title: Outside the exam room: policies for connecting clinic to community in diabetes prevention and treatment.
abstract: The public health burden and racial/ethnic, sex, and socioeconomic disparities in obesity and in diabetes require a population-level approach that goes beyond provision of high-quality clinical care. The Robert Wood Johnson Foundation's Commission to Build a Healthier America recommended 3 strategies for improving the nation's health: 1) invest in the foundations of lifelong physical and mental well-being in our youngest children; 2) create communities that foster health-promoting behaviors; and 3) broaden health care to promote health outside the medical system. We present an overview of evidence supporting these approaches in the context of diabetes and suggest policies to increase investments in 1) adequate nutrition through breastfeeding and other supports in early childhood, 2) community and economic development that includes health-promoting features of the physical, food, and social environments, and 3) evidence-based interventions that reach beyond the clinical setting to enlist community members in diabetes prevention and management.
authors.affiliation: Brown School, Washington University in St Louis, One Brookings Dr, St Louis, MO 63130. Email: jpurnell@wustl.edu.
authors.forename: Jason Q
authors.initials: JQ
authors.lastname: Purnell
authors.affiliation: Brown School, Washington University in St Louis, St Louis, Missouri.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Herrick
authors.affiliation: Brown School, Washington University in St Louis, St Louis, Missouri.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreland-Russell
authors.affiliation: Brown School, Washington University in St Louis, St Louis, Missouri.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Eyler
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D002648:Child; D002657:Child Development; D002662:Child Health Services; D002675:Child, Preschool; D003151:Community Health Centers / Q000592:standards*; D003920:Diabetes Mellitus / Q000517:prevention & control* / Q000628:therapy*; D005260:Female; D005582:Foundations; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D010043:Outcome and Process Assessment, Health Care; D011634:Public Health; D011785:Quality Assurance, Health Care / Q000379:methods*; D012931:Social Environment; D055815:Young Adult