No More Excuses: Managing the Health Crisis

Dr. Reed Tuckson is passionate about diabetes for two reasons: the debilitating physical and financial toll it exacts on its victims, and the fact that the disease is “overwhelmingly preventable,” says Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group. “We can prevent much of diabetes by simply changing our lifestyle.”

Even for people who are at risk, Tuckson, one of BE’s 100 Most Powerful Executives in Corporate America, says there are preventable measures that guard against ever getting the disease, and when managed properly, those who do have it can control secondary consequences. Despite this evidence the numbers are staggering: Of the 26 million Americans who have diabetes, the Centers for Disease Control and Prevention reports that 27% are unaware that they have the disease. Of the 79 million adults who have pre-diabetes, 85% don’t know their condition. African Americans are contracting diabetes at nearly twice the rate of almost all segments of the population. According to the United Health Foundation’s America’s Health Rankings–a state-by-state analysis of the nation’s health–the incidence of diabetes for African Americans is 13.3%. It is 8% for whites and 7% for the Asian community.

As a result, Tuckson has launched a number of pilot programs and initiatives to help educate people about better managing and preventing the disease, enlisting a range of complementary and seemingly unlikely partners. Through UnitedHealth Group’s Diabetes Prevention and Control Alliance, programs are being tested with the YMCA in preventive measures and pharmacies as intermediary points for those with diabetes. Tuckson is also in a second-year partnership with Surgeon General Regina Benjamin and the Bronner Bros. International Hair Show, which attracts roughly 60,000 hairstylists and attendees each year. The Hair Fitness competition awards stylists the event’s second-highest prize for exercise-friendly styles.

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Here, Tuckson explains the goal of his partnerships and what he’s doing to make sure everyone understands why diabetes should not be a major health challenge in our community.

With all the information available about the disease, what are we missing? The numbers seem to be increasing, particularly for African Americans.

Having the information is the first step, but the challenge is getting people to act on it, and the barriers to acting on that information are complex and challenging. We can say to someone that they should really eat a healthy diet that is not filled with high calories and excess fat. You can tell people, “Here is what you should eat.” But for so many people in America and especially for African Americans, we live in communities where you don’t have affordable access to healthy foods. In fact, there is extraordinary access to affordable unhealthy foods. So to go from the recommendation to action, you have to overcome that fact that it’s hard in many places to actually find affordable salad. It’s very easy to find an affordable cheeseburger. Grocery stores in our community don’t have healthy foods.

The socioeconomic issue is understandable, but considering the consequences of the disease, why is adopting a healthier lifestyle difficult for business professionals who can afford to make the change?
We’re living busy lives and people are rushing from here to there. We’re not taking the time to eat a healthy meal because we’re moving at a fast-food pace. Part of what we’re learning is that a lot of people don’t know how to cook healthy food anymore. We’ve cut out the educational part of cooking in our schools, and even when you put fresh fruits and vegetables in the supermarket, sometimes they don’t sell because people don’t know how to use them. That becomes a challenge.

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Another barrier: We know that one of the great ways to prevent diabetes is to exercise regularly and, once again, we’re not taking the time to work out. We’re busy, but we’re putting health considerations lower on the totem pole. Despite having the information, the world gets very complicated and it becomes more difficult to put the information into action the way you

should. Having said that, there really is no good excuse. This is within our control and it’s ultimately up to us to decide to make a difference. If we don’t decide to make it for ourselves, then we at least have to make it for our children. We are dooming our children to a life where they are going to be experiencing not only high levels of diabetes and its complications with obesity, but both together lead to heart attacks, stroke, blindness, kidney failure, and amputations. These are really serious. If we don’t do it for ourselves, we’ve got to cut the excuses out for our children.

Through testing and research, what have we learned about the disease?
There are three things that we understand today better than we ever have: We clearly understand the devastation of the complications of diabetes. It is an extraordinarily important risk factor or causative factor for heart attacks, stroke, blindness, kidney failure, and amputations.

Number two: We know that prevention works. For example, people with pre-diabetes, people who have the risk factors for diabetes–not the full-blown disease–[who] lose 5% of their body weight can reduce the conversion to full-blown diabetes by almost 60%. This is really encouraging information. That actually says that you can do something about this. You have control over it–and that’s exciting.

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The third thing we’ve learned is that the economic consequences of diabetes are devastating to America in general and the black community in particular. According to the CDC, one out of every five healthcare dollars is spent caring for someone who has diabetes. Now that is really frightening, because if you think about black businesses and black employees trying to afford the ever-increasing healthcare costs, imagine what this is going to do to the ability to afford healthcare–either offered by black businesses or being affordable to the individual.

What are some of the risk factors with those who have pre-diabetes?
Weight, diet, and exercise. There is a clear relationship between the foods we eat–[foods] high in sugars and calories–and whether or not we are exercising.

What is the prognosis for those who actually have diabetes?
The good news is if we are attentive and vigilant, we can learn to live with this disease and live without significant diabetes-related complications. Individuals with diabetes have to be attentive to their diet. They have to be attentive to their exercise routine. And for those who require medication–oral medicine or insulin injections–attentively following their treatment regimen can result in longevity. The way we measure glucose levels in the body is through a count called HbA1c–hemoglobin A1c, a commonly used blood test that monitors blood sugar control over a three-month period. We know that for every percentage point drop in HbA1c levels, we reduce the risk of complications such as kidney disease, eye disease, or nerve disease by 40%. That’s a good news story! On the one hand, I’ve given you statistics that if you can get your weight down, you have enormous opportunity to decrease your chances of ever getting the disease; and on the other hand, if you’re unfortunate enough to develop diabetes, you can reduce the complications by controlling the disease.

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There’s this feeling for some that being more disciplined removes the joy of eating.
All things in moderation. I watch what I eat, but I enjoy a wide variety of foods. I am attentive to how much of it I eat and how often I eat it. I also enjoy exercising. I’ve come to learn that once you get started exercising you can get hooked on it.

Being healthy is fun and eating healthy can also be fun. Eating good food cooked well is an enjoyable experience. Food that makes you sick and bloated and compromises your health–where’s the fun in that? You also don’t have to go to a gym to exercise. You can do a very good workout without expensive equipment in your living room or in your apartment. There’s no good excuse. You can get this done.

You’ve spearheaded several programs that encourage healthier behaviors.
We have two programs that we have been working on with the CDC, as well as other partners like the [YMCA] and also a series of retail pharmacy partners, called the Diabetes Prevention and Control Alliance. It is a diabetes prevention program working with the Y and [offers] lifestyle coaches who deliver intensive training to people in healthier eating, physical activity, and behavior modification in 16-week sessions. We make the Alliance programs available at no out-of-pocket cost to people who enroll in employer-provided health insurance plans through UnitedHealthcare and Medica in select markets. We are also offering it to other insurance companies and employer groups. By following the lifestyle coaches, we aim to encourage participants to lose 7% of their body weight and help them maintain that loss. [The program is based on the original U.S. Diabetes Prevention Program funded by the National Institutes of Health and the CDC, which showed that with lifestyle changes and modest weight reduction, a person with pre-diabetes can prevent or delay the onset of the disease by 58%.] In the diabetes control program, our retail pharmacy partners are supporting patients by providing real engagement [to help patients adhere to their treatment plans, help monitor for complications, and make sure they are taking their medications properly]. It turns out that pharmacies are a great place to assist us with education and behavior modification.

What made you consider partnering with Bronner Bros.?
We [would like] to promote the hair salon as a center for health in the black community by teaching hair salons to promote healthy hair behavior, with the goal of certifying salons as healthy hair salons, with curriculum. For some people, hair is a barrier [to exercising]. So let’s get that barrier out of the way. Let’s get the community of hair salons to reinforce each other about the right diet and right exercise, and let’s sustain that every time they come in.