It Takes a Community
In some towns, community health workers are bringing practical diabetes information into the homes of the people who need it most. Here's what they've learned—and how it can help you.
What's the best way to fight diabetes in a town in which nearly one quarter of adults over 40 have this condition? According to Lourdes Fernandez of Douglas, AZ, it might be 1 salsa at a time. "The ladies here like to dance the salsa," says Fernandez, a "community health promoter" who brings diabetes information to the people of her town. "I tell them they don't necessarily have to exercise—just start moving."
Is dancing the key to diabetes control? Or is it the community approach that is helping Douglas residents balance their blood sugar? Here's what experts have learned about facing diabetes as a community—and how it can help you and your neighbors.
The Town Taking Control
In Douglas, AZ, a town near the Mexican-American border, 22% of people 40 and older have diabetes. (That rate is much higher than the national average and higher than in most Latino communities.) It's also a community in which language barriers; long work hours; traditional, high-fat recipes; and other factors have made it difficult for residents to control their blood sugar.A program run by the Southwest Center for Community Health Promotion—a Prevention Research Center funded by the Centers for Disease Control and Prevention—works to bridge these gaps. In the program, community health advisors (known in Latino communities as promotoras) receive special training in diabetes management. They then take what they've learned into the homes and hearts of the people who live in their community, encouraging them to get active, eat healthy, talk with their doctors, and schedule necessary tests and exams.
Emma Torres—a pioneer of the promotora model—has spent the past 20 years inspiring migrant farmworkers of nearby Yuma, AZ, to take better care of their health. "Their work hours—from 3 am to very late at night—make it difficult for them to attend hospital support groups. Many are shy around doctors who don't speak Spanish. Many don't have insurance and don't know how to seek medical care," explains Torres. "Our promotoras fill in the gaps by going to their homes with the information and support they need."
Douglas resident Loreto Pedrego, 53 (diagnosed with diabetes in July 2006), agrees that it was the promotoras' special blend of persistence and knowledge that helped her adopt healthier habits in the past year. "Before, I was confused and did not understand my disease," says Pedrego. "My promotoras have given me support and friendship. I learned that I can live with diabetes if I take care of it."
Bringing Home Health
Even if your community doesn't offer a promotora program, you can still benefit from what the promotoras in Arizona and other places have learned. Here is what you can do to bring their message into your own home and town.Love what you eat. Take the recipes that you love most and substitute healthier ingredients and cooking techniques. In Arizona, promotoras teach Latino residents to use whole-wheat tortillas instead of white-flour ones, to substitute olive oil for lard, and to boil chicken instead of frying it.
Take a friend to checkups. For Maria E. Caballero, 67, of Yuma (who was diagnosed with diabetes 17 years ago), the benefits of the promotora program extend from the kitchen to the doctor's office. "My promotoras have taught me to feel comfortable enough to ask my doctor all the questions I may have." You can use a health advocate, too. When you go to the doctor's office, take along a friend or relative to serve as support, take notes, and help you ask questions.
"The promotoras have taught me to be patient with my condition and myself," says Maria E. Caballero.
Seek support. Would you like to learn more about diabetes in a friendly, supportive setting? Ask your doctor or local hospital to direct you to a diabetes support group in your area. There, you can learn more about your condition, make friends, swap healthy recipes, and maybe even find a walking partner.
Choose exercise that's fun. Salsa may not be the activity for you, but try to get active in a way that doesn't feel like work. Join a mall-walking group with your girlfriends and catch up as you stride. Craving quiet time? Try yoga. Love the water? Swim. And gather with friends and family for active outings: Go bowling, or walk through a local zoo, museum, or amusement park.
Grow a healthier community. Participants in promotora programs have appealed to local parks to improve walking conditions and to schools to introduce healthier foods. You can take similar steps in your community. Try contacting your local township board, parks department, and school district to recommend healthier exercise and nutrition options. You can also ask managers at local supermarkets to stock healthy foods you enjoy. For more ideas on creating an active, healthy community, visit activelivingbydesign.org. Active Living by Design is a national program whose goal is to promote changes in local community design, transportation, and architecture that make it easy for people to be physically active.
Benefits For Everyone
"Everyone can think about what their community can do to make it easier for people with diabetes to make healthy changes," says Lisa K. Staten, PhD, associate professor at Mel and Enid Zuckerman College of Public Health at the University of Arizona and director of the Southwest Center for Community Health Promotion.After all, the effects of diabetes can reach far beyond your own doorstep. "When people don't get the support they need, diabetes can result in time off work, emotional changes that affect relationships, and money spent on medical costs," explains Dr. Staten. "On the positive side, the more support people with diabetes have, the happier their lives can be." By working to improve the health of your community, you can help make your neighborhood healthier for everyone who lives there—including, of course, you.
So You Want to Be a Promotora?
If you'd like to begin a promotora program in your area, look for a Prevention Research Center near you. There are 33 of these centers nationwide. Visit the Centers for Disease Control and Prevention Web site to learn more.
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