Primary care providers and young artists in several regions of California have teamed up to change the message teenagers and young adults get about type 2 diabetes.
Instead of warning youth about personal food and lifestyle choices that can lead to diabetes, this campaign stresses the social injustices, such as misleading advertising, poverty, and unequal access to healthy food and recreation, that have sucked their family members and communities into a perpetual cycle of disease. The work is detailed in an article on the arts and medicine published online in JAMA today.
The aim of the project, called The Bigger Picture, is to use video poems to tap into young people’s desire to help change the conversation nationwide, and eventually end type 2 diabetes in youth and young adults, lead author Dean Schillinger, MD, from the Division of General Internal Medicine and the Center for Vulnerable Populations at the University of California, San Francisco, and Zuckerberg San Francisco General Hospital, told Medscape Medical News.
“A child should not have type 2 diabetes,” he said.
The hope is that armed with knowledge of root causes, the teenagers can be part of a movement to change unfair and predatory practices just as people were motivated to fight against predatory advertising for tobacco, Schillinger noted.
The program also aims to engage healthcare providers around a larger fight that could create healthier environments for patients, he added. “We physicians and nurses and clinicians need to begin fighting this war beyond one patient at a time, one battle at a time.”
Young artists’ powerful and emotional poetry can reach their peers in ways physicians with charts and statistics cannot, Schillinger argues.
Already, three county health departments in California have chosen The Bigger Picture as their campaign for healthier drink initiatives, and the artists’ faces appear on billboards in subways and on buses.
Four New Videos Released as Diabetes Hits Hard in Ethnic Minority Youth
Four new Bigger Picture videos have been released and are featured in the JAMA paper. Among the messages in the videos are that low wages prevalent in some communities have meant reduced access to healthy foods, and that targeted advertising of sugar-sweetened beverages has harmed communities.
In one video called “Monster,” two artists talk of their fathers’ dependence on energy drinks and heavily sugared coffee to help them through the long workdays necessary to support their families.
In another called “Empty Plate,” an artist addresses the legacy of poverty that means farmers who harvest fresh produce do not earn enough to buy it themselves.
Getting these messages across is imperative to stop the cycle that is hitting patients at increasingly younger ages, Schillinger says.
He and coauthor Natasha Huey, from Youth Speaks, a San Francisco-based youth development and arts education organization, write in the paper: “Over the last decade, rates [of type 2 diabetes] have tripled in American Indian, doubled in African American, and increased 25% to 50% in Asian, Pacific Islander, and Hispanic youth.”
The Bigger Picture has been a joint venture since 2011 with the Center for Vulnerable Populations and Youth Speaks. In 2-hour after-school workshops that run for 5 afternoons, Youth Speaks mentors collaborate with a Center for Vulnerable Populations primary care physician and a health communications professional to lead discussions about diabetes.
After the workshops, participants write poems that blend their new knowledge with their family experience. A filmmaker turns the top poems into videos, which feature the poet and often his or her family members and the neighborhood where they live. So far, the campaign has produced 27 videos.
Physicians Need to “Get on This,” As They Did With Tobacco
The collaborators are looking for two main outcomes, Schillinger said.
One is that people of all ages see diabetes not as a medical problem only but also as a social problem “afflicting our entire nation and draining our economy.”
In the short term, researchers plan a longitudinal study to test whether implementing the Bigger Picture campaign in public high school assemblies will change behavior.
The other message is for healthcare providers, Schillinger said, and it is that “we are a very powerful social and political group and we should be doing everything in our power to prevent a child from getting type 2 diabetes, not just in our offices but in our communities.”
He concluded, “We really owe it to our patients to get on this, just like we did with tobacco.”
Schillinger reports funding from the National Institute on Minority Health and Health Disparities, the National Institute of Diabetes and Digestive and Kidney Diseases, the Metta Fund, and the James Irvine Foundation. Huey reported grant funding from the California Endowment, the Metta Fund, and the James Irvine Foundation.
JAMA. Published online February 14, 2018. Full text
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