Pamela Bailie knows the specific populations in Rochester that are most at risk of developing diabetes.
It’s African Americans and Latinos, said Bailie, with an added cross-section of anyone in the city’s poorest households.
And among those groups, the risk is multiplied when people live in neighborhoods where grocery stores are scarce, crime is high and the perception of safety is low, said Bailie, who coordinates outreach for the Center for Community Health and Prevention at the University of Rochester Medical Center.
These are variables called social determinants of health. They explain why life expectancy is not just correlated with the number of pathogens a person is exposed to, but also (and even more strongly) with the social environment they inhabit.
Now, as the number of Americans with diabetes continues to grow, and the cost of insulin to treat it keeps rising, some communities in Rochester have taken new steps to prevent the disease.
Bailie trains people to run diabetes prevention programs tailored to their communities.
In theory she said, the approach is simple: Eat healthy, get some exercise, and lose a moderate amount of weight. In practice, though, it’s more complex.
Each program uses the same basic structure, but each one also needs a particular approach, she said, because they each serve a particular group of people with a unique set of circumstances.
At URMC’s Strong Ties clinic on West Henrietta Road, Jessica Hashim runs a diabetes prevention program for patients who are at the clinic for help with mental health issues. Schizophrenia, to major depression to borderline personality disorder, she said. “A whole array.”
This population often has what medical experts call “comorbidities,” or other health issues that come along with their mental health diagnoses.
As a result, Hashim said, it’s particularly important for the people in her programs at Strong Ties to develop healthier habits that can help prevent diabetes.
Most diabetes prevention programs emphasize exercise, but Hashim said that can be a barrier for her groups. “This population does not have access to gym memberships,” she said.
“When you’re trying to survive and get by on a limited income, your food is your priority. Your shelter is your priority,” said Hashim.
But she’s built a list of activities that she counsels her groups try out – for free.
“Maybe you can get off the bus a stop early and walk the rest of the way home. Maybe you can listen to music and dance a bit while you cook or clean,” she said.
Other diabetes prevention groups are born out of communities of faith.
Wanda Parker and Odulyn Skerritt are the facilitators of a group that meets at the Faith Hope and Charity church in Rochester’s Plymouth-Exchange neighborhood.
They both said one of the primary jobs of the facilitator is to listen.
At a Friday evening group meeting in late November, Parker and Skerritt heard a litany of dietary concerns from the members. One person was concerned he was relying too much on snacks from vending machines. Another worried about drinking enough water. A third lamented the fried foods he was trying to cut back on.
Bailie, who trains the facilitators, said their emphasis on listening is important.
“We talk a lot about culture in training,” Bailie said. “Food itself is such a cultural thing. To tell somebody that you can no longer eat the food that you love, and that your grandmother made, your mother made, you’re making now — it’s a lot. And it can be very offensive to people.”
Bailie said the leaders also need to know the geography of their communities. She said telling people to walk around the block each day won’t work if they don’t live in a neighborhood where they feel safe walking outside.
Facilitators and participants both said building the groups around already-existing communities helps keep participants accountable.
“If you want, I will send you a text message every two minutes asking if you’re at the gym,” said Tiffanie Crocker, encouraging some of her peers to meet their exercise goals.
The group encourages her, too, she explained. “We know each other, so we can be more open,” she said. “we laugh, we share, we politely criticize each other, but we do it in a way that’s like, okay, you can’t ask us to hold you accountable, and then not hold you accountable.”
