BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SCR 134
---------------------------------------------------------------
|AUTHOR: |Pan |
|---------------+-----------------------------------------------|
|VERSION: |April 25, 2016 |
---------------------------------------------------------------
---------------------------------------------------------------
|HEARING DATE: |June 8, 2016 | | |
---------------------------------------------------------------
---------------------------------------------------------------
|CONSULTANT: |Reyes Diaz |
---------------------------------------------------------------
SUBJECT : Diabetes: the "Screen at 23" campaign
SUMMARY :1) Urges the Department of Public Health (DPH) to endorse and
support the "Screen at 23" campaign's efforts to increase
awareness of diabetes among Asian-American communities,
including the use of appropriate screening measures for
Asian-American patients and to eliminate disparities. Urges DPH
to encourage all public and private health providers and
facilities to also participate in these efforts.
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 measure:
1) Finds that approximately 2.5 million Californians, or 9% of
the population, are diagnosed with diabetes (the fifth
leading cause of death among Asian Americans); 46% are
estimated to have prediabetes; and residents of Asian
American heritage comprise 14% of the state's population, who
are 30% more likely to have diabetes than White Americans and
are at greater risk of developing prediabetes, diabetes, and
associated risks at a lower body mass index (BMI) than
Whites, Hispanics, Blacks, and Native Americans.
2) Finds that Asian Americans face health care disparity in type
2 diabetes detection and diagnosis, as the current guidelines
SCR 134 (Pan) Page 2 of ?
for screening Asian Americans at a BMI of 25kg/m2 not only
miss 36% of diabetes diagnoses but also underestimate the
prevalence of prediabetes among Asian Americans.
3) Finds that two out of three people with type 2 diabetes die
from heart attack or stroke, and adults with diabetes are at
risk for developing end-stage renal disease and kidney
failure, blindness, and lower limb loss.
4) Finds that the per capita health care cost of diabetes in the
state is $14,800 per year, and the annual cost is $37.1
billion, including $27.6 billion in medical costs and $9.5
billion in indirect costs and productivity loss.
5) Finds that 38% of all hospitalized Asian Americans in the
state have diabetes, which leads to more expensive hospital
care regardless of the reason for hospitalization, and that
early detection and treatment can mitigate diabetes-related
complications, risks, and costs.
6) Finds that screening Asian American patients at a BMI of 23
instead of 25 would unmask more than 67,000 diabetes cases
and many thousands more prediabetes cases in the state,
thereby initiating treatment or early interventions to reduce
negative comorbidities like heart disease, kidney disease,
and limb amputations.
7) States that the National Institutes of Health recently found
that more than half of Asian Americans with diabetes are
undiagnosed, and community-based participatory research and
studies on Asian-American subpopulations have shown that
Asian Americans develop diabetes at a lower BMI; states that
the World Health Organization recommends screening Asian
patients at a lower BMI than non-Hispanic Whites, and the
2015 official guidelines of the American Diabetes Association
recommend Asian Americans be tested for type 2 diabetes at a
BMI of 23.
8) Finds that the Asian American, Native Hawaiian, and Pacific
Islanders Diabetes Coalition has coordinated the "Asian BMI"
efforts of more than 15 national and regional organizations,
culminating in the launch of the "Screen at 23" campaign;
states that California has the opportunity to become one of
the first states to formally recognize and recommend
screening adult Asian Americans for type 2 diabetes at a BMI
SCR 134 (Pan) Page 3 of ?
of 23, enabling thousands of individuals to get the early
care and treatment needed to live healthier and happier
lives.
9) Urges DPH to endorse and support the "Screen at 23"
campaign's efforts to increase awareness of diabetes among
Asian-American communities, including the use of appropriate
screening measures for Asian-American patients and to
eliminate disparities; urges DPH to encourage all public and
private health providers and facilities to also participate
in these efforts.
10)Requests the Secretary of the Senate to transmit copies of
this measure to the author, the Governor, and the Director of
DPH for appropriate distribution.
FISCAL
EFFECT : This measure has not been analyzed by a fiscal
committee.
COMMENTS :
1)Author's statement. According to the author, approximately 2.5
million Californians, or 9% of the population, are diagnosed
with diabetes. However, Asian Americans are often not screened
for diabetes but are 30% more likely to develop diabetes than
White Americans. Additionally, diabetes is the fifth leading
cause of death among Asian Americans. Since Asian Americans
can develop diabetes at a lower body mass index, the current
guidelines for diabetes screening miss 36% of Asian American
diabetes diagnoses, or approximately 116,000 individuals in
California. SCR 134 raises much needed awareness to screen all
Asian American adults for diabetes at a body mass index of 23
kg/m2 or greater versus the standard 25 kg/m2.
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 Center for Disease Control and
Prevention (CDC), more than one-third of U.S. adults are
SCR 134 (Pan) Page 4 of ?
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,
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
SCR 134 (Pan) Page 5 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.
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 (FY) 2013-14, federal
funding for diabetes prevention decreased from more than $1
million in previous FYs to $817,000. DPH's maternal diabetes
program also experienced significant reductions in federal
funding over the last three FYs, declining from $1.2 million
in FY 2010-11 to $71,000 in FY 2013-14. In FY 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 FYs 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)Related legislation. AB 2782 (Bloom), would have imposed a
health promotion fee of $0.02 per fluid ounce on bottled sugar
sweetened beverages (SSBs) and concentrates, and established
SCR 134 (Pan) Page 6 of ?
the Healthy California Fund from which moneys would be
allocated to various state departments for purposes of
reducing the incidence and impact of diabetes, obesity, and
dental disease in California. AB 2782 failed without being
heard in the Assembly Health Committee.
AB 2424 (Gomez), would, among other things, create the
Community-based Health Improvement and Innovation Fund in the
State Treasury from which moneys would be available, upon
appropriation by the Legislature, for certain purposes,
including, but not limited to, reducing health inequity and
disparities in the rates and outcomes of priority chronic
health conditions, including diabetes. AB 2424 is pending on
the Senate Floor.
7)Prior legislation. SB 203 (Monning, of 2015), would have
required a safety warning to be affixed to SSBs that states
"STATE OF CALIFORIA SAFETY WARNING: Drinking beverages with
added sugar(s) contributes to obesity, diabetes, and tooth
decay." SB 203 failed in the Senate Health Committee.
AB 1357 (Bloom, of 2015), was substantially similar to AB
2782. AB 1357 failed passage in the Assembly Health Committee.
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 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, that includes 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 Department of Motor Vehicles to sponsor a diabetes
awareness, education, and research specialized license plate
program; established the Diabetes Awareness Fund; and
specified that revenues from the fund would 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
SCR 134 (Pan) Page 7 of ?
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, 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; and 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.
8)Support. The cosponsors and other supporters of this bill cite
information from the National Institutes of Health and the CDC
that states over half of all Asian Americans with diabetes are
undiagnosed. Supporters argue that this measure will help
doctors be aware of the appropriate screening guidelines for
Asian Americans; help Asian Americans be more aware of their
risk for developing diabetes; lead to earlier treatment and
intervention to manage and care for diabetes; and allow those
with prediabetes the opportunity to reverse their diabetes and
avoid it completely.
SUPPORT AND OPPOSITION :
Support: Asian American, Native Hawaiian, and Pacific Islander
Diabetes Coalition (cosponsor)
American Federation of State, County and Municipal
Employees (AFSCME), AFL-CIO
National Council of Asian Pacific Islander Physicians
(cosponsor)
American Diabetes Association
Oppose: None received
-- END --
SCR 134 (Pan) Page 8 of ?