Ironically after my turkey-induced feeding frenzy, I came across this article “Diabetes or Prediabetes Predicted for half of Americans by 2020” (see below) about the growing impact chronic diseases, such as diabetes, will have on American citizenry.  As well intentioned the author is to alert the public to this growing health problem, a few questions came to my mind as I read: How will the author get people to think about health care and diabetes?  And, how will he get the public to think about the issue in such a way that they want to solve them through public policies, not only through individual actions?

Unfortunately, the author’s communication strategy is in need of a few critical framing elements that would edify policy solutions.  On The FrameWorks Institute website, we have a Food and Fitness toolkit available that demonstrates how our research recommendations (e.g., the utility of framing elements) can be incorporated into such communiqués on food and fitness, and health that would be more effective in (re) directing the public’s thinking about chronic diseases, such as diabetes. (http://frameworksinstitute.org/toolkits/foodfitness/)

Below are a few suggestions that apply our food and fitness research to the attached article that may prove to be useful reminders to you when creating or revising your own communications materials:

1) Starting off with a value.  Ideas and issues come in hierarchies: Level One: Big ideas and culturally shared values; Level Two: Issue-types; Level Three: Specific issues and policies. At FrameWorks, we find most advocates and experts begin their communications at Level 3, talking about the specific policy issue right off the bat, instead of situating the specific policy issue in a larger vision of “what is this about.” By presenting a more shared value at the outset of your messaging, you remind the public of the widely shared values they already incorporate into their thinking about how to make important choices for their communities and for the world.

In American society, a popular cultural model of Health Individualism (e.g., “You just need to eat less and exercise more”) often crowds out considerations of how communities can work together and remediate chronic health issues for all.

Based on our food and fitness research, there were three values found which served to increase people’s support for food and fitness promoting policies and moved people’s thinking away from notions of individualism:

1.     Fairness– (between places) or the idea that that certain towns or communities are struggling because they are not given a fair chance to get in good shape and are denied the resources they need to breathe healthy air, exercise safely and conveniently, and get nutritious foods.

2.     Ingenuity– or the idea that we as a society are not devoting enough attention to effective policies and programs that would get American communities in good shape.

3.     Prevention– the idea that that we should prevent further damage to our nation’s quality of life by helping American communities get in good shape.

For this article, the value of Prevention would have highlighted the need for increasing safety and convenience in environments where people exercise, increasing regular access to affordable and nutritious foods, and would lead to devoting more medical  and other resources to addressing chronic diseases such as diabetes–which would save money and lives in the long run.

2) Using simplifying models. By providing a simplifying model—a conceptual picture or metaphor– you can guide the public’s reasoning in more constructive, systems-based ways of thinking as opposed to health and wellness being an individualized and consumer choice.  FrameWorks found two simplifying models that increased policy support when combined with the aforementioned values:

1.     Food and Fitness Environment- the notion that people’s community environment determines whether they end up fit or not.

2.     Public Structures – the notion that the quality and functioning of a community’s systems (e.g., transportation, market places, schools with physical fitness requirements).

For this article in particular, the value of Prevention (the prevention of negative outcomes) can work well with the simplifying model of Food and Fitness Environments because the food and fitness environment can be measured from place to place to provide a powerful disincentive to individualize the issue of diabetes.

3) Providing context when discussing solutions.  By connecting the dots for your audience, you are focusing on issues and trends that highlight the role for civic engagement and action, and for which there are public solutions for remediating chronic diseases and other health concerns. Therefore, solutions should be contextualized and thematic by connecting community interventions to outcomes in causal sequences.

4) Using social math. Statistics or uninterrupted numbers are not frames.  The article uses a lot of unframed data, hoping to dramatically call attention to the problem of diabetes, but the cultural model of health individualism will “eat” these numbers unless they are framed.  In addition, the article’s unframed data cues crisis thinking (when the problem is too great to resolve) and leaves people too overwhelmed to participate in finding solutions.  Instead, the author should frame the data by talking about community health and prevention as solutions as opposed to promoting crisis and sympathy to help people see diabetes more clearly.

Here’s the value, domain and model put together from the toolkit.

Prevention     +         Health                                  +    Food and Fitness Environment
(Value)            +        (Domain- i.e., Diabetes)   +    (Simplifying Model)

This is an example of all three put together:

“We should prevent further damage to our nation’s quality of life by helping American communities get in good shape, saving money and lives in the long run. The decisions made in our neighborhoods and municipalities about whether and where to site a supermarket, create mass transit options or maintain a neighborhood park affect our future health. Promoting and maintaining individual health (and reducing incidences of chronic diseases) requires attention to community health. Where we live or work, or our food and fitness environment, is one of the most important things determining whether we end up fit and healthy or not.  When people do not have access to a healthy environment or opportunities to make healthier choices, they have worse health and a lower quality of life.  When we improve these food and fitness environments, the health of the people who live and work there improves as well.”


Yndia Lorick-Wilmot, PhD

Senior Associate, FrameWorks Institute

Article: “Diabetes or Prediabetes predicted for half of Americans by 2020” By Dr. Gupta CNN, November 23,2010
More than half of all Americans will have diabetes or prediabetes by the year 2020, at a cumulative cost of $3.35 trillion unless something drastically changes with U.S. health trends, according to a new analysis conducted by UnitedHealth Group’s Center for Health Reform and Modernization.

Study investigators say diabetes and prediabetes will also account for an estimated 10 percent of total health care spending by the end of the decade at an annual cost of almost $500 billion. That’s up from an estimated $194 billion in 2010.

The report, “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead,” was unveiled this week, because November is National Diabetes Prevention month. The study offers solutions designed to improve health and life expectancy, while also saving up to $250 billion over the next 10 years.

Approximately 26 million Americans have diabetes. Diabetes is one of the fastest growing diseases in the country, according to the American Diabetes Association. Experts predict that one out of three children born in the year 2000 will develop diabetes in their lifetimes, which will raise their risks for heart and kidney disease, nerve damage, blindness and limb amputation.  An additional 67 million Americans are estimated to have prediabetes. In prediabetes, there are often no symptoms. In fact, the ADA notes more than 60 million Americans do not know they are on the verge of developing this dangerous illness.

Just last month, the Centers for Disease Control and Prevention released a report projecting that one in three Americans would have diabetes by 2050. The CDC noted the main contributing factors for the increase were an aging population, with diabetics living longer, an increase in the number of at-risk minorities, and an increase in the number of obese people in the U.S.  “Obesity is a significant contributor to the new cases of diabetes. It is certainly a factor,” Ann Albright, director of the CDC’s Division of Diabetes Translation tells CNN.

The most recent report by UnitedHealth addressed a number of strategies to combat diabetes over the next 10 years, focusing primarily on obesity, creating early intervention program to prevent prediabetes, instituting stronger medication programs and educating Americans on lifestyle changes they can make to combat or control their diabetes.

“There is nothing inevitable about these trends,” said Simon Stevens, executive vice president, UnitedHealth Group, and chairman of the UnitedHealth Center for Health Reform and Modernization. “What is now needed is concerted, national, multi-stakeholder action.”

“Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models. Done right, the human and economic benefits for the nation could be substantial.”


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