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More than 37 million Americans are living with diabetes; another 96 million are pre-diabetic, making it among the most widespread health conditions in the U.S. It can also be among the most debilitating — when not well-managed, it can cause heart disease, kidney failure, blindness, and even lower limb amputation. However, for the millions dealing with type 2 diabetes, it is also one of the most treatable chronic diseases.
In an effort to raise awareness around the issue, Spectrum News National Health Reporter Erin Billups joined Errol Louis to talk about their new collaborative special report “USA1C: Fighting the Rise of Diabetes,” which is currently airing on Spectrum News nationally.
The conversation covered “the social determinants of health” — a recognition that income and education levels and where people live are just as important as genetics. They also discussed Erin’s trip to the diabetes belt that stretches along the Mississippi Delta, where she met Dr. Faluso Fakorede, a leading advocate in the fight against diabetes. And they weighed in on their experiences here in New York where Mayor Eric Adams has advocated for systemic change in health care.
After their conversation, you can listen to the special in its entirety.
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Join the conversation, weigh in on Twitter using the hashtag #NY1YouDecide or give us a call at 212-379-3440 and leave a message. Or send an email to YourStoryNY1@charter.com
ABOUT THE SHOW
NY1’s Errol Louis has been interviewing powerful politicians and cultural icons for years, but it’s when the TV cameras are turned off that things really get interesting. From career highlights, to personal moments, to stories that have never been told, join Errol each week for intimate conversations with the people who are shaping the future of New York and beyond. Listen to "You Decide with Errol Louis" every Wednesday, wherever you listen to podcasts.
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Note: Below is a full transcript of the episode. The following is a transcription from a third-party service. Although the transcription is largely accurate, in some cases, it is incomplete or inaccurate due to inaudible passages or transcription errors.
Errol Louis: Welcome to You Decide, I’m Errol Louis. COVID is not the only epidemic that Americans need to worry about. In the background of all of our lives and increasing daily by leaps and bounds is the scourge of diabetes, specifically type two diabetes, which in many ways is a lifestyle disease. It’s mostly either brought on or made worse by poor diet, lack of exercise. It leads to obesity, heart disease, kidney failure, even amputation. And it is a clear and present danger sweeping through the country. The worst part is that it is actually preventable and in many cases even reversible. And this is affecting you, whoever you are, whether or not you have the disease. The dimensions are absolutely staggering. The solutions are known. What has been missing is the political will and the broad public understanding needed to demand change. I have spent most of the last six months off and on working with Erin Billups, who is the national health reporter here at Spectrum News, on a very big project that includes an hour long special on the diabetes crisis and how to deal with it. Welcome, Erin.
Erin Billups: Thanks for having me.
Errol Louis: Absolutely. We’re going to play the whole special. People can hear the whole thing. You can also watch it. You know, TV’s better if you want to get the visual element. But let’s explain how this came about. You and I tend to cross paths here and there in the newsroom, and we got to talking.
Erin Billups: Yeah. You know, I think I was sharing a story with you. I was in a car with relatives and a friend, friends of the family, all older members of the community. And everyone was talking about what they would do at dialysis and which dialysis center they go to. And then as we’re driving through and I grew up in Hollis, Queens, as we’re driving through different parts of Queens, I started to notice all the dialysis centers that were there now that were not there when I would take similar routes to the train station growing up. And I was like, we’ve got to talk about this.
Errol Louis: Yeah, it’s a whole thing. You mentioned that and you know where I go, I go on my morning walks or I’m taking my kid to school and you see these dialysis centers, you know, and it’s like, well, what’s this doing here? You know? And you see people in some cases being wheeled in and wheeled out and you’re the health reporter, so I start asking you questions and we start looking into it. And it turns out that this is literally an epidemic, right? I mean, this is affecting millions upon millions of Americans.
Erin Billups: It is a huge, huge problem. There are about 300,000 people dealing with end stage renal disease who need dialysis in the United States. You know, that costs about $90,000 a year per person. And for anyone who doesn’t know what dialysis is, when your kidneys are no longer working, you need to clean the toxins out of your blood. And the only way to do that is either get a new kidney, which is pretty hard to do, or you get hooked up to a machine that actually takes the blood out of your body, clears it of the impurities, and puts it back in your body so that you can function.
Errol Louis: I have good friends who have gone through the process. I’ve had meetings with them while they were getting the dialysis. It is painful. It is not pretty. It is difficult. It is life altering. Life restricting, really, because you’re not doing anything else on the day that you’re getting dialysis and you’re probably not doing anything the following day. You know, the normalization of it, we talk about this in the documentary, is really startling that entire communities have been waylaid by this disease and its after effects in some ways that are absolutely gruesome, like the epidemic of amputations, which is where we got started. I mean, you got to travel a lot more on this than I did. I’m sort of envious. You made it down to the Mississippi Delta. Tell us a little bit about Dr. Fakarede and how you ended up down there.
Erin Billups: Yeah, Dr. Faluso Fakaorede is, he’s a Northeastern educated interventional cardiologist and he went down to the Mississippi Delta area for training. And then he saw the stark reality of just so many African-Americans, Black people just burdened with this disease. And he saw that one of the first line responses for many of them who had uncontrolled diabetes. So they didn’t realize there was an education happening about why the foods they were eating, the drinks they were drinking, how that was playing such a heavy role in their health. So eventually what happens is things like peripheral artery disease, where your arteries get so clogged up that eventually blood isn’t flowing. If you stub your toe, the blood doesn’t go down there and help clean up. And then those toes get infected. They show up at the emergency room and doctors are like, we got to cut your foot off.
Errol Louis: Right.
Erin Billups: And so he was like, there’s got to be a better way. And he started seeing that because he, as a black man, was more able to see these patients as maybe an aunt or a cousin. He was spending a little bit more time with them, doing a lot more education and also reopening their blood vessels.
Errol Louis: Okay. Let’s listen to a little bit of your discussion with him down there in Mississippi.
Dr. Fakorede: If you look at the civil rights movement and how people actually literally came down to Mississippi to affect change, it wasn’t a large ask for me to come here and provide services.
Erin Billups: In the South Fakorede says racial disparities are on full display, a legacy of past injustices like the lingering effects of discriminatory housing practices, placing many far from adequate health care.
Dr. Fakorede: We live in an environment in physical neighborhoods whereby if things are debilitated, there are no sidewalks where they can exercise. There are no parks where the kids can go and play safely. And access to healthy foods are not an option.
Errol Louis: So you can verify that you were down there with a camera crew for a couple of days. What was it like?
Erin Billups: Maybe a little vignette would be helpful. You know, Dr. Fakorede told us to stay at a very specific hotel. He was like, you guys are coming from New York. You’ll like this place. And it was really quite a lovely hotel, had a cute little restaurant on the inside. And I ordered a Cobb salad because that looks to be the best option, especially, you know, there’s a heavier burden on me to eat healthy when we travel, because all of my stories about being healthy and it wasn’t a Cobb salad, it was Cobb soup.
Errol Louis: Oh, really?
Erin Billups: Well, as in nothing like dressing. There was so much of it. It was as if I had a soup. It was still yummy when I kind of pushed some of the salad dressing aside, but it was incredibly hard to find anything healthy anywhere in sight. The places that did offer salads, you know, iceberg lettuce. But I mean, the people are wonderful, they’re sweet. It was beautiful. But there is definitely this underside of health issues are not prioritized for everyone. And that was very, very clear.
Errol Louis: And a very starchy diet with lots of sugar and sugary drinks in particular will not just trigger obesity, but in fact, start you down that road to diabetes where the blood sugar kind of runs out of control and the whole cast of characters starts to show up. Right? Heart failure and on and on and on. Well, let’s go from the countryside to the inner city. There are some interesting people doing some interesting stuff. So up here in New York City, Dr. Michelle McMacken was somebody we talked to and they’ve got a real interesting approach here. This is in part because we have a newly elected mayor, Eric Adams, who happens to be vegan and in fact, has an important story about how he was diagnosed with diabetes and managed to reverse it.
Erin Billups: That’s right. I mean, I think several years ago when he first realized he had diabetes and then he was told that he would have to be on Metformin, one of the made diabetes medications for the rest of his life. And he said, wait, that’s my only option. And essentially his doctors here in the city told him, ‘Yeah, that’s your only option’. And he was like, that will not be my only option. And he went on his own quest, found doctors who spoke the language he wanted to hear, which was it is possible to put this in remission. It’s possible to reverse it. And he has that sort of personality where he put his mind to it and he made it happen. And I profiled him at that time. And I remember him saying to me, ‘Erin, I am going to make sure that at least our city hospital system tries to approach it this way. This will end up saving us money in the long run.’ And I said, Okay, great, I’d love to see that happen. Pilot program was set up at Bellevue Hospital and was very successful, but they just couldn’t serve all the people interested in being in this program.
Errol Louis: That and the demand is actually good news in a way. Right, if people actually want this. Let’s listen in on a little bit of that part of the interview.
Dr. Michelle McMacken: The regular check-ins, they need a lot of education around the different pillars of lifestyle change. People need to understand, how do I work with my family around this? What happens if I go to a party or out to dinner?
Erin Billups: In 2019 at Bellevue Hospital, a government run facility in New York City, Doctor Michelle McMacken helped launch a plant based medicine program to better support patients with diabetes pre-diabetes and other chronic conditions.
Dr. Michelle McMacken: A suboptimal diet is actually the number one risk factor for dying of a chronic disease. The evidence is so strong around eating a plant-based or mostly plant-based diet for reducing risk.
Erin Billups: Patients in the program are offered cooking classes and work with doctors, dieticians, health coaches and support groups to make lasting changes to their diets and daily habits.
Dr. Michelle McMacken: If it’s a relatively new diagnosis of type two diabetes and people make intensive lifestyle changes, we have great science to show that many of them can go into remission.
Errol Louis: And that’s the real point, right? I mean, it takes a little bit of work. You got to stay on it. But if you do, you can really make dramatic changes relatively quickly.
Erin Billups: Yes, you can. But, you know, most hospitals and politicians here, you know, cooking classes, doctors, dietitians, health coaches, support groups, all of that wraparound support sounds super expensive. And so I think that’s why you haven’t seen it happen. Earlier this year, Mayor Adams announced that he was expanding this plant based lifestyle medicine program throughout the hospital system in New York City, which is a huge deal from a public health perspective. And we’re going to have to watch it and see, are we really seeing a difference in these numbers?
Errol Louis: Look, I was under the impression that this was a demonstration project in the following sense, when he reversed his own diagnosis, Eric Adams flew out to the Cleveland Clinic, which is world renowned. Got a lot of attention. Again, very expensive process. Not everybody can fly themselves out to Cleveland and, you know, go through all of the different things that he went through. And my impression was that they were sort of not slow-walking it, but they were being especially careful to document every step that was taken in New York so that they would have kind of a bulletproof argument for a wide expansion of some of the plant based strategies that were intended to sort of go to scale here in New York. But the success of any individual strategy, I mean, I looked at it not quite as intensively as you did, but it sounds like they are well on their way. Let’s listen to this part of the interview.
Erin Billups: Adams has long advocated for systemic change in health care. Now he’s making Bellevue’s plant based medicine program available at six more sites, with Dr. McMacken leading the initiative.
Dr. Michelle McMacken: These evidence based lifestyle behaviors can have a huge impact, not just on preventing and reducing the risk of chronic diseases, but actually treating these conditions and in some cases actually turning things around. Just as Mayor Adams did.
Errol Louis: We have a mayor who was struck with diabetes who happened to take this particular course of action, who now believes that he can sort of bring it to scale and use it as public policy. You needed all three of those things to happen at the same time as you have a budget that can accommodate it.
Eric Adams: Is not how much it costs for this program. How much is going to cost us if we don’t have this program? Our health care system is not sustainable.
Errol Louis: And that’s one of the themes that really struck me over and over again, which is that what’s the estimate, $230 billion a year in direct costs that the federal government is spending? That’s through Medicare, Medicaid and military health facilities. That’s a lot of money. You know, quarter of a trillion dollars every single year.
Erin Billups: And if you pay for these services on the front end, you save a lot of money. You know, in the part that you focused on, Errol, there’s a wonderful sort of breakdown of how much is spent on each of these services, but no one actually takes into account cost savings for something like this when you’re budgeting.
Errol Louis: It’s so far out of control. I mean, it’s like crazy out of control. So we have this wonderful program up in the South Bronx that we visited. Chris Norwood is the head of Health People, and what they do is peer counseling where they train folks in the neighborhood to talk to their neighbors and teach them a little bit about what foods to get, what foods to avoid, how to do a little bit of exercise. It creates a certain kind of a morale and accountability when people are doing these things in groups. It’s a well-documented way of helping people get from one place to the next. In fact, let’s listen to the part where we went up there and spoke with Chris Norwood.
Chris Norwood: Even though I do this every day, it’s very hard still for me to get a handle on the level of mass illness we have. The only way is that we have to massively train local groups and I mean massive like an army.
Errol Louis: Why aren’t there 20 organizations like yours just in New York City, never mind all around the country.
Chris Norwood: Because I think part of it is getting the funding for this is so rough. The city has a $1.6 billion public health budget. That’s more than most countries, and the state, I can’t even count how many billions they have now with the federal aid. Neither one of them has a diabetes plan.
Errol Louis: Despite the program’s success, Norwood spends much of her time figuring out how to keep the lights on. Most of their operating budget is pieced together from foundation grants or from one time government funds earmarked for other purposes, such as reducing emergency room visits. The leadership that could redirect more resources toward programs like yours when they see what you’ve done. What do they say?
Chris Norwood: They sort of say, ‘that’s nice.’
Erin Billups: I love shortly after that segment, when Norwood says that people have been turned into commodities for a sickness industry. It’s hard not to see it that way when you see that it costs about $90,000 a year to keep someone on dialysis, and I suspect more than that, when you think about sort of the ripple effects of having to be on dialysis. How much work is being missed? You know, if you’re a parent who has a child under the age of 18, those are hours spent away from home, from rearing your child, from guiding them. There’s so much residual impact from people being tied up in this cycle of diabetes, uncontrolled diabetes.
Errol Louis: Well, let me but this is something I imagine you deal with in your health reporting all the time, which is that in this case, it would be $900 per person to do peer counseling. Right. That only sounds expensive until you consider the alternative, which is $90,000 a year for dialysis. But we have this turnstile system of money changing hands for health care, right, where you get paid for the procedures. That’s how people make money. And humans really are being used to feed that system as opposed to spending a much smaller, I mean, exponentially smaller. Knock off a couple of zeros and it’s $900 and the person learns enough about health that they never need diabetes treatment at all for the rest of their lives.
Erin Billups: Right. I mean, it is a perpetual problem of preventative versus proactive care. One thing I wish we were able to hit on in this, but, you know, TV limited time, is sort of farming subsidies. Who gets paid more money? The crops that are subsidies? Yeah, it’s corn, soybeans or rice. The ingredients into are highly processed foods you rarely see, like good fruits and vegetables subsidized at the same level.
Errol Louis: Okay. Well, look, there’s a lot more in this documentary. We want everybody to check it out. We get into the fact that the diabetes caucus, I didn’t know this, I’ve been studying politics for 40 years now. Diabetes Caucus is the largest caucus in Congress, over 300 members. You’d think that they could get something done. This is affecting every member in every district, urban and rural, every corner of the country. They don’t seem to be able to get it together. So there’s a lot of work to be done here. It starts with public understanding. That’s why we did the documentary. Erin Billups, thank you so much for all of the work you did on this and for coming in to talk about it today.
Erin Billups: I am so glad we got to work together on this. I hope that people listen and you know, we start to see some action.
Errol Louis: Yeah, the sequel is going to be much happier. There will be a sequel. We’ll let you listen to the entire discussion and we welcome your comments, as always. We’re going to play the whole documentary after a short break. The special is called “USA1C: Fighting the Rise of Diabetes.” And Erin, explain that title, USA1C.
Erin Billups: It’s sort of a play on the fact that diabetes is an issue that impacts people all over the country. You know, we thought of USA, but then the A1C is the blood test used to determine whether you have diabetes. It measures the level of sugars in your blood. And so anyone who has diabetes or has been told they have prediabetes, they know what the A1C test is. But we also want other people to know what that is. We want it to become common knowledge. USA1C.
Errol Louis: Hemoglobin A1C test is actually very important. I should mention my level. I’m very proud of this: 5.1.
Erin Billups: That’s very good. I’m not going to tell you mine.
