In the District of Columbia, heart disease and stroke are the 1st and 3rd leading causes of death, respectively . Nearly 29.4% of adults in DC reported having high blood pressure and 31.3% high cholesterol, both of which are a major risk factor for heart disease . Diabetes, overweight or obesity, poor diet, physical inactivity and other chronic diseases, comorbidities and lifestyle choices can also increase people’s risk for heart disease . The diabetes prevalence rate is 8.5% for District resident, a rate similar to the national average of 9.1%, however, demographic and geographic disparities persist. The District of Columbia is divided into 8 wards and currently diabetes prevalence in Wards 7 (14.2%) and 8 (16.5%) is almost three times higher compared to neighboring Ward 2(5.2%). In addition, over 66,000 people in DC, 11.8% of the adult population, have prediabetes with blood glucose levels higher than normal, yet not high enough to be diagnosed as diabetes . These trends in health also mirror income inequities by wards in the District with adverse health outcomes disproportionately affecting lower-income residents in Wards 5, 7, and 8. For example, while the median household income in the District is 31% higher than the US, residents of Wards 7 and 8 have median income levels lower than the US, at 27% and 43%, respectively .
With such disparities, DC Health aims to focus on and invest in the prevention and management of diabetes, prediabetes, cardiovascular disease, high blood pressure, and high blood cholesterol in the District with special emphasis on residents who are low-income, African-American and reside in Wards 5, 7 and 8. Strategic partners will include the District’s Department of healthcare Finance (Medicaid), Medicaid MCO’s, FQHC’s and other health systems, as well as existing community coalitions comprised of multi-sector partners. To address gaps in availability, access, coverage and participation in diabetes and CVD evidence-based programs, DC Health proposes to strengthen existing health systems strategies and advance and expand community-clinical linkages. For example, DC Health will actively engage partners to identify, refer and enroll District residents for participation in evidence-based CVD and diabetes prevention and management programs and services (including the Diabetes Prevention Programs (DPP) and Diabetes Self-Management Education and Support programs) by expanding the IT infrastructure to facilitate health care organizational capacity for referral and enrollment in community, evidence-based programs. DC currently offers these evidence-based lifestyle change programs that benefit both people with pre-diabetes or diabetes and people with high blood pressure, and with/or at risk high blood cholesterol. DC Health will also utilize a health systems change framework to establish systematic quality improvement measures and protocols for long-term sustainability for enhanced care.