The key takeaway from the video is that public health interventions are inherently complex but must be specific and narrow to the point of fulfilling their purpose and targeting the necessary populations. There are several intervention approaches aimed at when it is activated, who it targets, and how/what methods it utilizes. A combination of these interventions has to be considered based on the public health issues, involved stakeholders, and levels/types of interventions. It is important to remain flexible in public health approaches due to the wide range of influences, environmental, and population factors. However, models such as RE-AIM can help focus the intervention on effective components of public health interventions and ensure that the program is stronger and aims to achieve its objectives (Exploring Health Topics with Dr. Wade, 2018).
The National Diabetes Prevention Program (NDPP) in New York City is part of the nationwide CDC-sponsored initiative for diabetes prevention and mitigation. The program is overseen by WorkWell NYC and focuses on bringing the program to the workplace. A worksite ambassador applies with the city program, providing the scheduled sessions, meeting space, and marketing for the program at the workplace. A lifestyle coach is then provided by the city conducting once-a-week sessions for the first 6 months and bi-weekly/monthly sessions for the last 6 months. The yearlong course focuses on healthy eating, fitness, stress management, strong, healthy routines, incorporating habits into daily lifestyle, and coping mechanisms. The program is available to NYC employers and employees for free, but participants must have a BMI of over 25 and have a diagnosis of prediabetes or early-onset type 2 diabetes (NYC Office of Labor Relations, n.d.).
The program focuses somewhat only on one determinant of health which is social and community context. This determinant focuses on connecting people’s health and well-being with the characteristics of their context, such as people and contexts in which they live, learn/work, and spend time (NEJM Catalyst, 2017). Therefore, given that New Yorkers spend a significant portion of their time at work, it creates the social context necessary to provide conditions for cohesiveness and support on the issue. Interactions and relationships with other community members, including co-workers, can have a major impact on health and well-being, with a greater likelihood of positive outcomes if collaboratively working on similar health issues. Given that prediabetes and early onset type-2 diabetes are prevalent, along with the obesity needed to participate in this program, it is likely that population-level uptake will be on the increase.
The approach this program took as a city-wide intervention is effective, given that it offers the community context and social engagement through the workplace meaning much greater exposure. While prediabetes is a complex health condition influenced by multiple individual and environmental factors, food is one major component. Food is partially dependent on social contexts, which this program already addresses. However, another major element is the availability of healthy food options, which relies strongly on economic stability. Economic stability can impact how much money a household can spend on food and have choices on what types of foods are consumed. Furthermore, economic stability typically means better housing in neighborhoods with access to fresh, healthy produce, not food deserts (Oude Groeniger et al., 2019). One improvement that could be made to the NDPP is including financial management, particularly in terms of food purchasing. The program is free, which does allow for greater accessibility, and given that it is through the workplace, these participants are making some level of income. Therefore, in order to boost effectiveness and cover one more level of social determinants, a focus on financial management in the context of prediabetes diet management may be highly effective.
References
Exploring Health Topics with Dr. Wade. (2018). Public health interventions [Video file]. YouTube. Web.
NEJM Catalyst. (2017). Social determinants of health. Web.
NYC Office of Labor Relations. (n.d.). National diabetes prevention program. Web.
Oude Groeniger, J., Kamphuis, C. B. M., Mackenbach, J. P., Beenackers, M. A., & van Lenthe, F. J. (2019). Are socio-economic inequalities in diet and physical activity a matter of social distinction? A cross-sectional study. International Journal of Public Health, 64(7), 1037–1047. Web.