BILL ANALYSIS Ó
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Date of Hearing: August 30, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SCR
134 (Pan) - As Introduced April 25, 2016
SENATE VOTE: 37-0
SUBJECT: Diabetes: the "Screen at 23" campaign
SUMMARY: Urges the California Department of Public Health (DPH)
to endorse the "Screen at 23" campaign to screen all adult Asian
Americans with a body mass index (BMI) of 23 or higher for type
II diabetes. Specifically, this resolution:
1)Finds that approximately 2.5 million Californians, or 9% of
the population, are diagnosed with diabetes, 46% are estimated
to have prediabetes, and residents of Asian American heritage
compromise 14% of the State of California.
2)Finds that diabetes is the fifth leading cause of death among
Asian Americans.
3)Finds that Asian Americans are 30% more likely to have
diabetes than white Americans and are also at greater risk of
developing prediabetes, diabetes, and associated risks at a
lower BMI than white, Hispanic, Black, or Native Americans.
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4)Finds that the per capita health care cost of diabetes in
California is $14,800 per year and the annual cost for
diabetes in California is $37.1 billion, including $27.6
billion in medical costs.
5)Finds that screening Asian American patients at a BMI of 23
instead of 25 would unmask over 67,000 diabetes cases, and
many thousands more prediabetes cases in California, thereby
initiating treatment or early interventions to reduce negative
co-morbidities like heart diseases, kidney diseases, and limb
amputation.
6)Finds 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 that Asian Americans should be tested
for type II diabetes at a BMI of 23.
7)Finds that the Asian American, Native Hawaiian, and Pacific
Islanders (AANHPI) Diabetes Coalition has coordinated the
"Asian BMI" efforts of over 15 national and regional
organizations, culminating in the launch of the "Screen at 23"
campaign.
8)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.
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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.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
1)PURPOSE OF THIS RESOLUTION. 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. The author
notes that diabetes is the fifth leading cause of death among
Asian Americans, and 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. The author
concludes that this resolution raises much needed awareness to
screen all Asian American adults for diabetes at a BMI of 23
kg/m2 or greater versus the standard 25 kg/m2.
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2)BACKGROUND.
a) Diabetes. Diabetes is a chronic medical condition
marked by high levels of blood glucose (a form of sugar)
resulting from defects in insulin production, insulin
action, or both. Type I diabetes, previously known as
juvenile diabetes, is an autoimmune disease in which the
body does not produce the hormone insulin. Type II
diabetes (previously called non-insulin-dependent diabetes
or adult-onset diabetes), accounts for about 90% to 95% of
all diagnosed cases of diabetes. It usually begins as
insulin resistance, a disorder in which the cells do not
use insulin properly. As the need for insulin rises, the
pancreas gradually loses its ability to produce it.
Gestational diabetes occurs in pregnant women who have
never had diabetes before, but have higher than normal
blood glucose levels during pregnancy. Prediabetes is a
condition in which individuals have blood glucose levels
higher than normal but not high enough to be classified as
diabetes. People with prediabetes have an increased risk
of developing type II diabetes, heart disease, and stroke.
Without intervention, about one out of four people with
prediabetes will develop diabetes within three to five
years. Ethnic minorities and those who are poor or
disadvantaged have especially high rates of diabetes.
b) The California Wellness Plan (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 its 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
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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.
c) BMI. According to the Centers for Disease Control and
Prevention (CDC), BMI is a person's weight in kilograms
divided by the square of height in meters. A high BMI can
be an indicator of high body fat. BMI can be used to
screen for weight categories that may lead to health
problems, such as diabetes, but it is not diagnostic of the
body fat or health of an individual.
3)SUPPORT. The AANHPI Diabetes Coalition are the sponsors of
this resolution and note that over half of all Asian Americans
with diabetes are undiagnosed, according to the National
Institutes of Health and the CDC. AANHPI Diabetes Coalition
notes that the "Screen at 23" campaign is meant to raise
awareness and lead to more diabetes and prediabetes diagnoses
of Asian Americans, as well as promote the understanding that
Asian Americans experience diabetes disparities.
4)RELATED LEGISLATION.
a) AB 2696 (Beth Gaines) Chapter 108, Statutes of 2016
requires the Department of Public Health (DPH) to submit a
report to the Legislature on or before January 1, 2019,
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that includes a summary and compilation of recommendations
on diabetes prevention and management.
b) AB 2782 (Bloom) would have imposed a health promotion
fee of $0.02 per fluid ounce on bottled sugar sweetened
beverages and concentrates, and would have 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 was not set for
hearing in the Assembly Health Committee.
c) AB 2424 (Gomez), would, among other provisions, 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.
5)PREVIOUS LEGISLATION.
a) SB 203 (Monning) of 2015 would have required a safety
warning to be affixed to sugar sweetened beverages that
states "STATE OF CALIFORNIA SAFETY WARNING: Drinking
beverages with added sugar(s) contributes to obesity,
diabetes, and tooth decay." SB 203 failed passage in the
Senate Health Committee.
b) AB 1357 (Bloom) of 2015 was substantially similar to AB
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2782. AB 1357 failed passage in the Assembly Health
Committee.
c) AB 572 (Beth Gaines) of 2015 would have required DPH to
update the California Wellness Plan for 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 in the
Senate Appropriations Committee.
d) 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.
e) 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 held in
Senate Rules Committee.
f) AB 1592 (Beth Gaines) of 2014 would have required DPH to
complete and submit to the Legislature a Diabetes Burden
Report (report) by December 31, 2015, including, among
other things, actionable items for consideration by the
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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, who stated that DPH had
already submitted its report to the CDC, as required, and
would be unable to withdraw the report to include
additional information prescribed by the bill.
REGISTERED SUPPORT / OPPOSITION:
Support
Asian American, Native Hawaiian, and Pacific Islander Diabetes
Coalition (sponsors)
American Diabetes Association
National Council of Asian Pacific Islander Physicians
Opposition
None on file.
Analysis Prepared by:Lara Flynn / HEALTH / (916)
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319-2097