Your Privacy, Your Diabetes
I've been going through a bit of a blogging dry spell.
Last night, I forced myself to start a blog about other bloggers I admire. Talk about a lame excuse for a blog. Not that there aren't people out there who deserved to be written about. There are. But everyone going through a dry spell does that kind of post.
Eventually I'll put it up, but today something came across my desktop from Medscape that was worth commentary.
New York City has an epidemic of diabetes. A community health survey estimates that 9% of the city's adult population (20% of those over age 65 years) has diagnosed diabetes and the disease is now their 4th leading cause of death. Public health officials also estimate from this data that another 4% of the city's population has undiagnosed diabetes.
But New York isn't the only one in this boat. Nationally the statistics are just as grim: 9.6% of the US population over 20 years of age has diagnosed diabetes; 20.9% of US adults over age 60 have diabetes (note that US stats use age 60 and NY used age 65).
This is a horrible statement regarding the public's health and as such the city of NY wants to make improving diabetes control the target of public health programs.
Their first step was a law that went into effect in January 2006 that requires all diagnostic laboratories to report the results of all hemoglobin A1C (HgA1C) levels to the department of health, along with the name, address, and date of birth of the individual for whom the results are being reported.
The HgA1C number reflects the average blood sugar of an individual over a three-month period. The American Diabetes Association (ADA) recommends that people with diabetes maintain an HgA1C level of less than 7%. This level reduces the risk of diabetes complications, including kidney, eye, and nervous system diseases by 25%; for every one-point drop in HgA1C level (for example from 8 to 7%) the risk of heart disease drops by 35-50%.
The controversy for NY is that this is the first time that this depth of surveillance data has been kept on a population of individuals for a disease that is not infectious. In the past states' departments of health have rationalized that keeping data on individuals with infectious diseases such as tuberculosis was important to prevent the spread of disease.
Now there is a public outcry against the NY City law, because individuals express fear that their personal health information will be accessible to those who might use it to discriminate against them, such as employers and insurance companies.
Diabetes is a public health problem that needs to be addressed. NY City represents a slice of our society that reflects a public health problem of the whole nation. Surveillance programs such as this one provide opportunities to improve health outcomes, by identifying populations at risk and targeting them with monies for community health centers and diabetes education programs.
In NY City the health department plans to mail educational materials to individuals whose HgA1C levels don't meet the ADA goal. They will provide them with information about diabetes education classes, city-sponsored exercise and weight-loss programs, and other opportunities to improve their own health. They will also suggest that the individual talk with their health care provider to see what they can do to improve their HgA1C. The department of health will follow this with a list mailed to health care providers of the individuals under their care who don't meet the ADA goals and their lab results.
NY City's public health system has a long-standing history of collecting data on individuals with diseases that are concern to public health, as do all states. In fact, the state of Vermont has a similar data collection system for diabetes, called the Vermont Diabetes Information System. To date the confidentiality of individuals in these surveillance programs has not been breached to cause individual harm.
In my opinion, in the risk versus benefit analysis that is common to the practice of medicine, the potential improvements to public health far outweigh the individual risk. We'll all be watching NYC as they take this bold move to improve the health of its residents. I predict that they will begin to see data that shows inprovement in diabetes management outcomes, and we will soon forget the outcry in favor of improving the health of of our nation.
Laurie
"There is no nonsense so errant that it cannot be made the creed of the vast majority by adequate governmental action"..........Bertrand Russell (1872 - 1970)
Related Topics: Facing a Diabetes Disaster
Technorati tags: diabetes, diabetes NYC
Last night, I forced myself to start a blog about other bloggers I admire. Talk about a lame excuse for a blog. Not that there aren't people out there who deserved to be written about. There are. But everyone going through a dry spell does that kind of post.
Eventually I'll put it up, but today something came across my desktop from Medscape that was worth commentary.
New York City has an epidemic of diabetes. A community health survey estimates that 9% of the city's adult population (20% of those over age 65 years) has diagnosed diabetes and the disease is now their 4th leading cause of death. Public health officials also estimate from this data that another 4% of the city's population has undiagnosed diabetes.
But New York isn't the only one in this boat. Nationally the statistics are just as grim: 9.6% of the US population over 20 years of age has diagnosed diabetes; 20.9% of US adults over age 60 have diabetes (note that US stats use age 60 and NY used age 65).
This is a horrible statement regarding the public's health and as such the city of NY wants to make improving diabetes control the target of public health programs.
Their first step was a law that went into effect in January 2006 that requires all diagnostic laboratories to report the results of all hemoglobin A1C (HgA1C) levels to the department of health, along with the name, address, and date of birth of the individual for whom the results are being reported.
The HgA1C number reflects the average blood sugar of an individual over a three-month period. The American Diabetes Association (ADA) recommends that people with diabetes maintain an HgA1C level of less than 7%. This level reduces the risk of diabetes complications, including kidney, eye, and nervous system diseases by 25%; for every one-point drop in HgA1C level (for example from 8 to 7%) the risk of heart disease drops by 35-50%.
The controversy for NY is that this is the first time that this depth of surveillance data has been kept on a population of individuals for a disease that is not infectious. In the past states' departments of health have rationalized that keeping data on individuals with infectious diseases such as tuberculosis was important to prevent the spread of disease.
Now there is a public outcry against the NY City law, because individuals express fear that their personal health information will be accessible to those who might use it to discriminate against them, such as employers and insurance companies.
Diabetes is a public health problem that needs to be addressed. NY City represents a slice of our society that reflects a public health problem of the whole nation. Surveillance programs such as this one provide opportunities to improve health outcomes, by identifying populations at risk and targeting them with monies for community health centers and diabetes education programs.
In NY City the health department plans to mail educational materials to individuals whose HgA1C levels don't meet the ADA goal. They will provide them with information about diabetes education classes, city-sponsored exercise and weight-loss programs, and other opportunities to improve their own health. They will also suggest that the individual talk with their health care provider to see what they can do to improve their HgA1C. The department of health will follow this with a list mailed to health care providers of the individuals under their care who don't meet the ADA goals and their lab results.
NY City's public health system has a long-standing history of collecting data on individuals with diseases that are concern to public health, as do all states. In fact, the state of Vermont has a similar data collection system for diabetes, called the Vermont Diabetes Information System. To date the confidentiality of individuals in these surveillance programs has not been breached to cause individual harm.
In my opinion, in the risk versus benefit analysis that is common to the practice of medicine, the potential improvements to public health far outweigh the individual risk. We'll all be watching NYC as they take this bold move to improve the health of its residents. I predict that they will begin to see data that shows inprovement in diabetes management outcomes, and we will soon forget the outcry in favor of improving the health of of our nation.
Laurie
"There is no nonsense so errant that it cannot be made the creed of the vast majority by adequate governmental action"..........Bertrand Russell (1872 - 1970)
Related Topics: Facing a Diabetes Disaster
Technorati tags: diabetes, diabetes NYC
