The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs for Population-Level Diabetes Prevention and Control: Recommendations From the National Clinical Care Commission

Abstract

The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC’s population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.

The National Clinical Care Commission Report to Congress: Summary and Next Steps

“…The Commission also developed recommendations to address 1) population-wide policies and federal programs that can affect diabetes prevention and treatment; 2) diabetes prevention in populations at high risk for developing type 2 diabetes; and 3) the treatment of diabetes and its complications. These are discussed in detail in other articles in this series (7)(8)(9)(10)(11)(12). We summarize key recommendations below.…”

“…Such changes cannot be accomplished by health-related federal agencies alone. Federal agencies whose policies and programs shape the social and environmental contexts that influence diabetes incidence, treatment, and complications must also be actively engaged (7,8). To address this critical need, the NCCC recommends:…”

“…• Increasing breastfeeding rates and duration through effective federal programs and paid maternity leave. The NCCC also recommends that the federal government support research to increase our understanding of the social and environmental conditions associated with the risk of diabetes and its complications and to evaluate the impact of interventions on diabetes-related outcomes (7,8).…”

“…Such changes cannot be accomplished by health-related federal agencies alone. Federal agencies whose policies and programs shape the social and environmental contexts that influence diabetes incidence, treatment, and complications must also be actively engaged ( 7 , 8 ). To address this critical need, the NCCC recommends: Updating and revising the U.S. Department of Agriculture’s nutrition assistance programs to promote both food security and dietary quality across the life span.…”

The National Clinical Care Commission Report to Congress: Background, Methods, and Foundational Recommendations

“…Additional, specific, agency-level recommendations related to population-wide policies and programs are detailed in the article by Schillinger et al. ( 62 ).…”