BILL ANALYSIS Ó
SENATE COMMITTEE ON
HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2696
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|AUTHOR: |Beth Gaines |
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|VERSION: |April 18, 2016 |
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|HEARING DATE: |June 15, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Diabetes prevention and management
SUMMARY : Requires the Department of Public Health (DPH) to submit a
report to the Legislature, as specified with certain criteria,
regarding the prevention and management of diabetes and its
complications. Requires DPH to post annually specified
information on its Internet Web site.
Existing law:
1)Establishes DPH to protect and improve the health of
communities through education, promotion of healthy
lifestyles, and research for disease and injury prevention.
Establishes the California Diabetes Program (CDP) within DPH.
2)Provides DPH with the authority to perform activities that
protect, preserve, and advance public health, including
studies and dissemination of information.
This bill:
1)Requires DPH to submit a report to the Legislature, on or
before January 1, 2019, that includes a summary and
compilation of recommendations on diabetes prevention and
management, if any, from the University of California (UC),
the Centers for Disease Control and Prevention (CDC), the
California Wellness Plan, statewide diabetes stakeholder
groups, and other entities identified by DPH as having
relevant finding and recommendations.
2)Requires DPH report to include any recommendations on
evidence-based strategies to prevent or manage diabetes, an
analysis on the financial impact diabetes and its
complications have on the state, policy recommendations for
AB 2696 (Beth Gaines) Page 2 of ?
the prevention and management of diabetes, and the existing
level of coordination between state departments in providing
information to the public regarding managing and preventing
diabetes and its complications.
3)Requires DPH, commencing January 1, 2017, to post annually
information on its Internet Web site a summary of the amount
and source of funding directed to DPH and the expenditures on
programs and activities aimed at preventing and managing
diabetes.
4)Makes DPH's reporting requirement in 1) above inoperative on
January 1, 2024. Makes findings and declarations about the
effect of diabetes and its complications on the state's health
care system, as well as the disproportionate effect on the
underserved and on ethnic minorities.
FISCAL
EFFECT : According to the Assembly Appropriations Committee, the
report is consistent with ongoing diabetes-related activities;
costs are expected to be absorbable within existing resources.
PRIOR
VOTES :
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|Assembly Floor: |80 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
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|Assembly Health Committee: |19 - 0 |
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COMMENTS :
1)Author's statement. According to the author, diabetes has
reached epidemic levels in California. As of 2012, about 1 in
7 adult Californians has diabetes and as many as one in three
will be diagnosed in the near future. The total cost for
treatment of diabetes in California exceeds $24.5 billion
dollars. This dollar amount includes hospitalization,
outpatient treatment, disability payments, loss of individual
productivity, and more. As the number of those affected
increases, so too will the cost. Many of the costs related to
AB 2696 (Beth Gaines) Page 3 of ?
diabetes go towards the treatment of preventable
disease-related complications. These costly complications,
such as blindness and limb amputation, are avoidable if the
patient is properly educated on the management of the disease.
When people are made aware of the signs of the onset of
diabetes, they will be able to address the situation and seek
medical attention before the disease has progressed and the
irreversible damage to the body has been done.
2)Diabetes in California. DPH issued a study, The Burden of
Chronic Disease and Injury, in 2013 that highlights some of
the leading causes of death, such as heart disease, cancer,
stroke, and respiratory disease, all of which have a strong
connection to obesity. Diabetes is another serious chronic
disease stemming from obesity that adversely affects quality
of life and results in serious medical costs. The last decade
has witnessed a 32% rise in diabetes prevalence, affecting
some 3.9 million people and costing upwards of $24 billion per
year. According to the CDC, more than one-third of U.S. adults
are obese, and approximately 12.5 million children and
adolescents ages two to 19 years are obese. Research indicates
a tripling in the youth obesity rate over the past three
decades. While this increase has stabilized between the years
2005 and 2010, in 2010, 38%of public school children were
overweight and obese. Overweight youth face increased risks
for many serious detrimental health conditions that do not
commonly occur during childhood, including high cholesterol
and type-2 diabetes. Additionally, more than 80% of obese
adolescents remain obese as adults.
3)CDP. The CDP was established in 1981 and represents a
partnership between DPH and the University of California, San
Francisco. It primarily receives its funding from the CDC. A
few key objectives that the CDP focuses on include:
a) Monitoring statewide diabetes health status and risk
factors;
b) Engaging in outreach to increase awareness about the
disease;
c) Guiding public policy to support at-risk and
vulnerable populations;
d) Offering leadership, guidance, and resources to
community health interventions;
e) Seeking to improve the health care delivery system;
and,
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f) Reducing diabetes-related health disparities.
The CDP achieves these through partnering with different
individual, community, health care, policy, and environmental
entities.
4)The California Wellness Plan. In February 2014, DPH's Chronic
Disease Prevention Branch published the Plan, the result of a
statewide process led by DPH to develop a roadmap for DPH and
partners to promote health and eliminate preventable chronic
disease in California. The Plan aligns with the Let's Get
Healthy California Taskforce priorities and includes 26
priorities and performance measures developed in 2012 that are
based upon evidence-based strategies to prevent chronic
disease and promote equity. The Plan contains short,
intermediate, and long-term objectives with measurable effects
on a variety of chronic diseases, of which diabetes is a major
focus. The Plan also contains 15 objectives specific to
diabetes, including objectives to increase utilization of
diabetes prevention and self-management programs, as well as
broad objectives to reduce the prevalence of obesity and
diabetes among children and adults. DPH's chronic disease
programs plan to collaborate with local and state partners,
including the Office of Health Equity, that are engaged in
diabetes prevention to implement the objectives. DPH intends
to monitor the progress of Plan objectives and publish regular
reports on outcomes.
According to DPH, the Chronic Disease Control Branch Chief
ensures that, at a minimum, the Plan is reviewed in
conjunction with partners every five years to assess the need
for a new version. As funding permits and partners agree, a
process to create a new version of the Plan will be developed
and implemented, overseen by the Director of Coordination. The
process will capture observations and recommendations based on
lessons learned from Plan implementation efforts and from
which updated priorities and evidence-based strategies can be
determined. The process will identify specific revisions,
assign them to responsible parties, and establish target dates
for completion. This review process will be consistent with
the CDC and Evaluation Program guidelines. Triggers for
reviewing the Plan sooner than the five year cycle include,
but are not limited to: a) major changes to DPH authority; or
b) major changes in federal and/or state funding, guidance, or
requirements. Any future versions of the Plan developed in
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conjunction with partners will also be available to the public
on DPH's Web site. DPH further states that a one-day statewide
conference is planned for 2017 for partners and programs to
report on progress or short term outcomes of goals of the
Plan. A summary of conference reports will be posted online
after the conference.
5)State Auditor report. In January 2015, the State Auditor
published report 2014-113, titled "Even with a Recent Increase
in Federal Funding, Its Efforts to Prevent Diabetes Are
Focused on a Limited Number of Counties." The report
highlighted the fact that DPH manages federal grants that fund
its diabetes prevention efforts. California does not provide
any state funding for diabetes prevention. DPH spending on
diabetes prevention has declined over time due to reductions
in its federal funding. In fiscal year 2013-14, federal
funding for diabetes prevention decreased from more than $1
million in previous fiscal years to $817,000. DPH's maternal
diabetes program also experienced significant reductions in
federal funding over the last three fiscal years, declining
from $1.2 million in fiscal year 2010-11 to $71,000 in fiscal
year 2013-14. In fiscal year 2012-13-the most recent year for
which nationwide data is available-California had the lowest
per capita funding for diabetes prevention in the nation. The
report also found that DPH spent its limited federal funds in
an appropriate manner and complied with applicable grant
requirements. For the 40 expenditures reviewed from fiscal
years 2009-10 through 2013-14, DPH expenditures were in
accordance with federal requirements, and the amounts spent
were found reasonable. Additionally, despite a concern that
was raised about the relationship between DPH diabetes and
tobacco control programs, the report found DPH has not spent
its limited diabetes funds on tobacco cessation activities.
The Auditor recommended that the state consider providing state
funding to support efforts to address diabetes, that DPH
should develop a process for identifying and applying for
federal funding opportunities, including routinely and
proactively searching for grants, and DPH should ensure that
staff responsible for diabetes prevention continues to develop
appropriate knowledge and skills.
6)Prior legislation. AB 572 (Beth Gaines of 2015), would have
required DPH to update the California Wellness Plan 2014 to
include specified items, including priorities and performance
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measures that are based upon evidence-based strategies to
prevent and control diabetes, and to submit a report to the
Legislature by January 1, 2018, to include the progress of
those specified plan items. AB 572 was held under submission
in the Senate Appropriations Committee.
AB 270 (Nazarian of 2015), would have required DPH to apply to
the State Department of Motor Vehicles to sponsor a diabetes
awareness, education, and research specialized license plate
program. Would have established the Diabetes Awareness Fund,
with revenues to be used by DPH to fund programs related to
diabetes awareness and prevention. AB 270 was held under
submission in the Senate Appropriations Committee.
SB 1316 (Cannella of 2014), would have required the Department
of Health Care Services, DPH, and the Board of Administration
of the Public Employees' Retirement System to submit a report
to the Legislature regarding their respective diabetes-related
programs. SB 1316 was never referred out of Senate Rules
Committee.
AB 1592 (Beth Gaines of 2014), would have required DPH to
complete and submit to the Legislature a Diabetes Burden
Report by December 31, 2015, including, among other things,
actionable items for consideration by the Legislature that
would aid in attaining the goals set forth by DPH in the
California Wellness Plan for 2014. Would have required DPH to
include in the report guidelines that would reduce the fiscal
burden of diabetes to the state. AB 1592 was vetoed by the
Governor, stating that DPH had already submitted its Diabetes
Burden Report to the CDC, as required, and is unable to
withdraw the report to include additional information
prescribed by the bill.
7)Support. The California Center for Public Health Advocacy
(CCPHA) argues that the state has no plan in place to mitigate
the escalating fiscal impact of diabetes. While there has been
extensive legislation enacted to promote awareness and cost
saving measures for conditions, such as cardiovascular disease
and tobacco addiction, current law is woefully inadequate in
regards to diabetes. Diabetes prevention spending in
California is lower than any other state, at just $.03 per
person each year. CCPHA states that if legislative action is
not taken, California can expect a worsening diabetes crisis
that will overwhelm health care providers, dramatically
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increase health care costs, and leave millions of Californians
suffering needlessly.
SUPPORT AND OPPOSITION :
Support: California Center for Public Health Advocacy
Oppose: None received
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