A Strategic Approach to Advancing Health Equity for Priority Populations with or at Risk for Diabetes - The Massachusetts Department of Public Health (MDPH) proposes to implement statewide and priority population approaches to prevent and control type 2 diabetes and reduce diabetes inequities as part of Component A. The purpose of the integrated strategy is to build on a foundation established through previous CDC chronic disease funding to focus on approaches that have the highest potential for maximal impact for all Massachusetts residents while strategically centering our work on the unequal burden of type 2 diabetes borne by residents and communities that have systematically experienced greater obstacles to health. MDPH proposes to serve all residents of Massachusetts with a particular focus on priority populations. Diabetes remains a significant public health problem, especially among populations that have faced historical and systemic barriers to health. In Massachusetts, diabetes and prediabetes impact 2 out of 5 residents and diabetes is the 7th leading cause of death for all adults. The state’s priority populations experience diabetes and prediabetes at substantially higher rates compared to the general population and include people with a disability, people with household incomes <$25K, people who have not graduated high school, people living in rural areas, and people who are Black, Hispanic, and Asian, suggesting the significant impact of the social determinants of health. We have selected Strategies 1, 4, 5, 11, 12, and 13 to further our public health approaches. Strategy 1 will increase the number of diabetes self-management education and support and complementary diabetes support programs and services that are accessible to the priority populations and increase the number of new programs in the state. Strategy 4 will focus on the quality care of diabetes in community health centers, which serves a large portion of the priority populations, through increased provider awareness and improved use of electronic systems of care. Strategy 5 will increase the accessibility of lifestyle change organizations to the priority populations and increase the number of programs in the state. Strategy 11 will increase the number of Accountable Care Organizations that adopt innovative payment approaches to covering National Diabetes Prevention Program (National DPP) and community health workers (CHWs). Strategy 12 will increase the number of CHWs who work on diabetes and become state certified, and increase CHW leadership in diabetes prevention and care. Strategy 13 will increase the number of community health centers that are trained in addressing the social determinants of health. The anticipated outcomes of this proposal include improved self-care practices, improved quality of patient care and resources, enhanced policies and systems that support diabetes management and type 2 diabetes prevention, enhanced infrastructure that supports CHW integration into team-based care, increased sustainable financing for the National DPP and CHWs, and improved skills of clinical partners to address the root causes of health inequities. MDPH has the capability to serve all populations and communities within Massachusetts. As a recipient of CDC chronic disease cooperative agreements 1305, 1422, 1815, and 1817, MDPH has built extensive programmatic and epidemiological expertise on improving and tracking public health chronic disease interventions and approaches. Our clinical and community partnerships with community health centers, lifestyle change organizations, Statewide Diabetes Network, Massachusetts Association of Community Health Workers, and culturally competent providers enable us to effectively implement the proposed strategies. MDPH’s proposal builds on Massachusetts’ significant investment in the CHW workforce, and the recent advances made to the MA Medicaid Program (MassHealth) under a 1115 Medicaid Waiver that offers the potential for sustainable funding. MDPH permanent physical address: 250 Washington Street, Boston, MA 02108
