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Consensus of Ideas

What is the d16 Consensus of Ideas?

The diaTribe Foundation hosted its inaugural d16: Executive Innovation Lab on Diabetes and Obesity from January 13–15, 2016 in Palo Alto, CA. d16 engaged leaders across diverse sectors to produce innovative, systems-level solutions that could reduce the societal burden of diabetes, heighten the urgency and need for action around the epidemic, and bring a new way of thinking into the diabetes ecosystem. Using elements of “design thinking,” participants were guided through collaborative workshops to offer innovative solutions to the most pressing challenges in type 2 diabetes.

Forty-two participants attended d16, including prominent medical professionals, entrepreneurs, manufacturing leaders, policy-oriented healthcare experts, academics, tech leaders, government decision makers, educators, media experts, food and nutrition scholars, and philanthropists. Participant biographies are available at d16.diatribe.org.

Summarized below are the twelve ideas that came out of d16 that we believe are the most investible, scalable, and impactful. They are not finalized project proposals, and we welcome any and all feedback to further develop and improve upon them.

The full Consensus of Ideas report can be found here

National Diabetes “Show Up” Day

The majority of people with diabetes experience stigma related to their disease, and this contributes to many negative consequences, including: patients ‘hiding’ their diabetes from their friends, family, peers and employers; the perpetuation of this stigma in the media; an absence of type 2 diabetes advocates...

Working Title: National Diabetes “Show Up” Day

Summary: The majority of people with diabetes experience stigma related to their disease, and this contributes to many negative consequences, including: patients ‘hiding’ their diabetes from their friends, family, peers and employers; the perpetuation of this stigma in the media; an absence of type 2 diabetes advocates or a strong patient voice to influence policy and funding; and negative psychosocial impacts that affect quality of life and patient outcomes.

The LGBT community, in particular, offers many lessons in how to address stigma from which the diabetes community can learn. d16 participants created the concept of National Show Up Day, inspired by the LGBT rights movement’s “Coming Out” Day. This day is about a sea change in public perception, behavior, and conversation about type 2 diabetes. It is about providing a safe place for people with diabetes to talk about their disease and about demonstrating that they are not alone. It is an annual day set aside each year for individuals to speak publicly or to their family and friends as people living with type 2 diabetes and for their community — loved ones, employers, caregivers, government, nonprofits, and shops and restaurants — to show people with type 2 diabetes that they are supported in all areas of their lives. This day would be coupled with mechanisms to keep the conversation ongoing, from small efforts like design icons for vendors and restaurants to display to show their support, to larger details like an annual awards program to recognize businesses and individuals who have truly “shown up.” It is backed with a sound partner strategy (i.e., Nike creates a custom “Show Up” shoe, Walgreens gives free A1c tests on Show Up Day, etc.) and a go-to-market plan. While the movement may start with a single “Show Up” day, over the long-term it could evolve into a broader movement surrounding health and wellness in our day-to-day lives.

System Impact: d16 identified “stigma” and the lack of a strong, visible type 2 diabetes patient advocacy community as root causes influencing and perpetuating the scope of the epidemic. When patients and their communities don’t talk to each other about type 2 diabetes:

  • Misinformation is more easily spread;
  • Patients feel more isolated, which can lead to cycles of poor mental health and health behavior;
  • Businesses, researchers, government officials, and others do not understand the urgency, breadth, depth, and nuances of the problem, and how it impacts their constituents, and;
  • Communities will continue to blame patients for their disease, failing to rally to address the root causes of the diabetogenic environment.

National Show Up Day mobilizes the entire type 2 ecosystem to “show up” together to combat the root cause of stigma, help eliminate the shame associated with diabetes, put the need to address diabetes at the forefront of people’s minds, and encourage those with type 2 diabetes to become advocates. In addition to addressing stigma, National Show Up Day would aim to transform the conversation to focus on the root causes of the epidemic and free people from self-blame and shame.

Anthology of Bright Spots

Various efforts throughout the US and abroad have been shown to significantly improve outcomes related to diabetes, but many of these models have not been scaled or replicated on a systemic level, due in part to a lack of information-sharing. An opportunity identified at d16 was to create an accessible “anthology”

Working Title: Anthology of Bright Spots (“What’s Working”)

Summary: Various efforts throughout the US and abroad have been shown to significantly improve outcomes related to diabetes, but many of these models have not been scaled or replicated on a systemic level, due in part to a lack of information-sharing. An opportunity identified at d16 was to create an accessible “anthology” of existing work that has been demonstrated to be effective in improving outcomes for people with type 2 diabetes. The size and scope could be expanded over time. Such an anthology could also include insights from other disease areas that could be applied to diabetes. This could be an evolving anthology with regular updates, and it could be available through multiple platforms (an annual report, a website, etc.). The anthology could include resources for each model including primary contacts, accessible publications or data reports, and other information to help people replicate successful efforts in other networks. On a broader scale, the Anthology of Bright Spots could further highlight those efforts that have impacted the field of diabetes through an awards program or through a national convening event to connect those interested in either contributing resources, scaling existing projects, or in learning about those models.

System Impact: The diabetes ecosystem is fragmented, resulting in a lack of knowledge sharing across people in different sectors. These include those involved with academia, local grassroots efforts, policy initiatives, clinical research, and more. There are several consequences to this fragmentation:

  • Resources are wasted when leaders in the field cannot effectively learn from each other;
  • Models of success on the local level are not replicated or scaled to the fullest extent they could be;
  • Different stakeholders in diabetes remain working in silos;
  • And potential funders do not have information about how to invest their philanthropic dollars in ways that will have the greatest impact.

An Anthology of Bright Spots would serve to increase transparent information sharing in diabetes, highlight successful efforts in diabetes that can be scalable, and allow for cross-sector collaboration.

A “Carbon Taxes” Health Code for Food Distributors

How might we create a standard set of nutrition guidelines for all food distributors (manufacturers, restaurants, vending machines, etc.) with a corresponding score or “award” for those who meet the guidelines...

Working Title: A “Carbon Taxes” Health Code for Food Distributors

Summary: How might we create a standard set of nutrition guidelines for all food distributors (manufacturers, restaurants, vending machines, etc.) with a corresponding score or “award” for those who meet the guidelines? The idea stems from carbon taxes, in which the government will decide what the threshold for nutritional foods offered must be for any given food distributor, and those who meet that threshold would receive some form of tax reduction or other financial incentive. Moreover, these places would also receive a very visible, easy-to-understand stamp of approval. For instance, restaurants who meet the threshold would have to put a green stamp on all their menus (and perhaps are also then rewarded financially, i.e. tax subsidies), those who are middle-tiered would put a yellow stamp, and those that very poorly address the guidelines receive a red stamp (and perhaps are also then punished financially, i.e. increased taxes).

System Impact: Across the diabetes ecosystem, many incentives currently in place enforce a “diabetogenic” environment. As one d16 participant said, American culture and society have created a “perfect storm” for creating a diabetes epidemic. By providing financial incentives for food distributors to offer more nutritious foods, the quality of food commercially available will be more likely to improve, thus making “the healthy choice the easy choice.”

The goal of this program would be to incentivize food distributors to offer increased selections of healthier food, and to provide a clear and visible marker for consumers as to where they can eat that provides nutritional foods.

Increasing Diabetes Representation in Film and Television

Diabetes is a disease that is largely ignored, misunderstood and stigmatized by the general public. While this is due to a complex set of factors, one contributing factor is that there is very little representation of the diabetes patient experience in film and television...

Working Title: Increasing Diabetes Representation in Film and Television

Summary: Diabetes is a disease that is largely ignored, misunderstood and stigmatized by the general public. While this is due to a complex set of factors, one contributing factor is that there is very little representation of the diabetes patient experience in film and television. Just as the gay rights movement benefitted tremendously from shows such as Ellen, Glee, andModern Family, or as the environmental movement benefitted from An Inconvenient Truth, we believe that providing more visibility for diabetes in entertainment and media would help to both build a sense of urgency around addressing this public health epidemic as well as help to educate the public and reduce the stigma associated with the disease. One example from outside of diabetes that can serve as a model is Google’s work with film/television producers to create female characters with computer engineering backgrounds. With funding support, a backbone organization could encourage film and television writers to include characters or families with diabetes. This effort could expand into a broader patient movement, in which people with diabetes get involved through signed petitions, a shared hashtag, or other initiatives to publicly call upon film/media executives to include characters with diabetes and remove inaccurate portrayals of diabetes (i.e., diabetes as a punch line).

System Impact: Stigma and the lack of public understanding about type 2 diabetes deter companies, governmental bodies, or the general public from giving the disease proper attention. Increased visibility of type 2 diabetes through outlets that reach millions of viewers would enhance public health literacy, generate public empathy for patients, and help transform public opinion of diabetes from a shameful or non-serious condition to a major health crisis that impacts society.

Investing in the Healthcare Team of the 21st Century

The healthcare system in America was developed as an acute care management model — with a primary focus on diagnosing and treating symptoms and illnesses. However, diabetes, obesity, as well as many other chronic conditions...

Working Title: Investing in the Healthcare Team of the 21st Century

Summary: The healthcare system in America was developed as an acute care management model — with a primary focus on diagnosing and treating symptoms and illnesses. However, diabetes, obesity, as well as many other chronic conditions, require a shift in the way individuals and their conditions are addressed — with greater participation of the person with the condition and a greater emphasis on daily management or self-management. The Affordable Care Act (ACA) has created unique opportunities to shift our healthcare delivery system to better match the daily needs of the growing segment of our population living with chronic conditions.

According to research by the Commonwealth Fund, the ACA encourages three core approaches for improving healthcare delivery: testing new models of healthcare delivery, shifting from a reimbursement system based on the volume of services to one based on the value of care, and investing in resources for system-wide improvement. Accountable Care Organizations (ACOs) and patient-centered medical homes (PCMHs) are two such examples of evolving care models influenced and/or supported by the ACA. The Centers for Medicare and Medicaid Services also offers a “menu of options” for healthcare systems to improve care, increase care access, and lower costs through better care coordination.

A critical component of this shift is a transformation of the patient’s healthcare team. The typical primary care model in which patients spend less than 20 minutes with their doctor a few times a year does not provide: adequate continuity of care for people with diabetes; the time physicians need to adequately address the complex nature of diabetes and related conditions; and the clinical staff needed to ensure all of the medical, behavioral and psychosocial needs of a person with diabetes are being met. Several models in the U.S. have successfully leveraged care providers in addition to physicians — pharmacists, nurse practitioners, health educators, case managers, social workers, and more — to cost-effectively provide ongoing team-based support for people with diabetes. It is now necessary to identify care models that have proven to improve outcomes, care access, and quality and scale those programs.

System Impact: To provide greater access to a more comprehensive, continuous, and individualized care team for people with diabetes, ultimately driving down costs and improving health outcomes.

Kids as Change Agents

Many powerful social movements have originated in schools — D.A.R.E. and recycling are two examples. How might we create a similar movement among school-age children to become change agents for better nutrition and physical activity...

Working Title: Kids as Change Agents

Summary: Many powerful social movements have originated in schools — D.A.R.E. and recycling are two examples. How might we create a similar movement among school-age children to become change agents for better nutrition and increased physical activity? It would originate first on a local level within a specific school or school district, and successful programs or pilots would be scaled on a broader level. These efforts should be in addition to larger, national efforts to improve school lunch offerings and mandated physical fitness curricula. For instance, pilots could include:

  • Schools implementing mandatory nutrition courses in their school curriculum.
  • Students could have homework assignments to take their families for a walk or to eat fruits and vegetables.
  • Schools could bring back revitalized “home economics” courses that teach kids how to cook healthy and convenient meals, which they could then bring home for their families to eat.
  • Rather than school buses, schools could have “walking buses” or “biking buses” with supervised walking or biking groups to school in the morning.

System Impact: The goal is to make kids passionate about nutrition and exercise in a way that will not only affect the way they behave, but also that will impact their parents. Just as kids compel their parents to recycle, wear seat belts, quit smoking, etc., they would be aware of what constitutes healthy eating and physical activity and encourage it at home.

Diabetes Shark Tank

The “Diabetes Shark Tank” would entail a conference in which people are invited to submit and defend proposals for diabetes “moonshots,” or programs/interventions that could make wide-scale impact on the lives of people with diabetes...

Working Title: Diabetes Shark Tank

Summary: The “Diabetes Shark Tank” would entail a conference in which people are invited to submit and defend proposals for diabetes “moonshots,” or programs/interventions that could make wide-scale impact on the lives of people with diabetes. The Epilepsy Foundation and the American Heart Association have launched ‘Shark Tank’ initiatives to spur investment in ideas to help their patient populations. While both of these programs are relatively new, they may yield important insights that would be helpful as we think about a similar program in diabetes. Such an initiative would create an innovative and exciting marketplace bringing together bright minds to create and invest in the future of diabetes prevention and treatment.

System Impact: Funding for diabetes, both at the federal and private philanthropic level, is very low relative to the population impacted. Only 3% of NIH funding goes to diabetes, a disease that affects the entire US population to some extent. Moreover, funding for innovation in health services in delivery, which examines access, care quality, and population health amounts to just 0.3% of total healthcare expenditures and roughly one-twentieth the sum that goes into science research. Under current funding:

  • There is a lack of innovation within the critical areas of public health, access, behavior change, and other social or mental health fields.
  • The brightest minds are not attracted to diabetes, as it receives less funding and prestige than other areas such as oncology or surgery.
  • Our system is designed to focus on pharmaceutical and technological advances, rather than solutions that affect the root causes of diabetes on a societal level.

This program would encourage more focus and innovation on projects that could make scalable impact and address the societal causes of diabetes, rather than focusing on treatment of symptoms. Moreover, it would create a new funding stream and could attract new investors focused on impact into diabetes.

Accessibility of Healthy Food in Low-Income Communities

The past decade has seen a “healthy lifestyle” movement in America; however, this focus on healthy living has largely been concentrated in higher-income, mostly white communities. Examples include organic food markets...

Working Title: Accessibility of Healthy Food in Low-Income Communities

Summary: The past decade has seen a “healthy lifestyle” movement in America; however, this focus on healthy living has largely been concentrated in higher-income, mostly white communities. Examples include organic food markets, boutique exercise studios, or even farm-to-kitchen or chef-to-kitchen food delivery services such as Blue Apron. The idea for this program is to adapt these models for low-income communities, or to scale up programs that have shown effectiveness already around the country. One example is local non-profit grocery stores that bring nutritious food to people at affordable prices. Other ideas would include a mobile “produce truck” in low-income neighborhoods, a low-cost “Blue Apron” product, providing nutrition education inserts at all grocery stores in low-income neighborhoods, and more. These ideas could be piloted in local communities and then, for those that demonstrate effectiveness and feasibility, could be scaled to reach additional communities.

System Impact: Studies consistently show that low socioeconomic status is one of the most significant risk factors for type 2 diabetes. These populations already are the most disadvantaged when it comes to treatment options, as drug prices continue to rise and the most advanced diabetes medications are not yet generic. Thus, altering the built environment and increasing the offerings and affordability of nutritious foods may have a significant impact on reducing diabetes risk in these groups.

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