Community wellness for an at-risk population in Santa Barbara

Throughout my career as a nephrologist, I’ve taken a keen interest in rising rates of diabetes among children and what that means for their future health, since diabetes is the leading cause of kidney failure. And I’ve been especially focused on how this manifests itself in Hispanic communities, both in South America and in Santa Barbara, California, where I live.

Although kidney disease can strike anyone, some groups—including Hispanics—are more at-risk than others. The Centers for Disease Control estimate that more than half of Hispanics will develop type 2 diabetes in their lifetime, versus 40 percent for non-Hispanics. This fact, along with higher rates of blood pressure, means that Hispanics are 35 percent more likely to develop kidney failure than the general population.

Perhaps even more disturbing, nearly 39 percent of Hispanic children ages 2-19 are overweight or obese, versus 29 percent of non-Hispanic children the same age, putting them, too, at greater risk for type 2 diabetes and kidney disease.

But in Santa Barbara, a new public health effort is working to alter that trajectory. The Santa Barbara Wellness Initiative serves a predominantly low-income Hispanic neighborhood, offering a comprehensive program of nutrition, exercise, and lifestyle information and support to students and parents at Franklin Elementary School and Community Service Center.

What is really unique about the program is its recognition of stress as a factor in disease development and progression. Studies have found that low income is, in itself, a significant stressor, particularly in a wealthy community like Santa Barbara. In recent years that stress has been compounded by anti-immigrant policies and the sense of being unwelcome.

Although staff at the Santa Barbara Wellness Initiative can’t change income levels or immigration sentiment, they can help clients manage the stress they experience. Using questionnaires, college student volunteers majoring in psychology and social work gather information about the emotional wellbeing of each family, and then support them in adopting stress-reduction practices that improve their emotional—and physical—health. The goal is to dramatically lower the prevalence of childhood obesity and type 2 diabetes in this community in Santa Barbara—and thus reduce the future incidence of kidney disease.

Alejandra Gutierrez, the executive director of the Santa Barbara Wellness Initiative, is well-acquainted with both the trials and triumphs of kidney disease because her father is a survivor who is doing well with his third donated kidney. She has recruited a team of bilingual pre-med college students to help her educate and inspire students and their families to eat better, exercise more, reduce their stress, and improve their chances for living long and healthy lives. Her program includes a community garden and a twice-monthly on-site farmers market full of fresh fruits and vegetables; games and sports offered after school, as well as access to the gym in the evenings and on weekends so that families can exercise together; stress-reduction offerings like yoga and meditation; and periodic health presentations from local health care providers and the pre-med volunteers.

The program is a resurrection of one I created in 2000 before I was diagnosed with lung cancer. At the start of the school year, we weighed all of the children, collected data on them twice more throughout the year, and, following our program of exercise and nutrition education, saw statistically significant reductions in BMI for three straight years. Unfortunately, I had to abandon the program in order to battle my own illness, so I am thrilled that Alejandra and her team are again offering it the community, better than ever. It is an excellent example of a community wellness program created by and for the people it serves, with promising implications for future health.

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About the Author(s)

Michael Fisher, M.D.

Nephrologist Dr. Michael Fisher is the author of “Surviving Kidney Disease: True Stories of Love, Courage, Hope, and Heroism…and a Roadmap for Prevention.” He has been the co-medical director of acute dialysis at Santa Barbara Cottage Hospital since 1984, and is also a clinical associate professor of medicine at the USC Keck School of Medicine. For more information, visit his website.

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