Our review of the California Department of Public Health's (Public Health) diabetes prevention programs, highlighted the following:
Diabetes—a chronic disease affecting one out of 12 adults in California—is a growing epidemic that drains the health and economic well-being of families, employers, and communities. In terms of cost alone, in 2012 the American Diabetes Association estimated that the annual health care and related costs of treating diabetes in California were roughly $27.5 billion. The California Department of Public Health (Public Health), whose mission is to improve the health of Californians, manages federal grants that fund its diabetes prevention efforts. However, Public Health's spending on diabetes prevention has declined over time due to reductions in its federal funding. In fiscal year 2013-14, its federal funding for diabetes prevention decreased from more than $1 million in previous fiscal years to $817,000. Moreover, Public Health's maternal diabetes program also experienced significant reductions in federal funding over the last three fiscal years, declining from $1.2 million in fiscal year 2010-11 to only $71,000 in fiscal year 2013-14. In fact, in fiscal year 2012-13—the most recent year for which nationwide data is available—California had the lowest per capita funding for diabetes prevention in the nation.
One reason for this is that California does not provide any state funding for diabetes prevention, while several other states do. For instance, in fiscal year 2012-13, New York allocated $7.2 million of state funds for diabetes prevention, although a portion was for obesity prevention. Consequently, its per capita diabetes funding was 42 cents, while California's was the lowest in the nation at 3 cents. Public Health recently received two additional federal grants that will add millions of dollars to its diabetes prevention efforts, creating an opportunity for it to expand its diabetes prevention activities in California. However, even with this new funding, Public Health has not been able to expand its diabetes prevention activities to many of the counties in the State that have a high prevalence of diabetes.
Public Health does not have a formal process for searching for federal grants, nor does it have a staff member who routinely searches for diabetes-related grant opportunities. The chief of the Chronic Disease Control Branch attempts to identify federal grants, but does so amid numerous other competing duties. As a result, Public Health may be missing out on additional funding opportunities. For instance, we found two grants, each worth up to $500,000 per year, for which Public Health was eligible to apply but did not do so. Public Health stated it did not have the resources and capacities required to apply for these particular grants. However, it lacks these resources and capacities in part because it receives limited funding from grants. To make a difference in preventing diabetes, Public Health needs to overcome this dilemma, and the first step in doing so is to at least be aware of diabetes-related funding opportunities.
Our review indicated that Public Health spent its limited federal funds in an appropriate manner and complied with applicable grant requirements. For the 40 expenditures we reviewed from fiscal years 2009-10 through 2013-14, Public Health's expenditures were in accordance with federal requirements, and the amounts spent were reasonable. Additionally, despite a concern that was raised about the relationship between Public Health's diabetes and tobacco control programs, Public Health has not spent its limited diabetes funds on tobacco cessation activities.
We also found that Public Health ensured that the 10 staff members responsible for managing its diabetes prevention efforts met or exceeded the relevant qualifications for their respective positions. In fact, two are licensed medical doctors, while another has a doctoral degree and six have master's degrees. However, until we brought the issue to its attention, Public Health had not ensured that these staff received periodic diabetes-related training as a best practice for keeping informed about this disease and its effect on millions of Californians. For example, only four of the 10 staff members were able to provide evidence demonstrating their attendance at training related to diabetes prevention during the past fiscal year.
Public Health has tracked its progress in implementing diabetes prevention strategies in accordance with grant requirements. It has established goals related to decreasing the prevalence of diabetes in California. For example, its goals include increasing the number of diabetes self-management education programs and increasing the number of people with diabetes who are enrolled in these programs. Public Health has also set a goal to decrease the prevalence of diagnosed diabetes in adults from 10 percent to 9 percent by 2022. This goal is lofty because it aims to reduce the number of Californians with diabetes by a significant number per year when the number of newly diagnosed individuals each year has been increasing by an even larger amount. If it expects to meet this goal, Public Health will need to do more than it has been able to in the past with its limited funding.
If state lawmakers desire Public Health to increase its efforts to address diabetes, they should consider providing state funding to aid in those efforts. For instance, the Legislature could provide funding to establish a grants specialist position to identify and apply for federal and other grants.
To increase its efforts to prevent and control diabetes, Public Health should develop a process for identifying and applying for federal funding opportunities, including routinely and proactively searching for grants. In addition, Public Health should seek funding for a grants specialist position to identify and apply for federal and other grants.
To ensure that staff responsible for diabetes prevention have adequate knowledge and skills, Public Health should ensure that it follows its recently developed process to track training related to diabetes prevention for all employees participating in this effort.
Public Health agreed with our recommendations. However, Public Health incorrectly stated that it had already fully implemented them. As a result, we provide clarification on some of its statements on page 39.