HJNO May/Jun 2022

48 MAY / JUN 2022 I  HEALTHCARE JOURNAL OF NEW ORLEANS COLUMN MEDICAID IN THE UNITED STATES, the second most chronic health condition is diabetes. Ac- cording to the Centers for Disease Control and Prevention 2020 National Diabetes Statistics Report, approximately 34.1 mil- lion adults — more than 1 in 10 — are living with type 1 or type 2 diabetes, and anoth- er 88 million are prediabetic. Population Health Metrics projects that, by 2060, the number of U.S. adults with diagnosed dia- betes will have tripled. 1 According to a 2017 report published by Clinical Diabetes and Endocrinology, there is a “diabesity” epi- demic (obesity and type 2 diabetes) that is likely to be “the biggest epidemic in human history.”They assert, “Diabetes has been se- riously underrated as a global public health issue and the world can no longer ignore ‘the rise and rise’ of type 2 diabetes.” 2 Here in Louisiana, diabetes is taking a similar toll, accounting for over 25% of the total of Medicaid managed care claims in 2019. 3 With risk factors that include obesi- ty and family history, diabetes in Louisiana is particularly predictable and prevalent. Because obesity disproportionately affects those living in poverty, Medicaid recipients are especially at risk. And with the third highest rate of poverty — 66.6% above the national average — our state needs more than focused healthcare to win its fight against diabetes. In Louisiana, our Medicaid population represents a fragile group with extremely complex health needs that are amplified and exacerbated by exceptionally poor SDOH (social determinants of health) fac- tors. Health potential and outcomes can’t be separated from our social, emotional, and environmental conditions. People who live in poverty, in substandard hous- ing, and in violent neighborhoods have far greater difficulty maintaining good health. For someone desperate to pay the rent, buy groceries, or keep their family safe, health becomes a low priority. Moreover, research has shown that diabetes care is mitigated for someone facing unstable housing, lack of access to healthy food, economic inse- curity, unsafe neighborhoods, and sub- standard education options. 4,5 THE FIGHT AGAINST DIABETES: Where Healthcare and the Social Determinants of Health Intersect