BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SCR 134|
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CONSENT
Bill No: SCR 134
Author: Pan (D)
Introduced:4/25/16
Vote: 21
SENATE HEALTH COMMITTEE: 7-0, 6/8/16
AYES: Hernandez, Nguyen, Mitchell, Monning, Nielsen, Pan, Roth
NO VOTE RECORDED: Hall, Wolk
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Diabetes: the Screen at 23" campaign
SOURCE: Asian American, Native Hawaiian, and Pacific
Islander Diabetes
Coalition
National Council of Asian Pacific Islander Physicians
DIGEST: This resolution 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.
ANALYSIS:
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.
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2)Provides DPH with the authority to perform activities that
protect, preserve, and advance public health, including
studies and dissemination of information.
This resolution:
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 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
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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
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; and urges DPH to encourage all public
and private health providers and facilities to also
participate in these efforts.
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
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cause of death among Asian Americans. Since Asian Americans
can develop diabetes at a lower BMI, 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 Centers for Disease Control and
Prevention (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
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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
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
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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.
Related/Prior Legislation
AB 2782 (Bloom, 2016) would have imposed a health promotion fee
of $0.02 per fluid ounce on bottled sugar sweetened beverages
(SSBs) and concentrates, and established 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, 2016), among other things, creates 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 set to be heard in
the Senate Health Committee on June 29, 2014.
SB 203 (Monning, 2015) would have required a safety warning to
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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, 2015) was substantially similar to AB 2782. AB
1357 failed passage in the Assembly Health Committee.
AB 572 (Beth Gaines, 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, 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, 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, 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 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 was unable to withdraw the report to include
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additional information prescribed by the bill.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
SUPPORT: (Verified 6/17/16)
Asian American, Native Hawaiian, and Pacific Islander Diabetes
Coalition (co-source)
National Council of Asian Pacific Islander Physicians
(co-source)
American Diabetes Association
American Federation of State, County and Municipal Employees,
AFL-CIO
OPPOSITION: (Verified6/17/16)
None received
ARGUMENTS IN 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
resolution 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.
Prepared by:Reyes Diaz / HEALTH / (916) 651-4111
6/22/16 15:15:22
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