Foundation has chosen to pursue “A Nationwide Tax on Sugar-Sweetened Beverages” for the required “organizing project,” and anticipates that the class will provide structure and support to help us contribute to the ongoing efforts to pass a soda tax in San Francisco.
Working Title: Increasing Diabetes Representation in Film and Television
Summary: Diabetes is a disease that is largely ignored, misunderstood and stigmatized by the general public. While this is due to a complex set of factors, one contributing factor is that there is very little representation of the diabetes patient experience in film and television. Just as the gay rights movement benefitted tremendously from shows such as Ellen, Glee, and Modern Family, or as the environmental movement benefitted from An Inconvenient Truth, we believe that providing more visibility for diabetes in entertainment and media would help to both build a sense of urgency around addressing this public health epidemic as well as help to educate the public and reduce the stigma associated with the disease. One example from outside of diabetes that can serve as a model is Google’s work with film/television producers to create female characters with computer engineering backgrounds. With funding support, a backbone organization could encourage film and television writers to include characters or families with diabetes. This effort could expand into a broader patient movement, in which people with diabetes get involved through signed petitions, a shared hashtag, or other initiatives to publicly call upon film/media executives to include characters with diabetes and remove inaccurate portrayals of diabetes (i.e., diabetes as a punch line).
System Impact: Stigma and the lack of public understanding about type 2 diabetes deter companies, governmental bodies, or the general public from giving the disease proper attention. Increased visibility of type 2 diabetes through outlets that reach millions of viewers would enhance public health literacy, generate public empathy for patients, and help transform public opinion of diabetes from a shameful or non-serious condition to a major health crisis that impacts society.
Working Title: Investing in the Healthcare Team of the 21st Century
Summary: The healthcare system in America was developed as an acute care management model — with a primary focus on diagnosing and treating symptoms and illnesses. However, diabetes, obesity, as well as many other chronic conditions, require a shift in the way individuals and their conditions are addressed — with greater participation of the person with the condition and a greater emphasis on daily management or self-management. The Affordable Care Act (ACA) has created unique opportunities to shift our healthcare delivery system to better match the daily needs of the growing segment of our population living with chronic conditions.
According to research by the Commonwealth Fund, the ACA encourages three core approaches for improving healthcare delivery: testing new models of healthcare delivery, shifting from a reimbursement system based on the volume of services to one based on the value of care, and investing in resources for system-wide improvement. Accountable Care Organizations (ACOs) and patient-centered medical homes (PCMHs) are two such examples of evolving care models influenced and/or supported by the ACA. The Centers for Medicare and Medicaid Services also offers a “menu of options” for healthcare systems to improve care, increase care access, and lower costs through better care coordination.
A critical component of this shift is a transformation of the patient’s healthcare team. The typical primary care model in which patients spend less than 20 minutes with their doctor a few times a year does not provide: adequate continuity of care for people with diabetes; the time physicians need to adequately address the complex nature of diabetes and related conditions; and the clinical staff needed to ensure all of the medical, behavioral and psychosocial needs of a person with diabetes are being met. Several models in the U.S. have successfully leveraged care providers in addition to physicians — pharmacists, nurse practitioners, health educators, case managers, social workers, and more — to cost-effectively provide ongoing team-based support for people with diabetes. It is now necessary to identify care models that have proven to improve outcomes, care access, and quality and scale those programs.
System Impact: To provide greater access to a more comprehensive, continuous, and individualized care team for people with diabetes, ultimately driving down costs and improving health outcomes.
Working Title: Kids as Change Agents
Summary: Many powerful social movements have originated in schools — D.A.R.E. and recycling are two examples. How might we create a similar movement among school-age children to become change agents for better nutrition and increased physical activity? It would originate first on a local level within a specific school or school district, and successful programs or pilots would be scaled on a broader level. These efforts should be in addition to larger, national efforts to improve school lunch offerings and mandated physical fitness curricula. For instance, pilots could include:
- Schools implementing mandatory nutrition courses in their school curriculum.
- Students could have homework assignments to take their families for a walk or to eat fruits and vegetables.
- Schools could bring back revitalized “home economics” courses that teach kids how to cook healthy and convenient meals, which they could then bring home for their families to eat.
- Rather than school buses, schools could have “walking buses” or “biking buses” with supervised walking or biking groups to school in the morning.
System Impact: The goal is to make kids passionate about nutrition and exercise in a way that will not only affect the way they behave, but also that will impact their parents. Just as kids compel their parents to recycle, wear seat belts, quit smoking, etc., they would be aware of what constitutes healthy eating and physical activity and encourage it at home.
Working Title: Diagnosis Support Groups
Summary: Access to peer support upon diagnosis of a disease and/or chronic condition can dramatically impact patient outcomes and quality of life. With advances in technology, access to such support no longer needs to be in-person. This is evidenced by the tremendous growth in online patient communities that provide information and support to individuals and/or caregivers sharing a similar diagnosis. Such communities exist within the diabetes community, but many of these communities are large, overwhelming and intimidating for people recently diagnosed when there is so much to learn and adopt. This initiative would create a community, or sub-communities within existing communities, for people based on their date of diagnosis. The goal is to group people together that are processing information, learning, and beginning their patient journey at the same time in a single, safe place. As diabetes often comes with significant levels of stigma, having a social support network can be critical — particularly as many patients find it challenging to talk about their diabetes with friends or loved ones.
System Impact: This program would ensure that nobody feels alone living with diabetes, helping to decrease feelings of stigma felt by patients. It would also help build up a diabetes patient community connected by shared experiences that feels empowered to take action.
Working Title: Diabetes Shark Tank
Summary: The “Diabetes Shark Tank” would entail a conference in which people are invited to submit and defend proposals for diabetes “moonshots,” or programs/interventions that could make wide-scale impact on the lives of people with diabetes. The Epilepsy Foundation and the American Heart Association have launched ‘Shark Tank’ initiatives to spur investment in ideas to help their patient populations. While both of these programs are relatively new, they may yield important insights that would be helpful as we think about a similar program in diabetes. Such an initiative would create an innovative and exciting marketplace bringing together bright minds to create and invest in the future of diabetes prevention and treatment.
System Impact: Funding for diabetes, both at the federal and private philanthropic level, is very low relative to the population impacted. Only 3% of NIH funding goes to diabetes, a disease that affects the entire US population to some extent. Moreover, funding for innovation in health services in delivery, which examines access, care quality, and population health amounts to just 0.3% of total healthcare expenditures and roughly one-twentieth the sum that goes into science research. Under current funding:
- There is a lack of innovation within the critical areas of public health, access, behavior change, and other social or mental health fields.
- The brightest minds are not attracted to diabetes, as it receives less funding and prestige than other areas such as oncology or surgery.
- Our system is designed to focus on pharmaceutical and technological advances, rather than solutions that affect the root causes of diabetes on a societal level.
This program would encourage more focus and innovation on projects that could make scalable impact and address the societal causes of diabetes, rather than focusing on treatment of symptoms. Moreover, it would create a new funding stream and could attract new investors focused on impact into diabetes.
Working Title: Accessibility of Healthy Food in Low-Income Communities
Summary: The past decade has seen a “healthy lifestyle” movement in America; however, this focus on healthy living has largely been concentrated in higher-income, mostly white communities. Examples include organic food markets, boutique exercise studios, or even farm-to-kitchen or chef-to-kitchen food delivery services such as Blue Apron. The idea for this program is to adapt these models for low-income communities, or to scale up programs that have shown effectiveness already around the country. One example is local non-profit grocery stores that bring nutritious food to people at affordable prices. Other ideas would include a mobile “produce truck” in low-income neighborhoods, a low-cost “Blue Apron” product, providing nutrition education inserts at all grocery stores in low-income neighborhoods, and more. These ideas could be piloted in local communities and then, for those that demonstrate effectiveness and feasibility, could be scaled to reach additional communities.
System Impact: Studies consistently show that low socioeconomic status is one of the most significant risk factors for type 2 diabetes. These populations already are the most disadvantaged when it comes to treatment options, as drug prices continue to rise and the most advanced diabetes medications are not yet generic. Thus, altering the built environment and increasing the offerings and affordability of nutritious foods may have a significant impact on reducing diabetes risk in these groups.
Working Title: Investing in the Health of People, Companies, and Cities
Summary: How might we create a model built upon currently existing employee wellness programs and other initiatives that provide financial incentives for people to improve their health? How might we create healthier communities, companies, and cities by investing in health?
- Employee Wellness Programs:
In the case of diabetes prevention and treatment, improving one’s health could mean losing weight, lowering A1c, or even improving mental health through yoga, meditation, or other efforts. Several programs that could be initiated include:
- Providing additional paid vacation days for employees who reach pre-set health goals.
- Providing a paid bonus for those who can show proof of regular physical activity.
- Providing a bonus for people with every tracked 100 miles they walk.
- Some other cash reward for every percentage point reduction in A1c.
As examples, Aetna’s wellness program currently pays employees $25 for every 20 nights they get at least seven hours of sleep, and IBM offers up to $500 in gift cards for employees and their children to exercise regularly. Piloting these programs in more businesses and scaling them up across the country could be impactful towards building a culture of health and decreasing overall health expenditures. Indeed, tracking outcomes of existing wellness programs has demonstrated a substantial return of interest; Johnson and Johnson leaders estimate that their wellness program saved the company $250 million on health care costs over the past decade.
Another example of how employers could directly influence the health behavior of their employees is UCSF’s campus-wide “ban” on soda, eliminating the sale of sugary beverages on campus to reduce sugar consumption by students and employees. Such efforts to create healthier work and learning environments, encouraging students and employees to reduce sugar consumption, could be replicated and scaled at other universities or companies.
2. Investing in Health: The Way to Wellville and A Culture of Health
How might we shift capital and outcomes to produce health upfront rather than try to recover it after illness occurs? How can we bring Silicon Valley thinking to health to help communities reduce obesity and diabetes, foster a healthy food supply and provide better access to care? Several initiatives are making headway on this front, and scaling up these investible ideas could move the needle on public health.
For example, a nonprofit called the Health Initiative Coordinating Council (HICCup), is leading a collaborative effort titled “The Way to Wellville” a five-year effort giving five small (<100,000 population) communities expert advice on capacity building, development of local leaders and sustainable business and financial models, access to capital and partners, and help with data collection and analysis so that they can meet and measure their goals for health. The “Wellville Accelerator” borrows from startup accelerator models in Silicon Valley, where emerging companies are incubated and mentored by experts. In Wellville, communities are the startups, HICCup is the accelerator, and better health is the return on the investment. Way to Wellville goes beyond pilots and helps communities apply well-known techniques in sustained initiatives and through institutions that are accountable, measurable, and ultimately fundable.
The Robert Wood Johnson Foundation has also partnered with The Reinvestment Fund as part of their Culture of Health program to work closely with cities to use data to better understand the needs of their most at-risk neighborhoods — and then invest in new initiatives that can revitalize housing, health, transportation, education, and other assets that help communities to become stronger and healthier. They’ve launched Invest Health, which will give up to 50 mid-sized cities $60,000 each to work across sectors and start to map out the kinds of changes they want to make.
System Impact: This idea positions health as a return on investment at the level of the workplace or city. For employers, diabetes poses a major economic burden, largely due to medical costs and loss of productivity costs. The incremental cost of diabetes among employees has been estimated at over $4,000 annually per person, with 30% of costs to employers attributed to medically-related work absences and disabilities. While prevention efforts and employee wellness programs may present initial upfront costs to employers, the long-term costs saved could offset them, particularly if there were a financial benefit incentivizing employers to implement these programs. Furthermore, organizations are finding promise in bringing Silicon Valley thinking to health, using data to map out goals based on successful models, working collaboratively across sectors to implement them, and making financial investments in communities and cities. If we can scale up examples of these programs that we know work, this idea presents an impactful, investible, and scalable approach to preventing diabetes.
Who We Are
The diaTribe Foundation is dedicated to improving the lives of people with diabetes and advocating for action. Our team is focused on making people smarter about diabetes and obesity. We understand the patient experience and are proud that we are viewed as a highly credible resource. Our free publication, diaTribe, provides the most up-to-date and accurate resources, tips, and news on products and research in diabetes and obesity. We also serve as a voice for patients in advocating for healthcare and regulatory change.
For more information about d16, please visit diatribe.org/d16 or contact Kelly Close at email@example.com or Nicole Kofman at firstname.lastname@example.org.
Special thanks to HCM Strategists, Stiehlworks, Julie Sherman Studio, Lynn Carruthers and the d16 participants.