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The Promise of Public Private Partnerships: Inspiration from Houston

Novo Nordisk is a CHEF Platinum Sponsor

By Karin Gillespie, Klaus Madsen and Jerry Franz* 

Across the country health systems are under pressure for payors to deliver outcomes for people with complex chronic disease like diabetes.  While the financial burden on meeting quality metrics lies with the health systems, it is possible to partner with public health, community-based organizations, houses of faith, employers and other players who have a role in prevention and management.

Diabetes continues to take a heavy toll in the US, with 23.1 million diagnosed and 7.2 million more living with the disease but unaware they have it. Additionally, it is estimated that 84.1 million US adults have prediabetes, a condition placing them at high risk of developing diabetes.[1]

Urban areas are hit especially hard by diabetes. For the Chicago-Naperville-Elgin MSA, diabetes and prediabetes prevalence is projected to grow over the next decade.[2]

The number of Chicagoans with prediabetes is projected to grow from 2.8 million in 2015 to 3.3 million by 2030. Diabetes will increase as well: from 1 million in 2015 to 1.5 million by 2030. Within this group, 300,000 people were estimated to be undiagnosed in 2015 and this number will increase to 400,000 by 2030.[3]

Cities influence how people live, travel, move, and eat.[4] Cities can benefit from innovative models that can leverage resources in both the clinic and the community to better address prediabetes and diabetes.

One powerful model is the global Cities Changing Diabetes Initiative that currently encompasses 16 cities from Copenhagen to Shanghai, and Buenos Aires to Johannesburg.  Houston is the only US city participating in the initiative to date.  Catalyzed by Novo Nordisk, a global leader in diabetes care for more than 95 years, Houston-area government, non-profit, faith-based, and corporate interests have come together in a public-private partnership that in just four years has given new life and energy to creative approaches to help prevent diabetes and improve care for those with diabetes.  Part of Novo Nordisk’s global Cities Changing Diabetes initiative, Cities Changing Diabetes-Houston has developed and is now implementing activities and programs to reach Houstonians in the community and online with information and tools that could help improve health and quality of life for thousands of local citizens and lead the way for other US cities to follow in their footsteps.

The Cities Changing Diabetes change model starts with a thorough mapping of the diabetes burden in the community. Dr. Stephen Linder and team, with the UT Health School of Public Health, conducted 125 2-hour interviews in Houston neighborhoods, with community residents in their homes to understand their vulnerability to developing diabetes. The research showed that across vulnerable populations, the primary drivers of diabetes risk in Houston include the perception of physical change, transition or loss of community in neighborhoods (77.6 percent); the feeling of being financially constrained (44.8 percent); the adherence to unhealthy family food traditions (42.4 percent); the use of cars for long commutes (41.6 percent); and the experience of time poverty which precludes people from prioritizing their personal health (40 percent).[5]

Following the research phase, Cities Changing Diabetes Houston engaged more than 100 stakeholders to translate the vulnerability research into solutions.  Community stakeholders organized into Action Work Groups.

Cities Changing Diabetes-Houston currently has five efforts underway: the Houston Diabetes Resource Center (web community for diabetes-related resources and programs in Houston), a Peer Support network that trains people with diabetes to support one another, disaster preparedness and response that arose in the wake of Hurricane Harvey and is focused on assembling the resources that shelter operators, healthcare providers and patients need to better manage diabetes during and after a disaster, an employer Diabetes Prevention Program (DPP) that is helping 13 major employers implement DPP for their employees, and the Faith & Diabetes Initiative that trains houses of faith in diabetes management and prevention so they can deploy programs and policies within their congregations.

One Action Work Group focused on addressing the lack of trust in the traditional healthcare system that was identified by the research through improving linkages between communities of faith and healthcare organizations as a way to better reach Houstonians who – insured or uninsured – often did not seek help from healthcare providers to prevent and manage diabetes.  For many Houstonians, faith is a central part of their lives. Some 42% of Houston residents attend religious services at least once a week, and another 31% attend one or twice monthly.[6] This is higher than the national averages of 36% and 33% respectively.[7] The Houston communities of faith are very diverse, a reflection of the fact that Houston has been recognized as the most racially and ethnic diverse metropolitan area in the US.[8]

With a community as diverse as Houston addressing something as complex as the urban diabetes epidemic, it is important for stakeholders from different sectors to combine forces.

Dr. Faith Foreman, DrPH, MPH, BA, LVN, with the Houston Health Department, who serves as the anchor partner and convener of the initiative says: “Working together makes so much more sense. I think it’s the only way we will actually be able to reduce the impact of diabetes on the Houston community and figure out how to really make a difference.”

This sentiment is echoed by disease organizations such as the American Diabetes Association and American Heart Association who use CCD as a platform to engage government, employers and nonprofits.

“To address the diabetes epidemic, we need everyone on deck: elected officials, employers, nonprofits, healthcare providers, and families. Through Cities Changing Diabetes we have that in Houston.”, says Umesh Verma, Houston business leader and national Treasurer-elect for the American Diabetes Association.

Health Systems Seeking Solutions through Cities Changing Diabetes

Houston Methodist Hospital is among the several Texas Medical Center institutions who are seeking new solutions through their participation in Cities Changing Diabetes.

To Houston Methodist, CCD is a valuable resource that allows collaboration with employers, other hospital systems, community-based programs and public health to understand the needs of our patients and their communities and build effective interventions to support our mission,” says Archana Sadhu, MD, Director, System Diabetes Program at Houston Methodist.

Houston Methodist is actively involved with the CCD Faith & Diabetes program which integrates faith into evidence-based diabetes education and support to ultimately extend the traditional diabetes care team from the clinic to the community.  The Institute for Spirituality and Health at the Texas Medical Center and TMF Health Quality Institute (the Quality Improvement Organization for Texas) train lay leaders from Houston’s houses of faith in how to run a six-week Diabetes Self -Management Education and Support course in their communities.  The 29 inaugural trainees came from 13 different communities from Christian, Muslim and Hindu faiths representing more than 50,000 members. A second cohort of faith communities are receiving training in September 2018.

As a faith-based hospital, Houston Methodist was founded on the understanding that there is a distinct connection between the spiritual and physical aspects of humanity.  Gatherings such as the Faith & Diabetes Summit, hosted by Cities Changing Diabetes in early 2017 are important opportunities for us to create relationships with others in our city who also value how faith and medicine work together for wholeness,” says Rev. Kimberly S. Mabry, Project Manager – Faith & Health, Houston Methodist Hospital.  “Working with so many different stakeholders in the Action Work Group, we learned a lot about how we can work better together to address the most vulnerable members of Houston’s patient population,” states Rev. Mabry.

Several of churches in the Texas Annual Conference of the United Methodist Church have participated in the Faith & Diabetes training and have conducted Diabetes Self Management Education workshops in their congregations.  Brown Chapel AME Church has conducted workshops for a first cohort of church members and they are planning their next training for September 2018.

“Faith & Diabetes has been an eye-opening experience for our church. It has empowered us to help address the diabetes epidemic ravaging our community”, says Marguerite Butler.

Peer Support is another Cities Changing Diabetes program that is popular among Texas Medical Center institutions. It trains people with diabetes to lead support groups at healthcare organizations and in employer and community settings.  Houston Methodist, Memorial Health System, the Kelsey Seybold Clinic and UT Physicians have all sent participants to the two-day trainings on how to implement peer support in their facilities.

Cities Changing Diabetes has also tackled disaster preparedness for people with diabetes and chronic disease. It has been a year since Hurricane Harvey devastated Houston. For the Cities Changing Diabetes stakeholders, it was a catalyst to immediately collaborate on relief efforts and afterwards begin the essential planning in preparation for the next natural disaster.  For Melissa Edwards, executive director of the American Diabetes Association’s South and Central Texas operations, Cities Changing Diabetes became an important vehicle to engage with local government and professional societies such as the Harris County Medical Society and the local chapter of the American Association of Diabetes Educators.

“Through Cities Changing Diabetes, we were able to envision a future where Houstonians with diabetes receive the most optimal care, even in the middle of a disaster. Our Action Work Group developed and collected the materials necessary for the Harris County Office of Emergency Management to arm shelter operators and healthcare providers with the knowledge to run a “pop up” diabetes clinic at a mass shelter. Because of Cities Changing Diabetes, I feel that Houston is better prepared to help people with diabetes get the care they need during a time of disaster than we were before Harvey”, says Melissa Edwards.

Since its launch in 2014, Cities Changing Diabetes has worked hard to be a link between Houston’s health systems and community- and faith-based organizations to leverage and create programs and tools to ultimately help Houstonians at risk for diabetes and those with diabetes better prevent and manage the disease.

For more information about Cities Changing Diabetes, please visit

*Karin Gillespie, MBA, is an employee of Novo Nordisk and the US Project Lead for Cities Changing Diabetes. Klaus Madsen, MPH, Klaus Madsen Health Solutions, is a consultant to Novo Nordisk on Cities Changing Diabetes – Houston. Jerry Franz, Lecturer, Milken Institute School of Public Health, is a consultant to Novo Nordisk on Cities Changing Diabetes – Houston.

[1] Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017. Accessed September 3, 2018.

[2] Institute for Alternative Futures. Diabetes 2030 Forecasts, 2015 CHICAGO Metropolitan Area Diabetes Data & Forecasts Accessed 3 September 2018

[3] Institute for Alternative Futures. Diabetes 2030 Forecasts, 2015 CHICAGO Metropolitan Area Diabetes Data & Forecasts Accessed 3 September 2018

[4] Introduction to Cities: How Place and Space Shape Human Experience, Chen X, Orum A and Paulsen K. Wiley-Blackwell, February 2018.

[5] Data on file with Novo Nordisk, 2016.

[6] Pew Research Center. Religious Landscape Study. Adults in Houston Metro Area. 2015 Accessed 4 September 2018

[7] Ibid.

[8] Emerson MO, Brater J, Howell J, Wilner Jeaenty P, Cline M (2013) Houston region grows more racially/ethnically diverse, with small declines in segregation. Kinder Institute for Urban Research & Hobby Center for the Study of Texas. Accessed 4 September, 2018h

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