Cities Changing Diabetes – Houston has empowered faith and community leaders; teaching them the necessary skills to enable them to lead change in their communities on diabetes management. This has resulted in over 75,000 members of their congregations gaining access to a supportive network and education in diabetes prevention and treatment.
Local Partners: The Institute of Spirituality and Health (ISH) at the Texas Medical Center, TMF Health Quality institute
Houston has witnessed a dramatic population growth in recent years and is now the fourth largest metropolitan area in the United States, behind only New York, Los Angeles and Chicago. At almost 7 million people in the Greater Houston Region, the growth has been spurred by both US and international, migration making the city a very ethnically diverse and dynamic environment. Today 1 in 4 Houstonians are foreign born. In fact, Houston’s demographic diversity is two decades ahead of the rest of the country. Unfortunately, it has been difficult for local government to keep public transportation infrastructure up to accommodate the growth, which has caused Houstonians to spend many hours on highways contributing to them becoming “time poor.” This car-centric metropolis, alongside other urban factors such as inactive lifestyles and a lack of healthy eating habits, has led to Houston having one of the highest obesity rates in the United States. This is driving the level of type 2 diabetes in the city, with an estimated 15.6% of the adult population with the disease.
Using the Cities Changing Diabetes Projection Model, if no action is taken today to reverse the rising diabetes figures, by 2045, this number is projected to spiral to as much as 21.1%. Yet, if action is taken now to reduce obesity levels by 25% between now and 2045, almost 150,000 cases of type 2 diabetes can be avoided, with an estimated healthcare expenditure saving of almost $1.5 billion.
University of Texas School of Public Health conducted quantitative and qualitative studies to understand the factors that exist in Houston that make residents vulnerable to developing type 2 diabetes. The qualitative research was conducted in collaboration with University College London.
The results suggested that several factors – including low health literacy, unhealthy food traditions, long commutes and inhabiting neighbourhoods undergoing constant change and development – contribute to people being vulnerable to diabetes. Four ‘at risk’ groups were identified in the population, one of them which has not previously been perceived as an ‘at risk’ group; young, time-pressured people. The four risk profiles changed the traditional public health thinking that only people in underserved communities were at risk. In fact, every Houstonian is vulnerable.
Realizing that lack of trust in the healthcare system and being disconnected from the immediate community was a challenge, the Houston program team explored if communities of faith would be promising settings for prevention. With the insight that almost half of Houstonians regularly visit a house of faith, it was an obvious environment for health promotion and disease prevention. A Faith & Diabetes summit to seek input from religious leaders and a work group of grass roots members from the community began to build a leadership program.
The result is the Faith & Diabetes Initiative, which is training faith-based lay health leaders and building their capacity to deliver diabetes education and awareness to their congregation members.
This work is led by The Institute for Spirituality and Health (ISH) at the Texas Medical Center, which worked with TMF Health Quality Institute, Houston Health Department and Harris County Public Health to train multiple cohorts. Through CCD and in partnership with 23 houses of faith, 41 individuals completed an intense course to become health champions in their community. Their curriculum consisted of five components covering: 1) basics of diabetes self-management and treatment, 2) prevention and awareness, 3) the intersections between religious belief, practice and health, 4) leadership and communication techniques, and 5) evaluation methods and principles.
These community health leaders have become empowered to serve a population of more than 75,000 Christian, Muslim and Hindu residents, of which many are struggling to manage living with diabetes. The leadership training program prepared them to teach a six-week Diabetes Self-Management Education and Support curriculum for people in their community already diagnosed with diabetes, as well as lead the development and implementation of obesity and diabetes prevention projects using a resource guide of evidence-based interventions developed by Houston Health Department and Harris County Public Health. The Faith & Diabetes program is interlinked with the Houston Diabetes Peer Support Network that enables community members to stay closely connected with other community members with diabetes.
There will continue to be a strong collaboration with and among local city stakeholders to ensure continued commitment to create change. This includes evaluation of the training within the Faith & Diabetes Initiative, and training for more than 300 community members before the end of 2019.The city will also be collaborating with CCD partners in Leicester and Vancouver on an initiative designed to facilitate knowledge exchange, drive action orientated research and evaluate community-based interventions.