There’s a diabetes epidemic in America—we hear of it almost daily. The growing prevalence of diabetes goes beyond the United States—diabetes is a global public health issue. Throughout the world, an estimated 366 million individuals are projected to have diabetes by 2030, more than double the number in 2000. It's clear that more diabetes education, prevention, self-management, and adherence efforts are needed. Of course, all is easier said than done. So, where to start—and what’s the right approach to going global?
Using public health practice to understanding patients and their environments
In the past year, I’ve had the opportunity to help expand diabetes patient education efforts to countries around the globe through educational marketing. Educational marketing uses the principles of patient education and adult learning. As we go global with our work, expanding practice 
across borders, cultures, and ethnicities, we cannot simply impart our US-based approaches and terminology and assume they will traslate well to all. To help expand our work appropriately, as a health educator I look to the roots of public health practice—the principles of community organizing.
Community organizing involves assimilation within a community—working with community leaders and building a coalition.This approach should involve a collaboration between those in the community and those helping the community. In applying community organizing in educational marketing, we need to identify the "community leaders." We look to our partnership with the brand team in each country, those who best know the population demographics, market practices, cultural connotations, and regulatory guidelines. Rather than our push out US-centric solutions that may not fit the market needs of each country, native brand representatives can help us create the most suitable educational efforts.
A tool to help expand our view of diabetes across the globe—the patient journey
Employing a community organizing approach takes us a step closer to understanding global markets and making global change. But one tool—the patient journey—is especially useful as we navigate the conversations and plan work with global teams. A patient journey is a reality-based, visual representation of patients' experiences with a disease and how the disease impacts them in the context of their lives. The perspective, tensions, and frustrations of patients—as well as patients' interactions with other stakeholders—are captured along the journey.
A patient journey can help us dissect and visualize the experience of a patient with diabetes. It can unveil barriers, motivators, emotions, persons, and environments that influence the patient's journey and his or her paths to decision making. In considering the use of patient journeys in global work, think about this: All patients with diabetes, wherever they live, ultimately face many of the same barriers, motivators, emotions, and needs regarding their diabetes self-management and treatment engagement. A patient with diabetes in France has no less a fear of starting on insulin than does a patient with diabetes in the United States. What most often differs is the patient's environment: the healthcare system in his or her country, marketing regulations, cultural influences, and his or her healthcare team. Using a patient journey analysis to identify these differences can help collaborative teams to understand markets and environments and to plan the creation of culturally relevant solutions for patients and healthcare providers.
As a health educator, I'm excited to see the intersection of public health practice and educational marketing efforts. We’re taking the time to do foundational work, in a collaborative way with global brand teams, to understand patients with diabetes within their environments. These learnings, coupled with cultural competency and attention to health literacy practices, will help us create global-fitting solutions for all.
Erika Heiges, MPH, CHES
Director, Health Education
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