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 develop a detailed action plan for the prevention and treatment of diabetes, 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, that includes an update on the status of the plan and the progress of those specified plan objectives and outcomes. items.

The bill would also make related findings and declarations.

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 develop a detailed action plan for the prevention and treatment of diabetes, and to submit a report to the Legislature by an unspecified date January 1, 2018, that includes an update on the status of the plan and the progress of plan objectives and outcomes.

The bill would also make related findings and declarations.

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 develop a detailed action plan for the prevention and treatment of diabetes, and to submit a report to the Legislature by an unspecified date that includes, among other things, information on the financial impact of all types of diabetes on Californians, an assessment of the benefits of implemented programs aimed at controlling diabetes and preventing the disease, and action plans for battling diabetes. an update on the status of the plan and the progress of plan objectives and outcomes.

The bill would also make related findings and declarations.

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 by an unspecified date that includes, among other things, information on the financial impact of all types of diabetes on Californians, an assessment of the benefits of implemented programs aimed at controlling diabetes and preventing the disease, and action plans for battling diabetes.

The bill would also make related findings and declarations.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 572 (Beth Gaines) - Diabetes prevention: treatment

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 572 would require the Department of Public Health to update the California Wellness Plan 2014 to include specific information relating to diabetes and to report every other year on progress in meeting the plan’s goals.

Fiscal Impact:

• One-time costs of $150,000 for the Department of Public Health to contract with a university for technical analyses of strategies to prevent diabetes and performance measures to measure outcomes from those strategies (General Fund).

• Ongoing staff costs of $126,000 per year to develop the update to the Wellness Plan, prepare biennial reports to the Legislature, and provide administrative support (General Fund).

• Ongoing costs of $100,000 per year to contract with a university to provide the logistical support for stakeholder outreach and consultation on strategies to include in the update to the Wellness Plan and developing policy recommendations (General Fund).

Background:

The California Diabetes Program within the Department of Public Health is charged with monitoring diabetes prevalence, engaging in public outreach, and partnering with outside stakeholders to address diabetes.

The Department has recently released the California Wellness Plan 2014 which addresses a variety of health concerns, including diabetes and other chronic conditions.

In addition, the Department has completed a Diabetes Burden Report which analyzes programs and activities that address the burden of Diabetes. (Completion is a requirement of the Department’s federal grant funding.)

Proposed Law:

AB 572 would require the Department of Public Health to update the California Wellness Plan 2014 to include specific information relating to diabetes and to report every other year on progress in meeting the plan’s goals.

Specific provisions on the bill would:

• Require the Department to update the California Wellness Plan 2014 with specified information, including priorities and performance measures to prevent diabetes, an analysis of the financial impact of diabetes, detailed budget information required to implement strategies in the update, and policy recommendations;

• Require the Department to report to the Legislature by January 1, 2018 and every other year until 2024 on the progress of implementation of the information relating to diabetes added to the California Wellness Plan 2014.

Related Legislation:

• AB 270 (Nazarian, 2015) would require the Department of Public Health to apply to the Department of Motor Vehicles to create a specialized license plate program to support diabetes-related programs. That bill is pending in this committee.

• SB 1316 (Cannella, 2014) would have required the Department of Public Health, the Department of Health Care Services, and CalPERS to report on their diabetes-related programs. That bill was held in the Senate Rules Committee.

• AB 1592 (Beth Gaines, 2014) would have required the Department of Public Health to revise the Diabetes Burden Report to include additional, specified information. That bill was vetoed by Governor Brown.

Staff Comments:

The California Diabetes Program is generally funded with federal grant funds. However, staff is not aware of any additional federal funds that could be used for the requirements of this bill. Therefore, the Department would need to use General Fund to undertake the requirements of this bill.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 572

SUBJECT: Diabetes prevention: treatment.

SUMMARY:

Requires the Department of Public Health (DPH) to update the California Wellness Plan 2014 to include specified items, and requires DPH to report to the Legislature on or before January 1, 2018, and as specified, on the progress of the update.

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 update the California Wellness Plan 2014 (Plan) to include the following items:

   1. Priorities and performance measures that are based on evidence-based strategies to prevent or control diabetes. Requires the Plan to identify expected outcomes of the proposed priorities and performance measures and establish benchmarks for controlling and preventing relevant forms of diabetes.

   2. An analysis of the financial impact of diabetes on the state. Requires this assessment to include the number of persons living with diabetes, the number of family members affected by diabetes, the financial impact diabetes and its complications have on the state, and the financial impact of diabetes in comparison to other chronic diseases and conditions.

   3. A summary of expenditures by DPH on programs and activities aimed at preventing or controlling diabetes.

   4. A summary of the amount and source of any funding directed to DPH for programs and activities aimed at controlling or preventing diabetes.

   5. A description of the existing level of coordination between state departments and entities regarding activities, programmatic activities, and the provision of information to the public regarding managing and preventing diabetes and its complications.

   6. A detailed budget blueprint identifying needs, costs, and resources required to update the Plan. Requires this blueprint to include a budget range for each priority and performance measure identified.

   7. Policy recommendations for the prevention and management of diabetes.

2. Requires DPH to submit a report to the Legislature on or before January 1, 2018, and biennially thereafter, that includes the progress of the Plan updates. Requires the report to also include recommendations for improving Plan items based on activities and findings to date. Requires DPH to make this report and any updates available on its Internet Web site.

3. Specifies that the requirement to submit a report to the Legislature is inoperative on January 1, 2024.

4. Makes findings and declarations about the increased prevalence of diabetes in the state and the total health care cost of diabetes and related complications.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

1) Costs of $275,000 in the first year for staff and contract costs for fiscal and economic analysis, and $125,000 (General Fund) ongoing until the 2024 sunset for one full-time staff to track progress and report biennially.

2) Potentially significant up-front cost pressure to fund action steps to prevent and control diabetes, with potentially significant long-term savings if such action is successful.

PRIOR VOTES:

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. 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 Center for Disease Control and Prevention (CDC), more than one-third of U.S. adults are obese, and approximately 12.5 million children and adolescents ages 2 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.

4. 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.

5. 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.

6. Related legislation. SB 203 (Monning), would have required a safety warning to be affixed to sugar sweetened beverages that states “STATE OF CALIFORIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay”. SB 203 failed in the Senate Health Committee.

AB 270 (Nazarian), would require DPH to apply to the State Department of Motor Vehicles to sponsor a diabetes awareness, education, and research specialized license plate program. Establishes the Diabetes Awareness Fund and specifies that revenues from the fund will be used by DPH to fund programs related to diabetes awareness and prevention. AB 270 is pending in the Senate Appropriations Committee.

7. Prior legislation. 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. 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.

8. Support. Supporters of this bill argue that diabetes is the seventh-leading cause of death in the U.S. and is a leading cause of adult blindness, kidney failure, and non-traumatic amputation of the lower limbs. Supporters also point out that one out of every seven adults (nearly three million) in the state is diagnosed with diabetes, adding to health care costs and related costs totaling nearly $37.1 billion, which could be preventable with treatment and prevention programs. Supporters further argue that diabetes disproportionately affects underserved populations, including Black, Hispanic, and Asian and Pacific Islander communities.

SUPPORT AND OPPOSITION:

Support: American Diabetes Association

American Federation of State, County and Municipal Employees

Asian American, Native Hawaiian, and Pacific Islander Diabetes Coalition

Association of California Healthcare Districts

Bayer Corporation

Biocom

Boehringer-Ingelheim Pharmaceutical Company

California Academy of Family Physicians

California Black Health Network

California Chronic Care Coalition

Congress of California Seniors

National Council of Asian Pacific Islander Physicians

Oppose: None received.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 572

Author:(Beth Gaines)

As Amended Ver:April 16, 2015

Majority vote

SUMMARY: Requires the California Department of Public Health (DPH) to create a detailed diabetes action plan for the state, and to report the results of the plan to the legislature biennially. Requirements include the development of a detailed budget blueprint identifying needs, costs, and resources required to implement the plan and a proposed budget for each action step, as well as policy recommendations for the prevention and treatment of diabetes.

FISCAL EFFECT: According to the Assembly Appropriations committee:

1) Costs of $275,000 in the first year for staff and contract costs for fiscal and economic analysis, and $125,000 (General Fund) ongoing until the 2024 sunset for one full-time staff to track progress and report biennially.

2) Potentially significant up-front cost pressure to fund action steps to prevent and control diabetes, with potentially significant long-term savings if such action is successful.

COMMENTS: According to the author, diabetes has reached epidemic levels in California. Some estimate the yearly cost of diabetes in California to be over $24.5 billion. The author points out that California has no statutory requirements in place for the prevention and management of diabetes, and states that the State of California has no action plan that specifically addresses the fiscal impact of 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. 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. There is no known cure for diabetes. Increased risk of heart disease, stroke, and kidney damage (and the need for dialysis as a result) are the most deadly effects. 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.

According to the California Diabetes Program, diabetes costs in California exceed $24 billion each year. 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. California has an estimated 3.9 million adults with diabetes (2010), and the numbers are rising rapidly.

In January 2015, The California 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. The recommendations of the report were that the state should 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.

The California Black Health Network supports this bill due to the states lack of plan to mitigate the escalating fiscal impact of diabetes. They point out that 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.

There is no known opposition to this bill.

Analysis Prepared by: Dharia McGrew / HEALTH / (916) 319-2097 FN: 0000614

Date of Hearing: April 29, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 572

Author:(Beth Gaines) – As Amended Ver:April 16, 2015

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

SUMMARY:

This bill requires the California Department of Public Health (CDPH) to create a detailed diabetes action plan for the state, and to report the results of the plan to the legislature biennially. Requirements include the development of a detailed budget blueprint identifying needs, costs, and resources required to implement the plan and a proposed budget for each action step, as well as policy recommendations for the prevention and treatment of diabetes.

FISCAL EFFECT:

1. Costs of $275,000 in the first year for staff and contract costs for fiscal and economic analysis, and $125,000 (GF) for one full-time staff to track progress and report biennially.

2. Potentially significant up-front cost pressure to fund action steps to prevent and control diabetes, with potentially significant long-term savings if such action is successful. Diabetes is a very costly condition (nearly $11,000 on average per year to treat, per case) and a prevalent condition (nearly half of the California population has diabetes or pre-diabetes, with diagnosed diabetes representing about 6.4%). Lower-income populations and people of color suffer from diabetes disproportionately, and these populations are also more likely to receive care through Medi-Cal, meaning successful interventions to prevent and control diabetes could have significant potential for long-term state savings.

COMMENTS:

1. Purpose. According to the author, diabetes has reached epidemic levels in California. The author contends that the State of California has no action plan that specifically addresses the 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." This bill appears to address the question of cost mitigation. 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.

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

Date of Hearing: April 14, 2015

ASSEMBLY COMMITTEE ON HEALTH

Bonta, Chair

ABPCA Bill Id:AB 572

Author:(Beth Gaines) – As Amended Ver:April 8, 2015

SUBJECT:

California Diabetes Program.

SUMMARY: Requires the California Department of Public Health (DPH) to create a diabetes action plan for the state, and to report the results of the plan to the legislature biennially. Specifically, this bill:

1. Requires DPH to develop a detailed action plan for prevention and treatment of diabetes in the state of California, including at least:
   

   1. Priorities and performance measures that are based upon evidence-based strategies to prevent or control diabetes, expected outcomes of the action steps proposed, and establish benchmarks for prevention and control;
      
      

   2. Analysis of the financial impact of all types of diabetes on the state of California, as specified;
      
      

   3. A summary of expenditures on programs and activities aimed at preventing or controlling diabetes;
      
      

   4. A summary of the amount and source for any funding directed to the department for programs and activities aimed controlling or preventing diabetes;
      
      

   5. A description of the level of coordination existing between state departments and entities on activities, programmatic activities, and providing information to the public regarding managing, treating, and preventing all forms of diabetes and its complications;
      
      

   6. The development of a detailed budget blueprint identifying needs, costs, and resources required to implement the plan, include a proposed budget for each action step identified; and,
      
      

   7. Policy recommendations for the prevention and treatment of diabetes.

2. Specifies that in developing the plan, DPH may include previously developed priorities or performance measures from other relevant programs.

3. Requires DPH to report to the Legislature on an unspecified date, and biennially thereafter, the status of the plan, progress of plan objectives, and recommendations for future improvements. Includes a sunset provision for the reporting requirement, with an unspecified date.
   
   

4. Makes findings and declarations related to the fiscal impacts of diabetes in California.

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. As of 2012, about one in seven adult Californians have diabetes and many more will be diagnosed in the near future, and is estimated to affect one in three adults within the next 10 years. Some estimate the yearly cost of diabetes in California to be over $24.5 billion. The author points out that California has no statutory requirements in place for the prevention and management of diabetes, and states that the State of California has no action plan that specifically addresses the fiscal impact of diabetes. Furthermore, the author asserts that the state must create an action plan that provides policy guidance and considers the escalating fiscal impact of diabetes treatment and care.
   
   

2. BACKGROUND. 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, 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 10-20 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 the California Diabetes Program (CDP), 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.
   
   There is no known cure for diabetes. Increased risk of heart disease, stroke, and kidney damage (and the need for dialysis as a result) are the most deadly effects. 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.
   
   

3. THE CALIFORNIA DIABETES PROGRAM. 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 Centers for Disease Control and Prevention (CDC). A few key objectives that 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.

CDP achieves these through partnering with different individual, community, health care, policy, and environmental entities. On July 1, 2013, a new CDC-funded program “State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health” began. Funding allocated to pre-diabetes and diabetes decreased by $250,000. With this new grant, CDC funding for California chronic disease prevention overall decreased by $2.2 million. The new collaborative grant, known as Prevention First, Advancing Synergy for Health, requires coordination among programs that historically were categorically funded and stand-alone programs. Prevention First addresses individuals with pre-diabetes and diabetes.

4. THE CALIFORNIA WELLNESS PLAN. In February 2014, DPH 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.

5. 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 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.
   
   

6. DIABETES BURDEN REPORT. In September 2014 DPH published the Burden of Diabetes in California, a report funded by a grant from the CDC and Prevention. 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 analyzed data from a variety of state sources, including the California Health Interview Survey, the California Death Statistical Master File, the Office of Statewide Health Planning and Development Patient Discharge Data, and that Department of Finance Population Data to assess the most significant health risks associated with Diabetes. The report also discusses a number of ongoing activities by DPH that support the primary prevention of diabetes through the promotion of health 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 California’s 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.
   
   

7. STATE AUDITORS REPORT. In January 2015, The California 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, its federal funding for diabetes prevention decreased from more than $1 million in previous fiscal years to $817,000. Moreover, 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 only $71,000 in fiscal year 2013-14. In fact, 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 Auditor's report also found that DPH spent its limited federal funds in an appropriate manner and complied with applicable grant requirements. For the 40 expenditures we reviewed from fiscal years 2009-10 through 2013-14, DPH expenditures were in accordance with federal requirements, and the amounts spent were reasonable. Additionally, despite a concern that was raised about the relationship between DPH diabetes and tobacco control programs, DPH has not spent its limited diabetes funds on tobacco cessation activities.
   
   The recommendations of the report were that the state should 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.
   
   

8. SUPPORT. The California Black Health Network supports this bill due to the states lack of plan to mitigate the escalating fiscal impact of diabetes. They point out that 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. The Bayer Corporation states this bill would help the state in managing the growing numbers and costs associated with diabetes.
   
   

9. RELATED LEGISLATION.

AB 270 (Nazarian) requires DPH to apply to the State Department of Motor Vehicles to sponsor a diabetes awareness, education, and research specialized license plate program. Establishes the Diabetes Awareness Fund and specifies that revenues from the fund will be used by DPH to fund programs related to diabetes awareness and prevention. AB 270 was unanimously approved by the Assembly Transportation Committee on March 23, 2014 and is pending in the Assembly Appropriations Committee.

2. SB 203 (Monning) requires a safety warning to be affixed to sugar sweetened beverages that states “STATE OF CALIFORIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay”. SB 203 is pending in the Senate Health Committee.

10. PREVIOUS LEGISLATION.

1. 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 California Wellness Plan for 2014. Would have required DPH to include in the report guidelines that will reduce the fiscal burden of diabetes to the state. This bill 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.
   
   

2. 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 states it is 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 was held in the Senate Rules Committee without action.

3. SB 64 (Solis), Chapter 540, Statutes of 1999, requires every health care service plan and disability (health) insurer to provide coverage for the management and treatment of diabetes including equipment, supplies, medications, outpatient self-management education, and medical nutrition therapy, as medically necessary, determined by the plan and insurers in conjunction with the treating physician.

11. POLICY COMMENTS.
    
    

    1. DPH has developed proposed actions to address diabetes in California. The 2014 California Wellness Plan, which focuses heavily on diabetes and closely linked illnesses, outlines a number of obtainable, measurable goals for reducing diabetes in this state, similar to those requested in this bill. The 2014 Burden of Diabetes in California report contains some of the demographic information requested in this bill. DPH already has stated that it will issue the first progress report on the Plan in January 2017.
       
       

    2. The research goals of this bill are ambitious. As drafted, this bill requires DPH to assess the entire fiscal impact of diabetes on the state, as well as to project the cost of treating the issue. The breadth and this request is large and beyond what DPH typically undertakes, although knowing more about the fiscal impacts of the disease on the state could be valuable information for policy makers.

12. TECHNICAL AMENDMENTS.
    

    1. The bill was drafted with an open date for DPH to report the plan to the legislature and the sunset on report provisions. The author would like the amend the previously open dates to be:

       1. (c) The State Department of Public Health shall submit a report to the Legislature on or before January 1, 2018, and biennially thereafter,

2. (d) This section shall remain in effect only until January 1, 2024, and as of that date is repealed, unless a later enacted statute deletes or extends that date.
   
   

1. Section 104251 (a)(3) will be amended to read "A summary of expenditures by the Department on programs and activities aimed at preventing or controlling diabetes."

REGISTERED SUPPORT / OPPOSITION:

Support

American Diabetes Association
Bayer Corporation
Biocom
Boehringer-Ingelheim Pharmaceutical Company
California Academy of Family Physicians
California Black Health Network

Opposition

None on file.

Analysis Prepared by:

Dharia McGrew / HEALTH / (916) 319-2097