Diabetes Project in Indianapolis Showcases Impact of Community Health Workers

I recently authored an article in POLITICO highlighting the important work of the Community Health Worker (CHW) Policy Forum, convened by Lilly, to educate and create awareness around the important work of community health workers (CHWs) and to identify policy solutions to support workforce development opportunities for CHWs.

CHWs are an essential part of improving health equity for communities in need across the country. CHWs educate their clients about nutrition, disease prevention, chronic illness and medication adherence. Perhaps most importantly, they practice empathy, patience and understanding to help community members make healthier choices and gain access to the medical care they need.

In the piece, I describe the CHW Policy Forum’s new white paper outlining how investing in an expanded national CHW workforce is cost-effective and improves health outcomes, in part by addressing social determinants of health (SDOH), a critical factor in maintaining or improving health that providers can’t always see in a routine check-up.

Achieving long-term cost savings and better community-wide health outcomes is a win-win policy prescription too potent to ignore. So, Lilly convened a group of advocates and experts to start a broader dialogue about the importance of CHWs.

Our inspiration to lead this vital public advocacy work was found right in our own backyard here in Indianapolis, home to Lilly’s corporate headquarters.

In 2018, as the first U.S. Lilly Global Health Partnership, we collaborated with Indiana University Richard M. Fairbanks School of Public Health, Eskenazi Health and others to launch the Diabetes Impact Project – Indianapolis Neighborhoods (DIP-IN) – an 8-year, $12 million initiative to address health disparities in three racially and ethnically diverse areas of Indianapolis with high rates of diabetes. More than 2 in 10 adults in these neighborhoods lives with diabetes (23.4%), double the national average (11.3%).¹ This complex disease impacts individual health over decades and can diminish both quality and length of life.

The annual U.S. economic burden associated with prediabetes and diabetes was an estimated $404 billion in 2017. The medical costs for each person diagnosed with diabetes in the U.S., on average, are 2.3 times higher than for those without. It is estimated that by 2060, an estimated 1 in 6 adults will be diagnosed with diabetes.

The DIP-IN initiative represents a collaborative effort within the local community, aimed at tackling the elevated diabetes rates in the three Indianapolis neighborhoods facing disproportionately high prevalence of the condition. Among other initiatives, the program utilizes CHWs to help people in underserved areas prevent and effectively manage diabetes. The project came about after a local study published in 2017 found a 17-year difference in life expectancy between residents of suburbs of Indianapolis and the city center.

Our work with Indiana University Richard M. Fairbanks School of Public Health, Eskenazi Health and the local community aims to tackle systemic inequities head-on in historically underrepresented communities of color, with the goal of building resources and connections within those communities.

The project has 5 foundational design principles:

1. Engage partners from multiple sectors to address community health,

2. Focus on geographic communities most affected by the health disparity,

3. Practice authentic community engagement,

4. Commit for the long term, and

5. Utilize a holistic approach spanning the prevention continuum.

DIP-IN assembled resident steering committees so those living in the area were at the table and making key decisions about community health promotion initiatives. And perhaps most impactfully, we invested in CHWs from within both the local health system and community with a keen understanding of both community obstacles and resources.

In Indianapolis, CHWs have been a crucial bridge between individuals and medical and social resources while also working to positively change the neighborhood environment to promote healthier living, including creating safe walking paths, providing access to healthy food, and attending dozens of community events. They’ve provided emotional and logistical support to help residents make doctor appointments. They’ve strengthened care coordination, improved health literacy, and expanded the reach of health practices. They have connected community members to critical necessities, including heat and electricity. And they’ve helped patients overcome cultural barriers to quality care.

Lilly’s 30x30 goal is dedicated to expanding the important and successful work of CHWs as part of our global commitment to improving access to quality health care for 30 million people in resource-limited settings on an annual basis by 2030. We believe in strengthening communities and addressing social issues through investments in CHWs and know more must be done to support this critical piece of our nation’s health workforce.

One of our community liaisons, Ron Rice, said it best: “Community health workers are a way for us to create more trust when trust has been such a low commodity in our lives… It’s a way for people to finally take in the love, empathy and altruism of someone else and use those vehicles to change their lives.”

^1. Centers for Disease Control and Prevention. National Diabetes Statistics Report. Published November 29, 2023. Accessed February 8, 2024. https://www.cdc.gov/diabetes/data/statistics-report/index.html