Diabetes remains one of the most serious and costly chronic diseases facing communities today. In this episode, ASTHO Vice President of Community Health and Prevention Christi Mackie breaks down the differences between type 1, type 2, and gestational diabetes, common symptoms parents should watch for, and why routine screenings are essential. The conversation focuses on prevention and management of type 2 diabetes, highlighting how public health and healthcare systems intersect through nutrition, physical activity, and policy initiatives such as food-as-medicine programs and SNAP waivers. The episode also examines ongoing challenges with insulin affordability and shortages, as well as growing state efforts to limit ultra-processed foods—particularly in schools—as part of a broader, systems-based approach to improving long-term health outcomes.
Policy Trends Shaping Healthy Food and Chronic Disease in 2026 | ASTHO
Organizational Strategic Planning Guide | ASTHO
1
00:00:00,400 --> 00:00:02,480
This is public health.
Review morning edition for
2
00:00:02,480 --> 00:00:06,760
Thursday, January 15th, 2026.
I'm John Sheehan with News.
3
00:00:06,760 --> 00:00:09,240
From the association of.
State and territorial health
4
00:00:09,240 --> 00:00:10,680
officials.
Today.
5
00:00:10,680 --> 00:00:13,480
We discuss one of the most
serious and costly chronic
6
00:00:13,480 --> 00:00:17,680
diseases facing communities,
diabetes, as we continue our
7
00:00:17,680 --> 00:00:20,440
Legislative prospective series
examining the public health
8
00:00:20,440 --> 00:00:25,120
policy trends set to shape 2026.
Our guest is Christy Mackey,
9
00:00:25,360 --> 00:00:28,200
ASTO vice president of Community
Health and Prevention.
10
00:00:28,640 --> 00:00:30,280
So, Christy?
Let's let's.
11
00:00:30,280 --> 00:00:33,640
Start out with the basics.
What is the difference between
12
00:00:33,640 --> 00:00:38,760
type 1 diabetes and type 2O
Diabetes is a chronic or a long
13
00:00:38,760 --> 00:00:43,240
lasting health condition that
affects how your body turns food
14
00:00:43,240 --> 00:00:46,680
into energy.
So there's three different types
15
00:00:46,680 --> 00:00:50,760
of diabetes and I'm including
gestational diabetes in this as
16
00:00:50,760 --> 00:00:53,960
well.
So that is type 1, type 2 and
17
00:00:53,960 --> 00:00:57,320
gestational.
Type 1 diabetes is an autoimmune
18
00:00:57,320 --> 00:01:00,440
disorder, meaning we can't
prevent it.
19
00:01:01,040 --> 00:01:05,519
Your body attacks itself by
mistake and this creates a
20
00:01:05,519 --> 00:01:08,480
reaction where your body stops
making insulin.
21
00:01:08,920 --> 00:01:14,560
Insulin also acts as a key to
let blood sugar in to cells that
22
00:01:14,560 --> 00:01:16,920
can be used by your body as
energy.
23
00:01:16,920 --> 00:01:20,960
So if you don't have insulin,
there's a cause and effect
24
00:01:20,960 --> 00:01:24,520
there, right?
It creates a condition where
25
00:01:24,520 --> 00:01:29,840
your body has excess blood sugar
and that can be damaging to the
26
00:01:29,840 --> 00:01:33,720
body.
So it really does cause other
27
00:01:33,720 --> 00:01:37,440
serious conditions such as heart
disease, vision loss, and kidney
28
00:01:37,440 --> 00:01:41,400
disease.
Type 1 diabetes is typically
29
00:01:41,400 --> 00:01:45,760
diagnosed in children and
adolescents, though it could be
30
00:01:45,760 --> 00:01:50,880
diagnosed later in life.
Now, type 2 diabetes is related
31
00:01:50,880 --> 00:01:54,960
to insulin resistance.
So if you have type 2 diabetes,
32
00:01:55,000 --> 00:01:58,120
cells do not respond normally to
insulin.
33
00:01:58,120 --> 00:02:02,040
And like we've mentioned before,
insulin creates a mechanism for
34
00:02:02,040 --> 00:02:05,960
your cells to take food and turn
it into energy essentially.
35
00:02:05,960 --> 00:02:11,520
So with type 2 diabetes, your
cells become too resistant to
36
00:02:11,520 --> 00:02:14,560
insulin and your pancreas cannot
make enough.
37
00:02:14,720 --> 00:02:19,120
That's what leads to type 2.
Thinking about this though, it
38
00:02:19,120 --> 00:02:25,400
is a highly preventable disease,
meaning lifestyle factors and
39
00:02:25,400 --> 00:02:27,560
some genetics can play a role in
this.
40
00:02:28,080 --> 00:02:31,680
Risk factors include excess body
fat, especially around your
41
00:02:31,680 --> 00:02:36,040
belly and around your organs.
So that visceral fat, physical
42
00:02:36,040 --> 00:02:40,520
inactivity, eating processed or
highly processed food, high
43
00:02:40,520 --> 00:02:43,640
carbohydrate foods that are
saturated in fats.
44
00:02:43,720 --> 00:02:47,000
And then like I'd mentioned,
genetics can play a role.
45
00:02:47,000 --> 00:02:50,440
So if you have biological family
members have been diagnosed with
46
00:02:50,440 --> 00:02:56,000
type 2 diabetes, your risk tends
to increase exponentially for
47
00:02:56,280 --> 00:03:00,560
diagnosis in life.
And you mentioned, you know,
48
00:03:00,560 --> 00:03:06,160
when the body is not able to
convert insulin into energy that
49
00:03:06,160 --> 00:03:09,600
it leads to that that causes
reactions in the body.
50
00:03:09,600 --> 00:03:12,520
What kind of symptoms should
parents especially be on the
51
00:03:12,520 --> 00:03:15,240
lookout for in their kids?
Sure.
52
00:03:15,680 --> 00:03:19,680
I think it's important to note
that type 1 and type 2 diabetes
53
00:03:19,920 --> 00:03:24,480
the symptoms can be similar.
However, very important.
54
00:03:24,840 --> 00:03:29,520
Type 1 diabetes so symptoms can
develop in just a few weeks or
55
00:03:29,520 --> 00:03:34,320
months and tend to be severe.
Type 2, the symptoms may be
56
00:03:34,320 --> 00:03:39,040
similar, but they develop over
years and symptoms may not be as
57
00:03:39,040 --> 00:03:41,800
severe or sometimes not even
noticeable.
58
00:03:42,320 --> 00:03:46,200
So if you have the following
symptoms, it's always important
59
00:03:46,200 --> 00:03:50,600
to see a medical professional,
your doctor, your primary care
60
00:03:50,600 --> 00:03:55,000
physician, pediatricians to get
blood sugar tested.
61
00:03:55,000 --> 00:03:58,000
So frequent urination.
So typically at night.
62
00:03:58,160 --> 00:04:01,280
People are very thirsty, very
hungry.
63
00:04:01,640 --> 00:04:06,600
Losing weight without trying,
blurred vision can be a symptom,
64
00:04:07,200 --> 00:04:12,160
Numb and tingling hands,
tiredness, dry skin, sores that
65
00:04:12,160 --> 00:04:16,240
don't heal very quickly and
people will notice that they
66
00:04:16,240 --> 00:04:20,200
have infections more frequently
and it takes longer to clear
67
00:04:20,200 --> 00:04:23,840
those as well.
Check insurance and physicals
68
00:04:23,840 --> 00:04:25,960
with your primary care or your
children's.
69
00:04:25,960 --> 00:04:32,400
Pediatricians are vital and sort
of related to the public health
70
00:04:32,400 --> 00:04:36,840
aspects of of diabetes.
There are.
71
00:04:36,880 --> 00:04:41,240
Challenges to accessing insulin,
can you could you tell us about
72
00:04:41,240 --> 00:04:42,560
that?
Yeah.
73
00:04:42,560 --> 00:04:48,440
So we have a history since 2023
where certain brands of insulin
74
00:04:48,440 --> 00:04:50,520
have been periodically in
shortage.
75
00:04:50,840 --> 00:04:55,160
And so research suggests that
high costs, localized pharmacy
76
00:04:55,160 --> 00:04:59,480
shortages and insurance delays,
they contribute to patient
77
00:04:59,640 --> 00:05:01,800
rationing.
And that means, you know,
78
00:05:01,800 --> 00:05:04,880
they're taking less than
prescribed, so it makes it last
79
00:05:04,880 --> 00:05:07,520
longer or they skip it all
together.
80
00:05:07,760 --> 00:05:12,000
And so a large component of
diabetes management and self
81
00:05:12,000 --> 00:05:14,240
management is medication
adherence.
82
00:05:14,560 --> 00:05:18,320
If doses are missed or not taken
or administered as prescribed,
83
00:05:18,320 --> 00:05:22,760
complications arise and those
are they can be severe
84
00:05:22,760 --> 00:05:26,960
cardiovascular disease, kidney
failure and neuropathy.
85
00:05:27,200 --> 00:05:31,920
So what we see is adherence to
medication is linked to better
86
00:05:31,920 --> 00:05:36,400
health outcomes, improve quality
of life for individuals and it
87
00:05:36,400 --> 00:05:39,400
reduces, ultimately reduces
healthcare costs.
88
00:05:39,760 --> 00:05:44,360
I think one other point here is
that there's an assumption that
89
00:05:44,440 --> 00:05:47,200
many make about the
affordability of insulin.
90
00:05:47,480 --> 00:05:52,720
Federal caps have been put into
place around insulin co-pays,
91
00:05:53,080 --> 00:05:58,840
which applies only to Medicare.
So people who are not 65 and
92
00:05:58,840 --> 00:06:02,320
older typically do not qualify
for Medicare.
93
00:06:02,320 --> 00:06:06,760
So those out of pocket costs can
be very high for people under
94
00:06:06,760 --> 00:06:09,480
65.
And This is why 29 states,
95
00:06:09,520 --> 00:06:12,760
including the District of
Columbia have enacted laws
96
00:06:12,960 --> 00:06:18,160
lowering out of pocket costs for
insulin in in state regulated
97
00:06:18,160 --> 00:06:23,080
health plans.
Another aspect of sort of public
98
00:06:23,080 --> 00:06:27,120
health policy right now it
involves ultra processed foods.
99
00:06:27,680 --> 00:06:30,000
And I think people have an idea
of what that is.
100
00:06:30,000 --> 00:06:33,720
It's very much in the news right
now, and from a policy
101
00:06:33,720 --> 00:06:37,720
perspective, some states are
taking taking steps to limit
102
00:06:37,720 --> 00:06:40,600
them.
For example, California is and
103
00:06:40,600 --> 00:06:44,040
has enacted legislation to phase
out processed ultra processed
104
00:06:44,040 --> 00:06:48,120
foods from schools by 2035, and
it's likely that schools should
105
00:06:48,120 --> 00:06:51,000
should take note.
What should schools start
106
00:06:51,000 --> 00:06:54,000
thinking about preparing for
doing differently now?
107
00:06:54,480 --> 00:06:57,400
Sure.
I'm a little hesitant to make
108
00:06:57,400 --> 00:07:01,200
concrete recommendations at this
point for schools to prepare for
109
00:07:01,200 --> 00:07:06,400
this the California policy.
But what we know the policy is
110
00:07:06,400 --> 00:07:10,480
directive around involvement of
multiple state agencies and
111
00:07:10,480 --> 00:07:13,840
school systems.
And now California is moving
112
00:07:13,840 --> 00:07:18,400
into this space that moves from
policy to implementation.
113
00:07:18,920 --> 00:07:23,000
So in reality, this is going to
be system transformation period.
114
00:07:23,280 --> 00:07:27,400
So it's going to take multiple
government agencies, education,
115
00:07:27,520 --> 00:07:32,760
private sector and communities
all at the table, all centering
116
00:07:32,760 --> 00:07:38,320
around our K through 12 kiddos.
But this notion that there's an
117
00:07:38,320 --> 00:07:41,600
agreed upon direction, there's
alignment and there's
118
00:07:41,600 --> 00:07:44,280
commitment.
So establishing that now is a
119
00:07:44,440 --> 00:07:47,520
vital to the work ahead over the
next 10 years.
120
00:07:48,160 --> 00:07:51,680
Yeah.
And, you know, you're kind of
121
00:07:51,680 --> 00:07:55,000
hinting at the complexity of the
situation because while I think
122
00:07:55,000 --> 00:07:58,840
it, it is relatively easy to
say, yeah, no ultra processed
123
00:07:58,840 --> 00:08:01,400
food for kids that, you know,
that seems to be something that
124
00:08:01,400 --> 00:08:03,920
we can totally get behind in
practice.
125
00:08:04,360 --> 00:08:06,720
What are we talking about?
What foods?
126
00:08:06,720 --> 00:08:09,040
How do you mean restricting them
from schools?
127
00:08:09,040 --> 00:08:10,800
What if schools don't have any
money?
128
00:08:11,240 --> 00:08:15,040
It's incredibly complicated.
Many, many players involved in
129
00:08:15,040 --> 00:08:18,720
those decisions, but
nevertheless, there is a will to
130
00:08:19,000 --> 00:08:23,800
to enact it, right.
And I think what's important to
131
00:08:23,800 --> 00:08:28,320
note is California did define
ultra processed foods for the
132
00:08:28,480 --> 00:08:33,760
purpose of K through 12 meals in
schools so that they have that
133
00:08:33,760 --> 00:08:35,840
going for them.
You know, that's a great
134
00:08:35,840 --> 00:08:39,480
starting point, but you touched
on this too.
135
00:08:40,159 --> 00:08:44,800
It's so important for us to
under score like policy changes
136
00:08:44,800 --> 00:08:48,400
that might decrease ultra
processed foods in our diets,
137
00:08:49,000 --> 00:08:51,480
policies that promote eating
healthier.
138
00:08:51,640 --> 00:08:56,960
We really need to help people be
able to afford the alternative,
139
00:08:57,040 --> 00:09:00,880
which is being able to consume
more fruits and vegetables, lean
140
00:09:00,880 --> 00:09:05,440
meats, and this includes
accessibility and affordability
141
00:09:05,600 --> 00:09:09,960
and being able to find the food
in the 1st place, right?
142
00:09:10,480 --> 00:09:14,360
So it's not the sole
responsibility of anyone, agency
143
00:09:14,360 --> 00:09:17,040
or group.
We should see this as a multi
144
00:09:17,040 --> 00:09:21,200
sector approach, Departments of
health or public health,
145
00:09:21,200 --> 00:09:27,000
agriculture, transportation,
communities, healthcare and the
146
00:09:27,000 --> 00:09:29,800
private sector all working
together with this clear
147
00:09:29,800 --> 00:09:33,800
understanding that in order to
solve the puzzle here that we
148
00:09:33,800 --> 00:09:37,200
need to be able to fit all the
pieces together and each one of
149
00:09:37,200 --> 00:09:41,800
us has a piece of that puzzle.
So I, I go back to this, the
150
00:09:41,800 --> 00:09:45,880
vital relationships and
partnerships in play, we all
151
00:09:45,880 --> 00:09:50,000
have that role in addressing
access to nutritious foods.
152
00:09:50,040 --> 00:09:54,760
And I mean, if we're asking
individuals to make healthier
153
00:09:54,760 --> 00:09:58,360
choices because it is better for
health outcomes, their health
154
00:09:58,360 --> 00:10:01,240
and prevention of chronic
disease, we should create
155
00:10:01,240 --> 00:10:05,640
environments that are conducive
to that and assure that there's
156
00:10:05,640 --> 00:10:09,400
access to whole food, healthy
foods, fruits, vegetables,
157
00:10:09,480 --> 00:10:13,600
making sure that people have
what they need to make those
158
00:10:13,600 --> 00:10:16,440
healthier decisions.
Christy Mackey is.
159
00:10:16,440 --> 00:10:18,360
Asto Vice.
President of Community Health
160
00:10:18,360 --> 00:10:20,280
and Prevention.
She joined us as part.
161
00:10:20,280 --> 00:10:21,480
Of our.
Legislative Prospectus.
162
00:10:21,480 --> 00:10:24,080
Series.
Examining the policy trends set
163
00:10:24,080 --> 00:10:29,960
to shape public health in 2026.
Change is constant in public
164
00:10:29,960 --> 00:10:32,120
health and leading through it.
Takes skill.
165
00:10:32,480 --> 00:10:36,600
Join ASTO for Leading Change, a
new in person workshop designed
166
00:10:36,600 --> 00:10:40,240
for clinical and non clinical
public health professionals on
167
00:10:40,240 --> 00:10:44,040
March 24th and 25th at ASTO
headquarters in Arlington, VA.
168
00:10:44,560 --> 00:10:47,440
Participants will gain practical
strategies to navigate
169
00:10:47,440 --> 00:10:50,480
uncertainty, strengthen
organizational culture, and turn
170
00:10:50,480 --> 00:10:54,040
change into action.
Through hands on instruction and
171
00:10:54,040 --> 00:10:57,600
real world tools, you'll design
A concrete action plan to drive
172
00:10:57,600 --> 00:11:00,880
meaningful impact in your agency
now and beyond.
173
00:11:01,560 --> 00:11:04,640
You can find a link and more
information in the show notes.
174
00:11:05,960 --> 00:11:09,400
ASTO welcomes new member Andrea
Rivers, administrator for the
175
00:11:09,400 --> 00:11:11,960
Nevada Division of Public and
Behavioural Health.
176
00:11:12,840 --> 00:11:15,720
Administrator Rivers began her
state career with the Nevada
177
00:11:15,720 --> 00:11:18,680
Trauma Registry and has LED
initiatives in maternal and
178
00:11:18,680 --> 00:11:21,760
child health and public health
data systems, as well as
179
00:11:21,760 --> 00:11:26,400
statewide programs including
Nevada WIC and the Office of
180
00:11:26,400 --> 00:11:29,000
Analytics.
Known for her collaborative
181
00:11:29,000 --> 00:11:30,640
leadership and belief in
government.
182
00:11:30,640 --> 00:11:32,680
'S power.
To serve women, children and
183
00:11:32,680 --> 00:11:35,280
families effectively.
She has helped build.
184
00:11:35,280 --> 00:11:37,960
Systems that strengthen quality
accountability.
185
00:11:38,000 --> 00:11:43,720
And access to care.
Asto's Organizational Strategic
186
00:11:43,720 --> 00:11:46,920
Planning Guide provides health
agencies with an overview of the
187
00:11:46,920 --> 00:11:50,640
organizational strategic
planning process comprised of
188
00:11:50,640 --> 00:11:53,720
seven major phases that an
organization should complete on
189
00:11:53,720 --> 00:11:57,040
a recurring basis to adapt and
refine their plans over time.
190
00:11:57,760 --> 00:12:00,680
This allows organizations to
remain responsible as their
191
00:12:00,680 --> 00:12:04,280
needs and goals evolve.
In addition, the guide reviews.
192
00:12:04,280 --> 00:12:06,280
Keys to.
Success and highlights tips for
193
00:12:06,280 --> 00:12:08,520
addressing common challenges for
each phase.
194
00:12:09,000 --> 00:12:11,560
It helps organizations better
navigate uncertainties,
195
00:12:11,560 --> 00:12:14,160
anticipate challenges and
achieve success in their
196
00:12:14,160 --> 00:12:17,360
strategic planning.
Find a link in the show notes.
197
00:12:18,560 --> 00:12:20,720
This has been public health
review Morning edition.
198
00:12:20,840 --> 00:12:23,560
I'm John Sheehan for the
Association of State and
199
00:12:23,560 --> 00:12:24,920
Territorial Health Officials.
00:00:00,400 --> 00:00:02,480
This is public health.
Review morning edition for
2
00:00:02,480 --> 00:00:06,760
Thursday, January 15th, 2026.
I'm John Sheehan with News.
3
00:00:06,760 --> 00:00:09,240
From the association of.
State and territorial health
4
00:00:09,240 --> 00:00:10,680
officials.
Today.
5
00:00:10,680 --> 00:00:13,480
We discuss one of the most
serious and costly chronic
6
00:00:13,480 --> 00:00:17,680
diseases facing communities,
diabetes, as we continue our
7
00:00:17,680 --> 00:00:20,440
Legislative prospective series
examining the public health
8
00:00:20,440 --> 00:00:25,120
policy trends set to shape 2026.
Our guest is Christy Mackey,
9
00:00:25,360 --> 00:00:28,200
ASTO vice president of Community
Health and Prevention.
10
00:00:28,640 --> 00:00:30,280
So, Christy?
Let's let's.
11
00:00:30,280 --> 00:00:33,640
Start out with the basics.
What is the difference between
12
00:00:33,640 --> 00:00:38,760
type 1 diabetes and type 2O
Diabetes is a chronic or a long
13
00:00:38,760 --> 00:00:43,240
lasting health condition that
affects how your body turns food
14
00:00:43,240 --> 00:00:46,680
into energy.
So there's three different types
15
00:00:46,680 --> 00:00:50,760
of diabetes and I'm including
gestational diabetes in this as
16
00:00:50,760 --> 00:00:53,960
well.
So that is type 1, type 2 and
17
00:00:53,960 --> 00:00:57,320
gestational.
Type 1 diabetes is an autoimmune
18
00:00:57,320 --> 00:01:00,440
disorder, meaning we can't
prevent it.
19
00:01:01,040 --> 00:01:05,519
Your body attacks itself by
mistake and this creates a
20
00:01:05,519 --> 00:01:08,480
reaction where your body stops
making insulin.
21
00:01:08,920 --> 00:01:14,560
Insulin also acts as a key to
let blood sugar in to cells that
22
00:01:14,560 --> 00:01:16,920
can be used by your body as
energy.
23
00:01:16,920 --> 00:01:20,960
So if you don't have insulin,
there's a cause and effect
24
00:01:20,960 --> 00:01:24,520
there, right?
It creates a condition where
25
00:01:24,520 --> 00:01:29,840
your body has excess blood sugar
and that can be damaging to the
26
00:01:29,840 --> 00:01:33,720
body.
So it really does cause other
27
00:01:33,720 --> 00:01:37,440
serious conditions such as heart
disease, vision loss, and kidney
28
00:01:37,440 --> 00:01:41,400
disease.
Type 1 diabetes is typically
29
00:01:41,400 --> 00:01:45,760
diagnosed in children and
adolescents, though it could be
30
00:01:45,760 --> 00:01:50,880
diagnosed later in life.
Now, type 2 diabetes is related
31
00:01:50,880 --> 00:01:54,960
to insulin resistance.
So if you have type 2 diabetes,
32
00:01:55,000 --> 00:01:58,120
cells do not respond normally to
insulin.
33
00:01:58,120 --> 00:02:02,040
And like we've mentioned before,
insulin creates a mechanism for
34
00:02:02,040 --> 00:02:05,960
your cells to take food and turn
it into energy essentially.
35
00:02:05,960 --> 00:02:11,520
So with type 2 diabetes, your
cells become too resistant to
36
00:02:11,520 --> 00:02:14,560
insulin and your pancreas cannot
make enough.
37
00:02:14,720 --> 00:02:19,120
That's what leads to type 2.
Thinking about this though, it
38
00:02:19,120 --> 00:02:25,400
is a highly preventable disease,
meaning lifestyle factors and
39
00:02:25,400 --> 00:02:27,560
some genetics can play a role in
this.
40
00:02:28,080 --> 00:02:31,680
Risk factors include excess body
fat, especially around your
41
00:02:31,680 --> 00:02:36,040
belly and around your organs.
So that visceral fat, physical
42
00:02:36,040 --> 00:02:40,520
inactivity, eating processed or
highly processed food, high
43
00:02:40,520 --> 00:02:43,640
carbohydrate foods that are
saturated in fats.
44
00:02:43,720 --> 00:02:47,000
And then like I'd mentioned,
genetics can play a role.
45
00:02:47,000 --> 00:02:50,440
So if you have biological family
members have been diagnosed with
46
00:02:50,440 --> 00:02:56,000
type 2 diabetes, your risk tends
to increase exponentially for
47
00:02:56,280 --> 00:03:00,560
diagnosis in life.
And you mentioned, you know,
48
00:03:00,560 --> 00:03:06,160
when the body is not able to
convert insulin into energy that
49
00:03:06,160 --> 00:03:09,600
it leads to that that causes
reactions in the body.
50
00:03:09,600 --> 00:03:12,520
What kind of symptoms should
parents especially be on the
51
00:03:12,520 --> 00:03:15,240
lookout for in their kids?
Sure.
52
00:03:15,680 --> 00:03:19,680
I think it's important to note
that type 1 and type 2 diabetes
53
00:03:19,920 --> 00:03:24,480
the symptoms can be similar.
However, very important.
54
00:03:24,840 --> 00:03:29,520
Type 1 diabetes so symptoms can
develop in just a few weeks or
55
00:03:29,520 --> 00:03:34,320
months and tend to be severe.
Type 2, the symptoms may be
56
00:03:34,320 --> 00:03:39,040
similar, but they develop over
years and symptoms may not be as
57
00:03:39,040 --> 00:03:41,800
severe or sometimes not even
noticeable.
58
00:03:42,320 --> 00:03:46,200
So if you have the following
symptoms, it's always important
59
00:03:46,200 --> 00:03:50,600
to see a medical professional,
your doctor, your primary care
60
00:03:50,600 --> 00:03:55,000
physician, pediatricians to get
blood sugar tested.
61
00:03:55,000 --> 00:03:58,000
So frequent urination.
So typically at night.
62
00:03:58,160 --> 00:04:01,280
People are very thirsty, very
hungry.
63
00:04:01,640 --> 00:04:06,600
Losing weight without trying,
blurred vision can be a symptom,
64
00:04:07,200 --> 00:04:12,160
Numb and tingling hands,
tiredness, dry skin, sores that
65
00:04:12,160 --> 00:04:16,240
don't heal very quickly and
people will notice that they
66
00:04:16,240 --> 00:04:20,200
have infections more frequently
and it takes longer to clear
67
00:04:20,200 --> 00:04:23,840
those as well.
Check insurance and physicals
68
00:04:23,840 --> 00:04:25,960
with your primary care or your
children's.
69
00:04:25,960 --> 00:04:32,400
Pediatricians are vital and sort
of related to the public health
70
00:04:32,400 --> 00:04:36,840
aspects of of diabetes.
There are.
71
00:04:36,880 --> 00:04:41,240
Challenges to accessing insulin,
can you could you tell us about
72
00:04:41,240 --> 00:04:42,560
that?
Yeah.
73
00:04:42,560 --> 00:04:48,440
So we have a history since 2023
where certain brands of insulin
74
00:04:48,440 --> 00:04:50,520
have been periodically in
shortage.
75
00:04:50,840 --> 00:04:55,160
And so research suggests that
high costs, localized pharmacy
76
00:04:55,160 --> 00:04:59,480
shortages and insurance delays,
they contribute to patient
77
00:04:59,640 --> 00:05:01,800
rationing.
And that means, you know,
78
00:05:01,800 --> 00:05:04,880
they're taking less than
prescribed, so it makes it last
79
00:05:04,880 --> 00:05:07,520
longer or they skip it all
together.
80
00:05:07,760 --> 00:05:12,000
And so a large component of
diabetes management and self
81
00:05:12,000 --> 00:05:14,240
management is medication
adherence.
82
00:05:14,560 --> 00:05:18,320
If doses are missed or not taken
or administered as prescribed,
83
00:05:18,320 --> 00:05:22,760
complications arise and those
are they can be severe
84
00:05:22,760 --> 00:05:26,960
cardiovascular disease, kidney
failure and neuropathy.
85
00:05:27,200 --> 00:05:31,920
So what we see is adherence to
medication is linked to better
86
00:05:31,920 --> 00:05:36,400
health outcomes, improve quality
of life for individuals and it
87
00:05:36,400 --> 00:05:39,400
reduces, ultimately reduces
healthcare costs.
88
00:05:39,760 --> 00:05:44,360
I think one other point here is
that there's an assumption that
89
00:05:44,440 --> 00:05:47,200
many make about the
affordability of insulin.
90
00:05:47,480 --> 00:05:52,720
Federal caps have been put into
place around insulin co-pays,
91
00:05:53,080 --> 00:05:58,840
which applies only to Medicare.
So people who are not 65 and
92
00:05:58,840 --> 00:06:02,320
older typically do not qualify
for Medicare.
93
00:06:02,320 --> 00:06:06,760
So those out of pocket costs can
be very high for people under
94
00:06:06,760 --> 00:06:09,480
65.
And This is why 29 states,
95
00:06:09,520 --> 00:06:12,760
including the District of
Columbia have enacted laws
96
00:06:12,960 --> 00:06:18,160
lowering out of pocket costs for
insulin in in state regulated
97
00:06:18,160 --> 00:06:23,080
health plans.
Another aspect of sort of public
98
00:06:23,080 --> 00:06:27,120
health policy right now it
involves ultra processed foods.
99
00:06:27,680 --> 00:06:30,000
And I think people have an idea
of what that is.
100
00:06:30,000 --> 00:06:33,720
It's very much in the news right
now, and from a policy
101
00:06:33,720 --> 00:06:37,720
perspective, some states are
taking taking steps to limit
102
00:06:37,720 --> 00:06:40,600
them.
For example, California is and
103
00:06:40,600 --> 00:06:44,040
has enacted legislation to phase
out processed ultra processed
104
00:06:44,040 --> 00:06:48,120
foods from schools by 2035, and
it's likely that schools should
105
00:06:48,120 --> 00:06:51,000
should take note.
What should schools start
106
00:06:51,000 --> 00:06:54,000
thinking about preparing for
doing differently now?
107
00:06:54,480 --> 00:06:57,400
Sure.
I'm a little hesitant to make
108
00:06:57,400 --> 00:07:01,200
concrete recommendations at this
point for schools to prepare for
109
00:07:01,200 --> 00:07:06,400
this the California policy.
But what we know the policy is
110
00:07:06,400 --> 00:07:10,480
directive around involvement of
multiple state agencies and
111
00:07:10,480 --> 00:07:13,840
school systems.
And now California is moving
112
00:07:13,840 --> 00:07:18,400
into this space that moves from
policy to implementation.
113
00:07:18,920 --> 00:07:23,000
So in reality, this is going to
be system transformation period.
114
00:07:23,280 --> 00:07:27,400
So it's going to take multiple
government agencies, education,
115
00:07:27,520 --> 00:07:32,760
private sector and communities
all at the table, all centering
116
00:07:32,760 --> 00:07:38,320
around our K through 12 kiddos.
But this notion that there's an
117
00:07:38,320 --> 00:07:41,600
agreed upon direction, there's
alignment and there's
118
00:07:41,600 --> 00:07:44,280
commitment.
So establishing that now is a
119
00:07:44,440 --> 00:07:47,520
vital to the work ahead over the
next 10 years.
120
00:07:48,160 --> 00:07:51,680
Yeah.
And, you know, you're kind of
121
00:07:51,680 --> 00:07:55,000
hinting at the complexity of the
situation because while I think
122
00:07:55,000 --> 00:07:58,840
it, it is relatively easy to
say, yeah, no ultra processed
123
00:07:58,840 --> 00:08:01,400
food for kids that, you know,
that seems to be something that
124
00:08:01,400 --> 00:08:03,920
we can totally get behind in
practice.
125
00:08:04,360 --> 00:08:06,720
What are we talking about?
What foods?
126
00:08:06,720 --> 00:08:09,040
How do you mean restricting them
from schools?
127
00:08:09,040 --> 00:08:10,800
What if schools don't have any
money?
128
00:08:11,240 --> 00:08:15,040
It's incredibly complicated.
Many, many players involved in
129
00:08:15,040 --> 00:08:18,720
those decisions, but
nevertheless, there is a will to
130
00:08:19,000 --> 00:08:23,800
to enact it, right.
And I think what's important to
131
00:08:23,800 --> 00:08:28,320
note is California did define
ultra processed foods for the
132
00:08:28,480 --> 00:08:33,760
purpose of K through 12 meals in
schools so that they have that
133
00:08:33,760 --> 00:08:35,840
going for them.
You know, that's a great
134
00:08:35,840 --> 00:08:39,480
starting point, but you touched
on this too.
135
00:08:40,159 --> 00:08:44,800
It's so important for us to
under score like policy changes
136
00:08:44,800 --> 00:08:48,400
that might decrease ultra
processed foods in our diets,
137
00:08:49,000 --> 00:08:51,480
policies that promote eating
healthier.
138
00:08:51,640 --> 00:08:56,960
We really need to help people be
able to afford the alternative,
139
00:08:57,040 --> 00:09:00,880
which is being able to consume
more fruits and vegetables, lean
140
00:09:00,880 --> 00:09:05,440
meats, and this includes
accessibility and affordability
141
00:09:05,600 --> 00:09:09,960
and being able to find the food
in the 1st place, right?
142
00:09:10,480 --> 00:09:14,360
So it's not the sole
responsibility of anyone, agency
143
00:09:14,360 --> 00:09:17,040
or group.
We should see this as a multi
144
00:09:17,040 --> 00:09:21,200
sector approach, Departments of
health or public health,
145
00:09:21,200 --> 00:09:27,000
agriculture, transportation,
communities, healthcare and the
146
00:09:27,000 --> 00:09:29,800
private sector all working
together with this clear
147
00:09:29,800 --> 00:09:33,800
understanding that in order to
solve the puzzle here that we
148
00:09:33,800 --> 00:09:37,200
need to be able to fit all the
pieces together and each one of
149
00:09:37,200 --> 00:09:41,800
us has a piece of that puzzle.
So I, I go back to this, the
150
00:09:41,800 --> 00:09:45,880
vital relationships and
partnerships in play, we all
151
00:09:45,880 --> 00:09:50,000
have that role in addressing
access to nutritious foods.
152
00:09:50,040 --> 00:09:54,760
And I mean, if we're asking
individuals to make healthier
153
00:09:54,760 --> 00:09:58,360
choices because it is better for
health outcomes, their health
154
00:09:58,360 --> 00:10:01,240
and prevention of chronic
disease, we should create
155
00:10:01,240 --> 00:10:05,640
environments that are conducive
to that and assure that there's
156
00:10:05,640 --> 00:10:09,400
access to whole food, healthy
foods, fruits, vegetables,
157
00:10:09,480 --> 00:10:13,600
making sure that people have
what they need to make those
158
00:10:13,600 --> 00:10:16,440
healthier decisions.
Christy Mackey is.
159
00:10:16,440 --> 00:10:18,360
Asto Vice.
President of Community Health
160
00:10:18,360 --> 00:10:20,280
and Prevention.
She joined us as part.
161
00:10:20,280 --> 00:10:21,480
Of our.
Legislative Prospectus.
162
00:10:21,480 --> 00:10:24,080
Series.
Examining the policy trends set
163
00:10:24,080 --> 00:10:29,960
to shape public health in 2026.
Change is constant in public
164
00:10:29,960 --> 00:10:32,120
health and leading through it.
Takes skill.
165
00:10:32,480 --> 00:10:36,600
Join ASTO for Leading Change, a
new in person workshop designed
166
00:10:36,600 --> 00:10:40,240
for clinical and non clinical
public health professionals on
167
00:10:40,240 --> 00:10:44,040
March 24th and 25th at ASTO
headquarters in Arlington, VA.
168
00:10:44,560 --> 00:10:47,440
Participants will gain practical
strategies to navigate
169
00:10:47,440 --> 00:10:50,480
uncertainty, strengthen
organizational culture, and turn
170
00:10:50,480 --> 00:10:54,040
change into action.
Through hands on instruction and
171
00:10:54,040 --> 00:10:57,600
real world tools, you'll design
A concrete action plan to drive
172
00:10:57,600 --> 00:11:00,880
meaningful impact in your agency
now and beyond.
173
00:11:01,560 --> 00:11:04,640
You can find a link and more
information in the show notes.
174
00:11:05,960 --> 00:11:09,400
ASTO welcomes new member Andrea
Rivers, administrator for the
175
00:11:09,400 --> 00:11:11,960
Nevada Division of Public and
Behavioural Health.
176
00:11:12,840 --> 00:11:15,720
Administrator Rivers began her
state career with the Nevada
177
00:11:15,720 --> 00:11:18,680
Trauma Registry and has LED
initiatives in maternal and
178
00:11:18,680 --> 00:11:21,760
child health and public health
data systems, as well as
179
00:11:21,760 --> 00:11:26,400
statewide programs including
Nevada WIC and the Office of
180
00:11:26,400 --> 00:11:29,000
Analytics.
Known for her collaborative
181
00:11:29,000 --> 00:11:30,640
leadership and belief in
government.
182
00:11:30,640 --> 00:11:32,680
'S power.
To serve women, children and
183
00:11:32,680 --> 00:11:35,280
families effectively.
She has helped build.
184
00:11:35,280 --> 00:11:37,960
Systems that strengthen quality
accountability.
185
00:11:38,000 --> 00:11:43,720
And access to care.
Asto's Organizational Strategic
186
00:11:43,720 --> 00:11:46,920
Planning Guide provides health
agencies with an overview of the
187
00:11:46,920 --> 00:11:50,640
organizational strategic
planning process comprised of
188
00:11:50,640 --> 00:11:53,720
seven major phases that an
organization should complete on
189
00:11:53,720 --> 00:11:57,040
a recurring basis to adapt and
refine their plans over time.
190
00:11:57,760 --> 00:12:00,680
This allows organizations to
remain responsible as their
191
00:12:00,680 --> 00:12:04,280
needs and goals evolve.
In addition, the guide reviews.
192
00:12:04,280 --> 00:12:06,280
Keys to.
Success and highlights tips for
193
00:12:06,280 --> 00:12:08,520
addressing common challenges for
each phase.
194
00:12:09,000 --> 00:12:11,560
It helps organizations better
navigate uncertainties,
195
00:12:11,560 --> 00:12:14,160
anticipate challenges and
achieve success in their
196
00:12:14,160 --> 00:12:17,360
strategic planning.
Find a link in the show notes.
197
00:12:18,560 --> 00:12:20,720
This has been public health
review Morning edition.
198
00:12:20,840 --> 00:12:23,560
I'm John Sheehan for the
Association of State and
199
00:12:23,560 --> 00:12:24,920
Territorial Health Officials.