# Presentation: 071070

## Translating DPP into Public Health Activities

- Ned Calonge, MD,MPH
- Chief Medical Officer, Colorado Department of Public Health and Environment

## Objectives

- Discuss the funding and process of public health prevention efforts
- Discuss the potential role of public health in supporting the implementation of DPP in screening, behavior change, and chemoprophylaxis

## Funding of public health prevention efforts

- Little or no funding from state government
- Grant funding from CDC
- Tobacco settlement funds
- Foundation funding (local, national)
- Other

## Process of public health prevention efforts

- Collaborative community groups
- Grant and contract programs
- Specific programs

## Community collaborations

- Participants:
- Academic partners
- Health system partners
- Professional societies
- Private organizations
- Other stakeholders
- Products can be programs, guidelines, policies, goals, materials

## Grant and contract programs

- Contracts provide funding to community organizations and local health departments for relevant projects and programs
-  Sources include Prevention Block Grant, tobacco settlement money, private foundations, other programs

## Specific programs

- CDC funded, based on programmatic priorities
- Grants vary from state to state
- Programs include diabetes (care), cardiovascular disease, and weight gain prevention (diet and exercise)
- Programs are relatively “siloed”

## Other process issues

- Local health departments
- Local public health nursing services
- State/local relationships

## What exists currently to support implementation of DPP findings?

- Screening
- Behavior change
- Chemoprophylaxis

## Screening

- No public health funds currently
- Indirect support would involve working with community partners (health systems, insurers, community health services, other state agencies, etc.) to promote supportive policies for screening

## Screening

- Direct support could be provided on a small scale through collaboration  with Medicare, Medicaid, and other programs for low income individuals
- Population-based screening would require a significant resource commitment
- Community health fairs might be a source of direct care if integrated with a primary care system

## Screening alternatives

- Can DPP develop a high risk profile that could be used in lieu of biological testing as an indicator to recommend behavior change?
- How good is a single non-fasting (or fasting) fingerstick without an OGT in defining high risk individuals?

## Behavior change

- Existing programs in Colorado (all CDC-funded):
- Diabetes Coalition
- Cardiovascular Disease Coalition
- Weight gain prevention (diet and exercise)
- Relevant Prevention Block Grant contracts

## Behavior change

- Nearly all activities are dependent on collaboration with non-public health community partners
- State health serves as facilitator for collaborative efforts, some training, and some materials production and dissemination
- Programs could potentially provide direct services

## Behavior change

- Activities that could promote supportive public health support/programs:
- CDC could provide funding for specific DPP-like programs and activities
- Such projects could benefit from a program that stressed cooperative efforts between existing programs

## Behavior change

- Other funding sources (translational research grants from AHRQ)
- NIDDK might consider supporting translational research or program evaluation

## Chemoprophylaxis

- Public health could facilitate or provide education and training for health care providers
- Public health could be a source of care for low income individuals, via a grant-funded program or cooperative agreement (there are precedent programs)

## Issues for discussion

- What are the estimates of translational effectiveness outside of the highly motivated DPP populations?
- It would seem that effectiveness will be less in a general population with less motivated individuals, and cost effectiveness will be poorer for structured interventions

## Issues for discussion

- Are there alternative approaches that aren’t as resource intensive that might effectively support behavioral change in motivated individuals?
- Phone-based
- Internet-based
- Worksite-based
- Other

## Issues for discussion

- Would public health efforts best be targeted towards:
- General education and awareness campaigns, with integrated information on available community and private programs
- Community collaborative efforts
- Direct services and programs
- Combinations of the above?