Type 2 Diabetes as a Socioecological Disease: Can Youth Poets of Color Become Messengers of Truth and Catalysts for Change?

Engaging youth poets of color to develop artistic content to combat Type-2 diabetes (T2D) can increase their public health literary and social activation and foster compelling art that communicates how complex, multilevel forces interact to generate disease and disease disparities were the findings of Dean Schillinger, MD and colleagues in a recent Health Promotion Practices article. Dr. Schillinger directs the UCSF Health Communications Research Program and is a primary care physician whose research and policy work has focused on reducing the burden of chronic disease among communities of color. The current research is particularly innovative insofar that it used mixed-methods techniques to analyze the poetry with respect to its alignment with the socioecological model (SEM) of health.

T2D is exceedingly prevalent among U.S. adults and is now affecting youth of color. The nation’s ability to confront this growing epidemic as a multilevel social problem has been stymied by an absence of effective communication by both medical and public policy communities. 

Schillinger and colleagues explored whether spoken word workshops enable young artists of color to convey a critical consciousness about T2D. The Bigger Picture campaign (TBP) fosters creation and dissemination of art to shift from the narrow biomedical model toward a comprehensive socioecological model (SEM). Workshops offer (1) public health content, (2) writing exercises, and (3) feedback on drafts. Based on Freire and Boal’s participatory pedagogy, workshops encourage youth to tap into their lived experiences when creating poetry. The researchers analyzed changes in public health literary and activation among participants and mapped poems onto the SEM to assess whether their poetry conveyed the multilevel perspective critical to public health literacy. the research team then determine whether spoken-word positions young artists of color to integrate and convey a critical consciousness about T2D as a function of participating in workshops co-facilitated by public health and arts mentors.

The researchers found that, after the workshops, participants reported greater levels of public health literacy and activation related to T2D. Schillinger and colleagues further found direct evidence that the curricular content and workshop process were effective, as 95% of submitted poems featured at least three of five SEM levels, and nearly two thirds featured all five. At both the poem and stanza levels, the most frequent domains were sectors of influence, systemic forces and behavioral settings, suggesting that youths’ mental models for T2D extended beyond individual behavioral factors. As such, youth poets met TBP campaign’s objective to identify and integrate the multifaceted SEM of T2D into their poetry. Their poems shifted discourse away from individual-level “shame and blame” about unhealthy behavioral practices toward larger communal domains such as the systemic forces and the sectors of influence that determine health-jeopardizing exposures, risks, and behavior. While nearly some poems did feature individual factors as a primary domain, poets more frequently and collectively called out factors beyond the individual—such as poverty, racism, food insecurity, consumerism, and institutional oppression—as contributing to the epidemic and its disproportionate impact on low-income communities and communities of color.

Schillinger and colleagues conclude that engaging youth of color to develop artistic content to combat T2D via a collaborative and participatory approach led by public health practitioners and artists was an effective method for social activation among this cohort of youth. Enabling youth of color to use their “life as primary text” may have the ability to promote civic engagement while increasing public health literary though communications that reduce communal risk for the development of diseases such as T2D. Dr. Schillinger and his team will soon be releasing film versions of a new set of TBP poems as part of a campaign to promote COVID vaccination, entitled “Survival Pending Revolution.”

Dean Schillinger, MD

Dr. Schillinger is an internationally recognized health communication scientist and expert in chronic disease prevention and control. He is affiliated faculty at the Philip R. Lee Institute for Health Policy Studies and directs the UCSF Health Communications Research Program, serves as site director for an NIDDK Center for Diabetes Translational Research, and is Principal Investigator for CDC and NIH funded projects in diabetes-related policy, as well as a NIH project to develop measures of health literacy using computational linguistics and machine learning


Type 2 Diabetes as a Socioecological Disease: Can Youth Poets of Color Become Messengers of Truth and Catalysts for Change?
Abbs E, Daniels R, Schillinger D. Health Promot Pract. 2021 May 14:15248399211007818. doi: 10.1177/15248399211007818. Online ahead of print.