Existing law establishes the State Department of Public Health and sets forth its powers and duties pertaining to, among other things, protecting, preserving, and advancing public health, including disseminating information regarding diseases.

This bill would require the State Department of Public Health to submit a report to the Legislature on or before January 1, 2019, that includes a summary and compilation of recommendations, as specified, on diabetes prevention and management from certain sources, including the University of California and the federal Centers for Disease Control and Prevention. The bill would require the department to, commencing July 1, 2017, annually post on its Internet Web site a summary of the amount and source of any funding directed to, and expenditures by, the department for programs and activities aimed at preventing or managing diabetes.

Existing law establishes the State Department of Public Health and sets forth its powers and duties pertaining to, among other things, protecting, preserving, and advancing public health, including disseminating information regarding diseases.

This bill would require the State Department of Public Health to submit a report to the Legislature on or before January 1, 2019, that includes a summary and compilation of recommendations, as specified, on diabetes prevention and management from certain sources, including the University of California and the federal Centers for Disease Control and Prevention. The bill would require the department to, commencing July 1, 2017, annually post on its Internet Web site a summary of the amount and source of any funding directed to, and expenditures by, the department for programs and activities aimed at preventing or managing diabetes.

Existing law establishes the State Department of Public Health and sets forth its powers and duties pertaining to, among other things, protecting, preserving, and advancing public health, including disseminating information regarding diseases.

This bill would require the State Department of Public Health to submit a report to the Legislature on or before January 1, 2018, 2019, that includes a summary and compilation of recommendations, as specified, on diabetes prevention and management from certain sources, including the University of California and the federal Centers for Disease Control and Prevention. The bill would require the department to, commencing July 1, 2017, annually post on its Internet Web site a summary of the amount and source of any funding directed to, and expenditures by, the department for programs and activities aimed at preventing or managing diabetes.

Existing law establishes the position of the State Public Health Officer, who serves as the director of the State Department of Public Health. The officer is required to be a licensed physician and surgeon, pursuant to the Medical Practice Act, and to have demonstrated medical, public health, and management experience.

This bill would make technical, nonsubstantive changes to this provision.

 CONSENT 

Bill No: AB 2696

Author: Beth Gaines (R)

Amended: 4/18/16 in Assembly

Vote: 21

SENATE HEALTH COMMITTEE: 9-0, 6/15/16

AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 80-0, 6/1/16 - See last page for vote

SUBJECT: Diabetes prevention and management

SOURCE: Author

DIGEST: This bill requires the Department of Public Health (DPH) to submit a report to the Legislature, as specified with certain criteria, regarding the prevention and management of diabetes and its complications. This bill requires DPH to post annually specified information on its Internet Web site.

ANALYSIS:

Existing law:

1. Establishes DPH to protect and improve the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Establishes the California Diabetes Program (CDP) within DPH.
2. Provides DPH with the authority to perform activities that protect, preserve, and advance public health, including studies and dissemination of information.

This bill:

1. Requires DPH to submit a report to the Legislature, on or before January 1, 2019, that includes a summary and compilation of recommendations on diabetes prevention and management, if any, from the University of California (UC), the Centers for Disease Control and Prevention (CDC), the California Wellness Plan (Plan), statewide diabetes stakeholder groups, and other entities identified by DPH as having relevant findings and recommendations.
2. Requires the DPH report to include any recommendations on evidence-based strategies to prevent or manage diabetes, an analysis on the financial impact diabetes and its complications have on the state, policy recommendations for the prevention and management of diabetes, and the existing level of coordination between state departments in providing information to the public regarding managing and preventing diabetes and its complications.
3. Requires DPH, commencing July 1, 2017, to post information annually on its Internet Web site that includes a summary of the amount and source of funding directed to DPH and the expenditures on programs and activities aimed at preventing and managing diabetes.
4. Makes DPH’s reporting requirement in 1) above inoperative on January 1, 2024. Makes findings and declarations about the effect of diabetes and its complications on the state’s health care system, as well as the disproportionate effect on the underserved and on ethnic minorities.

Comments

1. Author’s statement. According to the author, diabetes has reached epidemic levels in California. As of 2012, about one in seven adult Californians has diabetes and as many as one in three will be diagnosed in the near future. The total cost for treatment of diabetes in California exceeds $24.5 billion dollars. This dollar amount includes hospitalization, outpatient treatment, disability payments, loss of individual productivity, and more. As the number of those affected increases, so too will the cost. Many of the costs related to diabetes go towards the treatment of preventable disease-related complications. These costly complications, such as blindness and limb amputation, are avoidable if the patient is properly educated on the management of the disease. When people are made aware of the signs of the onset of diabetes, they will be able to address the situation and seek medical attention before the disease has progressed and the irreversible damage to the body has been done.
2. Diabetes in California. DPH issued a study, The Burden of Chronic Disease and Injury, in 2013 that highlights some of the leading causes of death, such as heart disease, cancer, stroke, and respiratory disease, all of which have a strong connection to obesity. Diabetes is another serious chronic disease stemming from obesity that adversely affects quality of life and results in serious medical costs. The last decade has witnessed a 32% rise in diabetes prevalence, affecting some 3.9 million people and costing upwards of $24 billion per year. According to the CDC, more than one-third of U.S. adults are obese, and approximately 12.5 million children and adolescents ages two to 19 years are obese. Research indicates a tripling in the youth obesity rate over the past three decades. While this increase has stabilized between the years 2005 and 2010, in 2010, 38%of public school children were overweight and obese. Overweight youth face increased risks for many serious detrimental health conditions that do not commonly occur during childhood, including high cholesterol and type-2 diabetes. Additionally, more than 80% of obese adolescents remain obese as adults.
3. CDP. The CDP was established in 1981 and represents a partnership between DPH and UC San Francisco. It primarily receives its funding from the CDC. A few key objectives that the CDP focuses on include:
   1. Monitoring statewide diabetes health status and risk factors;
   2. Engaging in outreach to increase awareness about the disease;
   3. Guiding public policy to support at-risk and vulnerable populations;
   4. Offering leadership, guidance, and resources to community health interventions;
   5. Seeking to improve the health care delivery system; and,
   6. Reducing diabetes-related health disparities.

The CDP achieves these through partnering with different individual, community, health care, policy, and environmental entities.

1. California Wellness Plan. In February 2014, DPH’s Chronic Disease Prevention Branch published the Plan, the result of a statewide process led by DPH to develop a roadmap for DPH and partners to promote health and eliminate preventable chronic disease in California. The Plan aligns with the Let's Get Healthy California Taskforce priorities and includes 26 priorities and performance measures developed in 2012 that are based upon evidence-based strategies to prevent chronic disease and promote equity. The Plan contains short, intermediate, and long-term objectives with measurable effects on a variety of chronic diseases, of which diabetes is a major focus. The Plan also contains 15 objectives specific to diabetes, including objectives to increase utilization of diabetes prevention and self-management programs, as well as broad objectives to reduce the prevalence of obesity and diabetes among children and adults. DPH's chronic disease programs plan to collaborate with local and state partners, including the Office of Health Equity, that are engaged in diabetes prevention to implement the objectives. DPH intends to monitor the progress of Plan objectives and publish regular reports on outcomes.

According to DPH, the Chronic Disease Control Branch Chief ensures that, at a minimum, the Plan is reviewed in conjunction with partners every five years to assess the need for a new version. As funding permits and partners agree, a process to create a new version of the Plan will be developed and implemented, overseen by the Director of Coordination. The process will capture observations and recommendations based on lessons learned from Plan implementation efforts and from which updated priorities and evidence-based strategies can be determined. The process will identify specific revisions, assign them to responsible parties, and establish target dates for completion. This review process will be consistent with the CDC and Evaluation Program guidelines. Triggers for reviewing the Plan sooner than the five year cycle include, but are not limited to: a) major changes to DPH authority; or b) major changes in federal and/or state funding, guidance, or requirements. Any future versions of the Plan developed in conjunction with partners will also be available to the public on DPH’s Web site. DPH further states that a one-day statewide conference is planned for 2017 for partners and programs to report on progress or short term outcomes of goals of the Plan. A summary of conference reports will be posted online after the conference.

1. State Auditor report. In January 2015, the State Auditor published report 2014-113, titled "Even with a Recent Increase in Federal Funding, Its Efforts to Prevent Diabetes Are Focused on a Limited Number of Counties." The report highlighted the fact that DPH manages federal grants that fund its diabetes prevention efforts. California does not provide any state funding for diabetes prevention. DPH spending on diabetes prevention has declined over time due to reductions in its federal funding. In fiscal year 2013-14, federal funding for diabetes prevention decreased from more than $1 million in previous fiscal years to $817,000. DPH's maternal diabetes program also experienced significant reductions in federal funding over the last three fiscal years, declining from $1.2 million in fiscal year 2010-11 to $71,000 in fiscal year 2013-14. In fiscal year 2012-13—the most recent year for which nationwide data is available—California had the lowest per capita funding for diabetes prevention in the nation. The report also found that DPH spent its limited federal funds in an appropriate manner and complied with applicable grant requirements. For the 40 expenditures reviewed from fiscal years 2009-10 through 2013-14, DPH expenditures were in accordance with federal requirements, and the amounts spent were found reasonable. Additionally, despite a concern that was raised about the relationship between DPH diabetes and tobacco control programs, the report found DPH has not spent its limited diabetes funds on tobacco cessation activities.

The Auditor recommended that the state consider providing state funding to support efforts to address diabetes, that DPH should develop a process for identifying and applying for federal funding opportunities, including routinely and proactively searching for grants, and DPH should ensure that staff responsible for diabetes prevention continues to develop appropriate knowledge and skills.

Prior Legislation

AB 572 (Beth Gaines, 2015) would have required DPH to update the California Wellness Plan 2014 to include specified items, including priorities and performance measures that are based upon evidence-based strategies to prevent and control diabetes, and to submit a report to the Legislature by January 1, 2018, to include the progress of those specified plan items. AB 572 was held under submission in the Senate Appropriations Committee.

AB 270 (Nazarian, 2015) would have required DPH to apply to the State Department of Motor Vehicles to sponsor a diabetes awareness, education, and research specialized license plate program. The bill would have established the Diabetes Awareness Fund, with revenues to be used by DPH to fund programs related to diabetes awareness and prevention. AB 270 was held under submission in the Senate Appropriations Committee.

SB 1316 (Cannella, 2014) would have required the Department of Health Care Services, DPH, and the Board of Administration of the Public Employees' Retirement System to submit a report to the Legislature regarding their respective diabetes-related programs. SB 1316 was never referred out of Senate Rules Committee.

AB 1592 (Beth Gaines, 2014) would have required DPH to complete and submit to the Legislature a Diabetes Burden Report by December 31, 2015, including, among other things, actionable items for consideration by the Legislature that would aid in attaining the goals set forth by DPH in the California Wellness Plan for 2014. The bill would have required DPH to include in the report guidelines that would reduce the fiscal burden of diabetes to the state. AB 1592 was vetoed by the Governor, stating that DPH had already submitted its Diabetes Burden Report to the CDC, as required, and is unable to withdraw the report to include additional information prescribed by the bill.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 6/28/16)

American Federation of State, County, and Municipal Employees, AFL-CIO

Association of California Healthcare Districts

California Center for Public Health Advocacy

United Auburn Indian Community

OPPOSITION: (Verified 6/28/16)

None received

ARGUMENTS IN SUPPORT: The California Center for Public Health Advocacy (CCPHA) argues that the state has no plan in place to mitigate the escalating fiscal impact of diabetes. While there has been extensive legislation enacted to promote awareness and cost saving measures for conditions, such as cardiovascular disease and tobacco addiction, current law is woefully inadequate in regards to diabetes. Diabetes prevention spending in California is lower than any other state, at just $.03 per person each year. CCPHA states that if legislative action is not taken, California can expect a worsening diabetes crisis that will overwhelm health care providers, dramatically increase health care costs, and leave millions of Californians suffering needlessly.

ASSEMBLY FLOOR: 80-0, 6/1/16

AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

6/29/16 15:50:52

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 2696

SUBJECT: Diabetes prevention and management

SUMMARY:

Requires the Department of Public Health (DPH) to submit a report to the Legislature, as specified with certain criteria, regarding the prevention and management of diabetes and its complications. Requires DPH to post annually specified information on its Internet Web site.

Existing law:

1. Establishes DPH to protect and improve the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Establishes the California Diabetes Program (CDP) within DPH.
2. Provides DPH with the authority to perform activities that protect, preserve, and advance public health, including studies and dissemination of information.

This bill:

1. Requires DPH to submit a report to the Legislature, on or before January 1, 2019, that includes a summary and compilation of recommendations on diabetes prevention and management, if any, from the University of California (UC), the Centers for Disease Control and Prevention (CDC), the California Wellness Plan, statewide diabetes stakeholder groups, and other entities identified by DPH as having relevant finding and recommendations.
2. Requires DPH report to include any recommendations on evidence-based strategies to prevent or manage diabetes, an analysis on the financial impact diabetes and its complications have on the state, policy recommendations for the prevention and management of diabetes, and the existing level of coordination between state departments in providing information to the public regarding managing and preventing diabetes and its complications.
3. Requires DPH, commencing January 1, 2017, to post annually information on its Internet Web site a summary of the amount and source of funding directed to DPH and the expenditures on programs and activities aimed at preventing and managing diabetes.
4. Makes DPH’s reporting requirement in 1) above inoperative on January 1, 2024. Makes findings and declarations about the effect of diabetes and its complications on the state’s health care system, as well as the disproportionate effect on the underserved and on ethnic minorities.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, the report is consistent with ongoing diabetes-related activities; costs are expected to be absorbable within existing resources.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, diabetes has reached epidemic levels in California. As of 2012, about 1 in 7 adult Californians has diabetes and as many as one in three will be diagnosed in the near future. The total cost for treatment of diabetes in California exceeds $24.5 billion dollars. This dollar amount includes hospitalization, outpatient treatment, disability payments, loss of individual productivity, and more. As the number of those affected increases, so too will the cost. Many of the costs related to diabetes go towards the treatment of preventable disease-related complications. These costly complications, such as blindness and limb amputation, are avoidable if the patient is properly educated on the management of the disease. When people are made aware of the signs of the onset of diabetes, they will be able to address the situation and seek medical attention before the disease has progressed and the irreversible damage to the body has been done.
2. Diabetes in California. DPH issued a study, The Burden of Chronic Disease and Injury, in 2013 that highlights some of the leading causes of death, such as heart disease, cancer, stroke, and respiratory disease, all of which have a strong connection to obesity. Diabetes is another serious chronic disease stemming from obesity that adversely affects quality of life and results in serious medical costs. The last decade has witnessed a 32% rise in diabetes prevalence, affecting some 3.9 million people and costing upwards of $24 billion per year. According to the CDC, more than one-third of U.S. adults are obese, and approximately 12.5 million children and adolescents ages two to 19 years are obese. Research indicates a tripling in the youth obesity rate over the past three decades. While this increase has stabilized between the years 2005 and 2010, in 2010, 38%of public school children were overweight and obese. Overweight youth face increased risks for many serious detrimental health conditions that do not commonly occur during childhood, including high cholesterol and type-2 diabetes. Additionally, more than 80% of obese adolescents remain obese as adults.
3. CDP. The CDP was established in 1981 and represents a partnership between DPH and the University of California, San Francisco. It primarily receives its funding from the CDC. A few key objectives that the CDP focuses on include:
   1. Monitoring statewide diabetes health status and risk factors;
   2. Engaging in outreach to increase awareness about the disease;
   3. Guiding public policy to support at-risk and vulnerable populations;
   4. Offering leadership, guidance, and resources to community health interventions;
   5. Seeking to improve the health care delivery system; and,
   6. Reducing diabetes-related health disparities.

The CDP achieves these through partnering with different individual, community, health care, policy, and environmental entities.

1. The California Wellness Plan. In February 2014, DPH’s Chronic Disease Prevention Branch published the Plan, the result of a statewide process led by DPH to develop a roadmap for DPH and partners to promote health and eliminate preventable chronic disease in California. The Plan aligns with the Let's Get Healthy California Taskforce priorities and includes 26 priorities and performance measures developed in 2012 that are based upon evidence-based strategies to prevent chronic disease and promote equity. The Plan contains short, intermediate, and long-term objectives with measurable effects on a variety of chronic diseases, of which diabetes is a major focus. The Plan also contains 15 objectives specific to diabetes, including objectives to increase utilization of diabetes prevention and self-management programs, as well as broad objectives to reduce the prevalence of obesity and diabetes among children and adults. DPH's chronic disease programs plan to collaborate with local and state partners, including the Office of Health Equity, that are engaged in diabetes prevention to implement the objectives. DPH intends to monitor the progress of Plan objectives and publish regular reports on outcomes.

According to DPH, the Chronic Disease Control Branch Chief ensures that, at a minimum, the Plan is reviewed in conjunction with partners every five years to assess the need for a new version. As funding permits and partners agree, a process to create a new version of the Plan will be developed and implemented, overseen by the Director of Coordination. The process will capture observations and recommendations based on lessons learned from Plan implementation efforts and from which updated priorities and evidence-based strategies can be determined. The process will identify specific revisions, assign them to responsible parties, and establish target dates for completion. This review process will be consistent with the CDC and Evaluation Program guidelines. Triggers for reviewing the Plan sooner than the five year cycle include, but are not limited to: a) major changes to DPH authority; or b) major changes in federal and/or state funding, guidance, or requirements. Any future versions of the Plan developed in conjunction with partners will also be available to the public on DPH’s Web site. DPH further states that a one-day statewide conference is planned for 2017 for partners and programs to report on progress or short term outcomes of goals of the Plan. A summary of conference reports will be posted online after the conference.

1. State Auditor report. In January 2015, the State Auditor published report 2014-113, titled "Even with a Recent Increase in Federal Funding, Its Efforts to Prevent Diabetes Are Focused on a Limited Number of Counties." The report highlighted the fact that DPH manages federal grants that fund its diabetes prevention efforts. California does not provide any state funding for diabetes prevention. DPH spending on diabetes prevention has declined over time due to reductions in its federal funding. In fiscal year 2013-14, federal funding for diabetes prevention decreased from more than $1 million in previous fiscal years to $817,000. DPH's maternal diabetes program also experienced significant reductions in federal funding over the last three fiscal years, declining from $1.2 million in fiscal year 2010-11 to $71,000 in fiscal year 2013-14. In fiscal year 2012-13—the most recent year for which nationwide data is available—California had the lowest per capita funding for diabetes prevention in the nation. The report also found that DPH spent its limited federal funds in an appropriate manner and complied with applicable grant requirements. For the 40 expenditures reviewed from fiscal years 2009-10 through 2013-14, DPH expenditures were in accordance with federal requirements, and the amounts spent were found reasonable. Additionally, despite a concern that was raised about the relationship between DPH diabetes and tobacco control programs, the report found DPH has not spent its limited diabetes funds on tobacco cessation activities.
   
   The Auditor recommended that the state consider providing state funding to support efforts to address diabetes, that DPH should develop a process for identifying and applying for federal funding opportunities, including routinely and proactively searching for grants, and DPH should ensure that staff responsible for diabetes prevention continues to develop appropriate knowledge and skills.
2. Prior legislation. AB 572 (Beth Gaines of 2015), would have required DPH to update the California Wellness Plan 2014 to include specified items, including priorities and performance measures that are based upon evidence-based strategies to prevent and control diabetes, and to submit a report to the Legislature by January 1, 2018, to include the progress of those specified plan items. AB 572 was held under submission in the Senate Appropriations Committee.

AB 270 (Nazarian of 2015), would have required DPH to apply to the State Department of Motor Vehicles to sponsor a diabetes awareness, education, and research specialized license plate program. Would have established the Diabetes Awareness Fund, with revenues to be used by DPH to fund programs related to diabetes awareness and prevention. AB 270 was held under submission in the Senate Appropriations Committee.

SB 1316 (Cannella of 2014), would have required the Department of Health Care Services, DPH, and the Board of Administration of the Public Employees' Retirement System to submit a report to the Legislature regarding their respective diabetes-related programs. SB 1316 was never referred out of Senate Rules Committee.

AB 1592 (Beth Gaines of 2014), would have required DPH to complete and submit to the Legislature a Diabetes Burden Report by December 31, 2015, including, among other things, actionable items for consideration by the Legislature that would aid in attaining the goals set forth by DPH in the California Wellness Plan for 2014. Would have required DPH to include in the report guidelines that would reduce the fiscal burden of diabetes to the state. AB 1592 was vetoed by the Governor, stating that DPH had already submitted its Diabetes Burden Report to the CDC, as required, and is unable to withdraw the report to include additional information prescribed by the bill.

1. Support. The California Center for Public Health Advocacy (CCPHA) argues that the state has no plan in place to mitigate the escalating fiscal impact of diabetes. While there has been extensive legislation enacted to promote awareness and cost saving measures for conditions, such as cardiovascular disease and tobacco addiction, current law is woefully inadequate in regards to diabetes. Diabetes prevention spending in California is lower than any other state, at just $.03 per person each year. CCPHA states that if legislative action is not taken, California can expect a worsening diabetes crisis that will overwhelm health care providers, dramatically increase health care costs, and leave millions of Californians suffering needlessly.

SUPPORT AND OPPOSITION:

Support: California Center for Public Health Advocacy

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2696

Author:(Beth Gaines)

As Amended Ver:April 18, 2016

Majority vote

SUMMARY: Requires the Department of Public Health (DPH) to submit a report to the Legislature on or before January 1, 2019, that includes a summary and compilation of recommendations on diabetes prevention and management. Specifically, this bill:

1. Requires the report to include a summary and compilation of recommendations on diabetes prevention and management, if any, from all of the following sources:
   1. The University of California;
   2. The federal Centers for Disease Control and Prevention;
   3. The California Wellness Plan;
   4. Other statewide diabetes stakeholder groups; and,
   5. Other entities identified by DPH as having relevant findings and recommendations.
2. Requires DPH to include in the report any recommendations from the institutions listed in 1) above on all of the following items:
   1. Evidence-based strategies to prevent or manage diabetes;
   2. An analysis of the financial impact diabetes and its complications have on the state; and,
   3. Policy recommendations for the prevention and management of diabetes.
3. Requires DPH to include in the report a description of the existing level of coordination between state departments with regard to programmatic activities and the provision of information to the public regarding managing and preventing diabetes and its complications.
4. Requires DPH, commencing July 1, 2017, to annually post all of the following information on its Internet Web site:
   1. A summary of the amount and source of any funding directed to DPH for programs and activities aimed at preventing or managing diabetes; and,
   2. A summary of the expenditures by DPH on programs and activities aimed at preventing or managing diabetes.
5. Sunsets the reporting requirement on January 1, 2024.
6. Makes various findings and declarations regarding diabetes, including that there is no cure for any type of diabetes; however, there is evidence that diabetes can be prevented or delayed in onset through lifestyle changes and medical intervention.

FISCAL EFFECT: According to the Assembly Appropriations Committee, the report is consistent with ongoing diabetes-related activities; costs are expected to be absorbable within existing resources.

COMMENTS: According to the author, diabetes has reached epidemic levels in California. The author states as of 2012, about one in seven adult Californians have diabetes and many more will be diagnosed in the near future and within 10 years, it will be one in three adults. The author contends that, today, the State of California has no action plan in place to mitigate the escalating fiscal impact of diabetes and this bill would require DPH to create and submit to the State of California a "diabetes action plan." The author concludes the goal of the plan is to provide policy guidance addressing the escalating fiscal impact of diabetes treatment and care.

Diabetes. Diabetes is a chronic medical condition marked by high levels of blood glucose (a form of sugar) resulting from defects in insulin production, insulin action, or both. Type 1 diabetes, previously known as juvenile diabetes, is an autoimmune disease in which the body does not produce the hormone insulin. Type 2 diabetes (previously called non-insulin-dependent diabetes or adult-onset diabetes), accounts for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Gestational diabetes occurs in pregnant women who have never had diabetes before, but have higher than normal blood glucose levels during pregnancy. Prediabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes. People with prediabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke. Without intervention, about one out of four people with prediabetes will develop diabetes within three to five years. Ethnic minorities and those who are poor or disadvantaged have especially high rates of diabetes.

According to DPH, diabetes costs in California exceed $24 billion each year. Total health care and related costs for the treatment of diabetes in California are about $24.5 billion. Direct medical costs (e.g., hospitalizations, medical care, treatment, supplies) account for about $18.7 billion, the other $5.8 billion include indirect costs such as disability payments, time lost from work, and premature death. The average annual treatment cost per case for diagnosed diabetes in the U.S. was nearly $10,000 in 2007. Increased risk of heart disease, stroke, and kidney damage (and the need for dialysis as a result) are the most deadly effects of diabetes.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003268

Date of Hearing: April 20, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2696

Author:(Beth Gaines) – As Amended Ver:April 18, 2016

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Public Health to submit a report about diabetes. Specifically, this bill:

1. Requires a report to the Legislature on or before January 1, 2019, that includes a summary and compilation of recommendations on diabetes prevention and management, including evidence-based strategies, policy recommendations, and an analysis of the fiscal impact of diabetes on the state.
2. Requires CDPH to beginning July 1, 2017, to post information its web site about the amount and source of funding, as well as expenditures, for diabetes prevention and management.

FISCAL EFFECT:

The report is consistent with ongoing diabetes-related activities; costs are expected to be absorbable within existing resources.

COMMENTS:

1. Purpose. According to the author, diabetes has reached epidemic levels in California. The author contends the State of California has no action plan to mitigate the escalating fiscal impact of diabetes.
2. Background. There is evidence the high and growing prevalence of diabetes in the American populations is an economic burden. A recent economic analysis in the journal Diabetes Care places the total economic burden at $322 billion (or over $1,000 per person in the United States), of which $244 billion is in excess medical costs. According to the study's authors, the results "underscore the urgency to better understand the cost mitigation potential of prevention and treatment strategies." A January 2015 State Audit report found California's spending on diabetes prevention was minimal and suggested that if the Legislature wishes CDPH to address diabetes, state funding should be appropriated for that purpose.

In recent years, CDPH has prepared several reports that are related to diabetes, including the 2014 California Wellness Plan, the 2010 Obesity Prevention Plan, the 2013 Burden of Chronic Disease and Injury, and the 2015 Economic Burden of Chronic Disease in California.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 12, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2696

Author:(Beth Gaines) – As Amended Ver:March 18, 2016

SUBJECT: Diabetes prevention and management

SUMMARY: Requires the Department of Public Health (DPH) to submit a report to the Legislature on or before January 1, 2018, that includes a summary and compilation of recommendations on diabetes prevention and management. Specifically, this bill:

1. Requires the report to include a summary and compilation of recommendations on diabetes prevention and management, if any, from all of the following sources:
   1. The University of California;
   2. The federal Centers for Disease Control and Prevention (CDC);
   3. The California Wellness Plan;
   4. Other statewide diabetes stakeholder groups; and,
   5. Other entities identified by DPH as having relevant findings and recommendations.
2. Requires DPH to include in the report any recommendations from the institutions listed in 1) above on all of the following items:
   1. Evidence-based strategies to prevent or manage diabetes;
   2. An analysis of the financial impact diabetes and its complications have on the state; and,
   3. Policy recommendations for the prevention and management of diabetes.
3. Requires DPH to include in the report a description of the existing level of coordination between state departments with regard to programmatic activities and the provision of information to the public regarding managing and preventing diabetes and its complications.
4. Requires DPH, commencing July 1, 2017, to annually post all of the following information on its Internet Website:
   1. A summary of the amount and source of any funding directed to DPH for programs and activities aimed at preventing or managing diabetes; and,
   2. A summary of the expenditures by DPH on programs and activities aimed at preventing or managing diabetes.
5. Sunsets the reporting requirement on January 1, 2024.
6. Makes various findings and declarations regarding diabetes, including that there is no cure for any type of diabetes; however, there is evidence that diabetes can be prevented or delayed in onset through lifestyle changes and medical intervention.

EXISTING LAW establishes DPH to protect and improve the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention.

FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, diabetes has reached epidemic levels in California. The author states as of 2012, about one in seven adult Californians have diabetes and many more will be diagnosed in the near future and within 10 years, it will be one in three adults. The author contends that, today, the State of California has no action plan in place to mitigate the escalating fiscal impact of diabetes and this bill would require DPH to create and submit to the State of California a “diabetes action plan.” The author concludes the goal of the plan is to provide policy guidance addressing the escalating fiscal impact of diabetes treatment and care.
2. BACKGROUND.
   1. Diabetes. Diabetes is a chronic medical condition marked by high levels of blood glucose (a form of sugar) resulting from defects in insulin production, insulin action, or both. Type 1 diabetes, previously known as juvenile diabetes, is an autoimmune disease in which the body does not produce the hormone insulin. There is no known way to prevent type 1 diabetes. Type 2 diabetes (previously called non-insulin-dependent diabetes or adult-onset diabetes), accounts for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Gestational diabetes occurs in pregnant women who have never had diabetes before, but have higher than normal blood glucose levels during pregnancy. Immediately after pregnancy, about 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2. Women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10 to 20 years. Prediabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes. People with prediabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke. Without intervention, about one out of four people with prediabetes will develop diabetes within three to five years. Ethnic minorities and those who are poor or disadvantaged have especially high rates of diabetes. In 2010, one in seven African American (14.3%), one in nine American Indian/Alaskan Natives/Native Hawaiian/Other Pacific Islander (11.6 %), one in 10 Latino (10.9%), one in 11 Asian American (7.7%), and one in 14 white (7.0%) adults had diagnosed diabetes.
      
      According to DPH, diabetes costs in California exceed $24 billion each year. Total health care and related costs for the treatment of diabetes in California are about $24.5 billion. Direct medical costs (e.g., hospitalizations, medical care, treatment, supplies) account for about $18.7 billion, the other $5.8 billion include indirect costs such as disability payments, time lost from work, and premature death. The average annual treatment cost per case for diagnosed diabetes in the U.S. was nearly $10,000 in 2007.
      
      Increased risk of heart disease, stroke, and kidney damage (and the need for dialysis as a result) are the most deadly effects of diabetes. Uncontrolled high blood sugars may also affect the eyes and cause blindness. Diabetes frequently affects circulation, and a simple cut on the foot can lead to an amputation due to infection. Diabetics tend to experience longer hospitalizations and mortality rates. California has an estimated 3.9 million adults with diabetes (2010), and the numbers are rising rapidly.
   2. California Heart Disease, Stroke, and Diabetes Prevention. In July of 2013, DPH received a five-year grant from the CDC, referenced in California as Prevention First, in the amount of $2.4 million per year. In 2014, DPH applied for and was awarded supplemental funding for Prevention First to conduct activities aimed at increasing diabetes self-management programs and increasing the use of lifestyle intervention programs. The amount of the supplemental grant is $1.35 million per year, with 75% ($1 million) awarded to four local health departments – Alameda, Madera, Monterey, and Sacramento. The Prevention First grant (including supplemental) ends in 2018. It is not known if CDC will continue this funding past 2018.

In September 2014, DPH was awarded a four-year grant from the CDC, entitled State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke. The total funding amount per year is $3.52 million with $3 million being allocated to six local health departments – Fresno, Merced, San Joaquin, Shasta, Solano, and Tulare -- who conduct activities related to implementation of the National Diabetes Prevention Program. It is not known if CDC will continue this funding past 2018.

• 1. The California Wellness Plan. In February 2014, DPH's Chronic Disease Prevention Branch published the California Wellness Plan (Plan), the result of a statewide process led by DPH to develop a roadmap for DPH and partners to promote health and eliminate preventable chronic disease in California. The plan aligns with the Let's Get Healthy California Taskforce priorities and includes 26 priorities and performance measures developed in 2012 that are based upon evidence-based strategies to prevent chronic disease and promote equity. The Plan contains short, intermediate, and long-term objectives with measurable effects on a variety of chronic diseases, of which diabetes is a major focus. The plan contains 15 objectives specific to diabetes, including objectives to increase utilization of diabetes prevention and self-management programs, as well as broad objectives to reduce the prevalence of obesity and diabetes among children and adults. DPH's chronic disease programs plan to collaborate with local and state partners, including the Office of Health Equity, engaged in diabetes prevention to implement the objectives. DPH intends to monitor the progress of Plan objectives and publish regular reports on outcomes.
  2. Progress updates and Plan revisions. According to DPH, the Chronic Disease Control Branch Chief ensures that, at a minimum, the Plan is reviewed in conjunction with partners every five years to assess the need for a new version. As funding permits and partners agree, a process to create a new version of the Plan will be developed and implemented, overseen by the Director of Coordination. The process will capture observations and recommendations based on lessons learned from Plan implementation efforts and from which updated priorities and evidence-based strategies can be determined. The process will identify specific revisions, assign them to responsible parties and establish targets dates for completion. This review process will be consistent with the CDC and Evaluation Program guidelines. Triggers for reviewing the Plan sooner than the five year cycle include, but are not limited to: a) major changes to DPH authority; or, b) major changes in federal and/or state funding, guidance, or requirements. Any future versions of the Plan developed in conjunction with partners will also be available to the public on the DPH Website.
     
     DPH further states that a one-day statewide conference will be held on May 18, 2017, for partners and programs to report on progress or short term outcomes of goals of the plan. The meeting, entitled P21 2.0, will showcase the progress report on the Plan Objectives and Focus Areas shared at a February 2014 meeting that brought together experts and partners from multiple organizations and sector; discuss how chronic disease prevention efforts align and have contributed to Let's Get Healthy goals; and, highlight success and best practices.
  3. Diabetes Burden Report. In September 2014, DPH published the “Burden of Diabetes in California,” a report funded by a grant from the CDC. The brief report seeks to describe the current burden of diabetes among adults in the state, and to describe some of the current diabetes prevention and control activities being implemented by DPH. The report also discusses a number of ongoing activities by DPH that support the primary prevention of diabetes through the promotion of healthy eating, increased physical activity, tobacco cessation, and the prevention and control of overweight and obesity. Secondary prevention activities focus on evidence-based strategies to prevent or delay the onset of complications among Californians diagnosed with type 2 diabetes. DPH is establishing a statewide network of evidence-based lifestyle change programs that are designed to prevent the development of type 2 diabetes among people at highest risk and prevent or delay the onset of complications among people diagnosed with type 2 diabetes.

This report addresses some of the required components of this bill including diabetes burden, cost of diabetes in the state and some comparison with other chronic diseases, such as obesity and high blood pressure. The report required by this bill could serve as a complement to this existing report.

1. PREVIOUS LEGISLATION.
   1. AB 572 (Beth Gaines) of 2015, would have required DPH to update the 2014 Plan to include specified items, and required DPH to report to the Legislature on or before January 1, 2018, and as specified, on the progress of the update. AB 572 died Senate Appropriations Committee.
      
   2. AB 270 (Nazarian) of 2015 would have required DPH to apply to the State Department of Motor Vehicles to sponsor a diabetes awareness, education, and research specialized license plate program. Would have established the Diabetes Awareness Fund, with revenues to be used by DPH to fund programs related to diabetes awareness and prevention. AB 270 died in the Senate Appropriations Committee.
   3. AB 1592 (Beth Gaines) of 2014 would have required DPH to complete and submit to the Legislature a Diabetes Burden Report by December 31, 2015 including, among other things, actionable items for consideration by the Legislature that will aid in attaining the goals set forth by DPH in the Plan for 2014. Would have required DPH to include in the report guidelines that will reduce the fiscal burden of diabetes to the state. AB 1592 was vetoed by the Governor, stating that DPH had already submitted its Diabetes Burden Report to the CDC, as required, and is unable to withdraw the report to include additional information prescribed by the bill.
      
   4. SB 1316 (Cannella) of 2014 would have required the Department of Health Care Services, DPH, and the Board of Administration of the Public Employees' Retirement System to submit a report to the Legislature regarding their diabetes-related programs, and stated it was the intent of the Legislature to coordinate a response that assesses the quality of care and manages the costs paid for by state-financed health programs relating to diabetes. SB 1316 died in the Senate Rules Committee.
      

REGISTERED SUPPORT / OPPOSITION:

Support

None on file.

Opposition

None on file.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097