Question

What are some political economic circumstances in the United States that could impede people from engaging in exercise as prevention for diabetes and cardiovascular disease?

Answer 1

Successful diabetes prevention will require a concerted effort by individuals, healthcare providers, and health systems to improve awareness of diabetes risk, linkages to effective interventions, and subsequent behavioral changes. The ACA provides many opportunities to support population-based diabetes prevention. Some immediate impacts have come in the form of (1) national increases in the number and availability of evidence-based lifestyle prevention programs and (2) requirements for health payer coverage of diabetes screening tests and lifestyle interventions, which could substantially increase risk awareness and engagement of high-risk persons in cost-effective programs. More policy actions are needed to expand the availability of DPP-based intervention programs, both in overall number and via a wider array of delivery channels, and to ensure that new USPSTF recommendations for prediabetes screening and lifestyle intervention services are offered routinely by healthcare providers and incorporated into transparent health payer coverage policies. Similarly, it will be important to conduct research that evaluates the impact of broader policy actions on diabetes prevention. One example is whether health delivery system and payment reforms designed to promote chronic disease prevention, care coordination, and population health management can have a specific impact on diabetes prevention. Another example involves efforts to raise public awareness about diabetes prevention, obesity, or its risk factors. For instance, the CDC, AMA, ADA, and the Ad Council recently announced a partnership to launch a first-of-its-kind PSA campaign encouraging individuals to know their risk for diabetes and make lifestyle changes [79]. On a broader scale, the First Lady’s “Let’s Move” initiative aims to raise public awareness and mobilize policy action across sectors to solve the problem of childhood obesity [80]. As this work continues to unfold, ongoing research of the impact of policies and programs on diabetes prevention will be needed to identify and preserve the most successful policies and to ensure that diabetes prevention reaches all segments of the American population equitably.