Save 100 Babies©: engaging communities for just and equitable birth outcomes through Photovoice and Appreciative Inquiry.

This paper presents a community engagement model designed to advance social justice and equity for African American birth outcomes through the combined techniques of Photovoice and Appreciative Inquiry. In response to the persistent racial disparities in birth outcomes, Save 100 Babies© was constructed as a 2-day summit where the emphasis was placed on individual and community assets rather than deficits. The engagement was designed to create a level of readiness among individuals working within and outside the field of Maternal and Child Health to envision strategies to attain equitable birth outcomes. The goal of the conference was to facilitate higher level consciousness by guiding the participants though a process aimed at articulating assets, possibilities and the potential for co-creating the desired futures where racial disparities in birth outcome are eliminated [corrected]. As the result of the guided discourse that began with photographs of the lives of African American women, participants articulated the strengths they detected from the pictures, their recommendations for multifaceted changes in policies and practices, and their individual and organizational commitments for a changed future. Since the summit, participants have indicated ways they have fulfilled their vows that include informing families and communities about pregnancy risks, working with youth programs, supporting fatherhood involvement in pregnancy and birth, and advancing case management that is more attuned to women's strengths. Save 100 Babies© is evolving into a network and clearinghouse for sharing and disseminating information and resources for collaboration.

Charting plausible futures for diabetes prevalence in the United States: a role for system dynamics simulation modeling.

INTRODUCTION: Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed diabetes mellitus, type 1 and type 2, by the year 2010. The process for setting this objective, however, did not focus on the achievability or the compatibility of this objective with other national public health objectives. We used a dynamic simulation model to explore plausible trajectories for diabetes prevalence in the wake of rising levels of obesity in the U.S. population. The model helps to interpret historic trends in diabetes prevalence in the United States and to anticipate plausible future trends through 2010. METHODS: We conducted simulation experiments using a computer model of diabetes population dynamics to 1) track the rates at which people develop diabetes, are diagnosed with the disease, and die, and 2) assess the effects of various preventive-care interventions. System dynamics modeling methodology based on data from multiple sources guided the analyses. RESULTS: With the number of new cases of diabetes being much greater than the number of deaths among those with the disease, the prevalence of diagnosed diabetes in the United States is likely to continue to increase. Even a 29% reduction in the number of new cases (the HP 2010 objective) would only slow the growth, not reverse it. Increased diabetes detection rates or decreased mortality rates--also HP 2010 objectives--would further increase diagnosed prevalence. CONCLUSION: The HP 2010 objective for reducing diabetes prevalence is unattainable given the historical processes that are affecting incidence, diagnosis, and mortality, and even a zero-growth future is unlikely. System dynamics modeling shows why interventions to protect against chronic diseases have only gradual effects on their diagnosed prevalence.

Using the Essential Public Health Services as strategic leverage to strengthen the public health response to diabetes.

If current trends continue, health systems will soon be overwhelmed by type 2 diabetes mellitus. Successful population-based diabetes prevention and control efforts require a sound and continually improving infrastructure. In states and U.S. territories, the Diabetes Prevention and Control Programs supported by the U.S. Centers for Disease Control and Prevention's Division of Diabetes Translation serve as a fulcrum for building and refining the infrastructure that links diverse and dynamic partners dedicated to increasing the years and quality of life and achieving health equity among people with and at risk for diabetes. The National Public Health Performance Standards offer a conceptual framework that articulates the requisite infrastructure and services provided by an interconnected network of intersectoral partners to strengthen the public health response to diabetes. These standards associated with the Essential Public Health Services are valuable tools to assess the status of the performance of the health system's infrastructure to guide improvement. The process of engaging system partners in a system-wide assessment informs and leverages cross-sectoral assets to improve health outcomes for citizens in communities shouldering the growing burden of diabetes.

Understanding diabetes population dynamics through simulation modeling and experimentation.

Health planners in the Division of Diabetes Translation and others from the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention used system dynamics simulation modeling to gain a better understanding of diabetes population dynamics and to explore implications for public health strategy. A model was developed to explain the growth of diabetes since 1980 and portray possible futures through 2050. The model simulations suggest characteristic dynamics of the diabetes population, including unintended increases in diabetes prevalence due to diabetes control, the inability of diabetes control efforts alone to reduce diabetes-related deaths in the long term, and significant delays between primary prevention efforts and downstream improvements in diabetes outcomes.