Houston is the fourth largest city in the United States. There are 2.1 million people living in Houston and 4.3 million in Harris County1. Approximately one in 10 adults in Houston/Harris County have diabetes2.
Obesity is the most common chronic condition in Houston, affecting 32 percent of adults2. Obese men and obese women have a 7- and 12-fold risk, respectively, of developing diabetes3.
Of the estimated 415 million people worldwide who have diabetes, nearly two-thirds live in urban areas4. By 2040, the number of people with diabetes is expected to rise to 642 million, with 74% of them living in urban areas4.
Cities Changing Diabetes is a global program of Novo Nordisk in which seven cities around the world are learning how to improve diabetes detection and care in their communities. Houston is the only American city participating. The program aims to map the problem, share solutions and drive concrete action to fight the diabetes challenge.
Cities Changing Diabetes launched in Houston in November 2014 with a comprehensive analysis of the major gaps and vulnerabilities associated with diabetes. Soon after it launched, the program invested more than a year researching the diabetes epidemic in Houston. A community-wide assessment identified the populations most at risk for developing the disease and compared them to Houstonians already diagnosed with diabetes.
This work led to the formation of five Action Work Groups with more than 75 diverse members representing approximately 60 faith-based organizations, government, health insurance companies, medical providers, employers and non-profit entities.
The focus areas for the five Action Work Groups were:
On June 16, 2016, Cities Changing Diabetes – Houston unveiled new research showing three kinds of vulnerability to diabetes across communities and specified 14 social and cultural factors that reinforce them. The research, conducted by the University of Texas Health Science Center at Houston (UTHealth) School of Public Health and sponsored by Novo Nordisk, indicated that across vulnerable populations, the key social and cultural factors include the perception of change and transition (77.6%), the feeling of being financially constrained (44.8%), the adherence to nourishing traditions (42.4%), the use of cars for long commutes (41.6%) and the experience of time poverty (40%). The research was presented on June 16, 2016, at a Cities Changing Diabetes – Houston Town Hall event.
During the event, the Cities Changing Diabetes – Houston coalition announced a challenge grant of $100,000 ($50,000 in funds and $50,000 in technical assistance and support) to jump start the virtual Houston Diabetes Resource Center (HDRC). HDRC will serve as a “one-stop shop” website for consumers, providers and employers and house important resources for diabetes prevention, detection and care. Gateway to Care is going to administer the funds; the grant is provided by Novo Nordisk.
In addition to the HDRC, concepts the coalition developed and presented are:
For more information: News release: New research identifies Houston’s vulnerability to diabetes; highlights public health crisis
Various insights into vulnerability for type 2 diabetes and diabetes-related complications have emerged from the research, the most important of which are highlighted below.
Perceived changes and transitions at societal and community level as well as individual level lead to uncertainties and a sense of instability. Expanding cities such as Houston are, by definition, in flux and often unstable, which can easily exaggerate existing social stressors: for example, existing services change, move or are shut down, with concrete consequences for those relying on them.
Change and transition in Houston are experienced both practically (e.g. where a new influx of people crowds a neighbourhood), and psychologically (e.g. where that influx causes distress in residing individuals). Furthermore, the changing faces of neighbourhoods and society concern many, though some felt that “things were improving”.
In Houston, the notion of food as a ‘nourishing tradition’ has a profound impact on the way food is perceived and what certain meals and dishes mean for community coherence. Heritage is strongly interwoven with food in Houston, and traditional foods carry meaning beyond nutrition and diet. For many participants, food and food-related rituals constitute an essential social connector that relates people to a common identity. These foods and related rituals are also perceived as ‘comfort’ food.
Therefore, cooking and offering these foods creates a sense of community and connectivity, and providing this kind of food becomes a way of caring for oneself, others and a common culture or heritage.
However, because these foods and beverages are seen as part of a cultural identity that cannot and should not be changed, there is also a common justification among participants that following certain habits, whether healthy or not, is warranted.
The concept of ‘time poverty’ is highly relevant in a city such as Houston, where long working hours combine with long commutes and living in neighbourhoods where basic amenities are not readily accessible.
Time poverty fundamentally impacts the way people live their lives. It impacts social relations, neighbourliness, healthy living strategies, etc. and it is embedded into everyday life and practices: the way people work, live and eat. It is a kind of cultural time poverty. Among some of the participants, a longing for more social activities and social interactions in the community is interlinked with the notion of cultural time poverty.
Being time-poor means having to carefully manage free time, and often requires ‘trade-offs’ in order to complete everyday tasks. Thus, a hierarchy of demand (or need) is created, into which work, daily chores, management and, ultimately, leisure activities are organised. In order to create a situation in which diabetes and other chronic conditions can be successfully prevented, sufficient time and energy must be allocated to healthier living, and this should be reinforced beyond the individual at organisational and institutional levels.
The comparison of ‘self’ and ‘other’ is a fundamental way in which people make sense of their immediate social environment. As a result, normative body images shift in settings where body size increases or decreases in a significant proportion of a group of people.
But in scenarios where body weight across a group changes noticeably, the classification of self as ‘not as bad’, ‘healthier than’, ‘fitter than’, etc can have a detrimental effect on weight perception and management. When the normative body images change, so do the perceptions of what a ‘healthy body’ might look like.
Many Houston participants make references to the bodies of others as ‘big’ (just like their own), or ‘even bigger’ (where they feel noticeably slimmer than peers). As is the case with ‘nourishing traditions’, the relative notion of self in relation to peer appearance serves as justification for and validation of the status quo in Houston.
Diabetes affects all Houstonians. The disease affects our families, our communities, our schools, our workplace, our places of worship and ultimately our economy. There are steps we can take to confront and reduce the number of people impacted by this growing epidemic.
Houston is proud to participate in the Cities Changing Diabetes initiative along with other leading cities from around the world. I am very impressed by how our leaders from city agencies, Texas Medical Center institutions and other community partners are responding to the challenge set forth by Novo Nordisk to develop new solutions to address the diabetes epidemic in our city.
It is through community-wide initiatives and public-private partnerships like this that Houston gets its best work done, and I am highly motivated to support Cities Changing Diabetes.
I encourage you to engage in and support these efforts so Houston can serve as an example for the rest of the world of how a community can come together to tackle a problem. Together we can impact the health and future of Houstonians by reducing the incidence of diabetes.