Medicine

Cornell Spencer could be seen as a typical teenager from Harlem. Wearing baggy clothes and with a friendly swagger, he is interested in all things hip-hop. Yet, when his rhymes veer from the usual teenage topics of girls, cars and money, Spencer makes his greatest impact.

Spencer, 17, recently wrote a song about his mother’s and grandmother’s diabetes and he will debut it for his peers at the next American Diabetes Association event for teenagers. With his rapping partner, Terrell Amps, Spencer has been performing at these types of events all fall.

“Diabetes is affecting our community everyday,” said Spencer, whose grandmother died from the disease. “And now there are kids getting it.”

In Harlem, nearly 11 percent of the population has diabetes. Most of them, mainly adults who are overweight or obese, have type 2 in which the pancreas secretes some insulin to control blood sugar, but not enough for the body to function properly.

But in recent years adolescents have been diagnosed with type 2 at an alarming rate, and may now represent up to 45 percent of all diabetes cases, according to Dr. Diana Berger, the medical director of the diabetes prevention and control program for the New York City Department of Health and Mental Hygiene.

These numbers have led the Centers for Disease Control and Prevention to call diabetes and the associated problem of childhood obesity an epidemic.

In Harlem, where the prevalence of adolescent diabetes among African Americans is higher than in most other city neighborhoods, many schools, social service and public health agencies have folded fighting obesity and diabetes into their missions. Schools are adopting new lunch menus, celebrities are organizing outreach events and school groups are performing to educate their peers.

However, in the absence of firm statistics to illuminate the trend, citywide efforts have been thwarted. Before 2002, no city agency explicitly dealt with diabetes, Berger said, and now there are just three employees at the health department who focus on the issue, compared to the 160 staff members who work in the lead poisoning prevention program.

“Historically, public health has addressed immunization, clean food and clean water,” Berger said. “But our commissioner is very forward thinking. It takes an enormous societal shift and he is making that shift.”

And soon, Berger hopes the prevalence will be known. In July, she proposed to make it mandatory for all health facilities in the city to report blood sugar data from their diabetes patients, and earlier this month the New York City Board of Health voted unanimously to accept her proposal and change the health code.

One of the nation's leading nonprofits providing diabetes advocacy and information, the American Diabetes Association, is just starting to reach out to young people. For the first time, it organized a Diabetes Teen Summit in November at Roberto Clemente Junior High School in Harlem in coordination with the Coalition of 100 Black Women, the Damon Dash Group, the Sweet Enuff Movement, and several other community groups.

“The fastest growing community of diabetes sufferers is people between the ages of 10 and 19,” said Dionne Polite, who heads the association’s outreach programs and volunteer development. “This is a very serious thing, not only for the individual but for the country as a whole.”

The organization will continue to target this population, Polite said, and officials there hope the issue eventually will get national recognition.

“What we want to do is plant the seed,” Polite said, “talk to them [teens] about healthy choices and whether to supersize at McDonald’s or downgrade that Slurpy. That way we can make some sort of dent anyway we can.”

Because adolescents spend so much time in school, other attempts have been made to educate them in that environment. The American Diabetes Association is planning future educational outreach, and some schools have tried exposing students to proper nutrition through healthy lunch programs and cooking classes.

At the Harlem Children’s Zone Promise Academy , a charter school that opened in the fall of 2004, healthy lunches have always been a part of the school’s mission.

“We’re trying to get them away from the fast food craze,” said Andrew Benson, the executive chef. “We try to take foods that are familiar to them, like fried chicken, with the possibility of taking that food and serving it healthy.”

Benson said that through the lunches, parent and student cooking classes, and a monthly farmers market held at the school, some Harlem families were starting to learn healthier styles of eating.

Shamar Cotman, a heavy-set Roberto Clemente seventh-grader who attended the teen summit, said his family has been making efforts to eat a little better. “Chicken is all I eat at home,” he said, “fried and baked, but I know baked is better.”

In many Harlem homes, families don’t have the means to cook nutritionally sound meals since fresh foods such as fruits and vegetables are harder to find in the neighborhood, harder to keep and cost more, Benson said. And to complicate the picture even further, there are fast food restaurants on nearly every corner, well outnumbering grocery markets.

“Unfortunately you can get a whole plateful of junk for what you pay for a pound of broccoli,” Benson said. “We’re trying to open their minds and show them that there is other stuff out there.”

Amy Jordan is also trying to open minds, but she expects to do it through performance and peer interactions. It was she who introduced Spencer and Amps to the American Diabetes Association.

A professional dancer who missed an opportunity to dance for established music stars like Madonna and Janet Jackson because of complications from diabetes, Jordan, 36, also spoke to the crowd at the teen summit.

“The denial factor is so big with diabetes,” Jordan said at the event. “I’m here to say that if you do not take care of diabetes it will come back and haunt you.”

Jordan would know. She was 3 when she was diagnosed with type 1 diabetes, in which the pancreas produces little or no insulin, but refused to admit she had a problem through her teenage years. But when she was 22, her retinas started bleeding and it took 37 operations to make them stop. She is now legally blind, and trying to counsel others against taking the disease too lightly.

“There is not very effective outreach happening in the community,” Jordan said. “Parents are concerned and kids are going through the same things that caused my complications.”

Jordan founded the Sweet Enuff Movement, a foundation aimed at diabetes outreach through T-shirt sales, group performances and subtle media saturation. The Youth Ambassadors, a group of dancers that performs around the tri-state area, spread the word about diabetes through interactive programs.

“That’s my goal – getting involved with the community and having a dialogue,” Jordan said. “Not having a doom and gloom perspective. The Youth Ambassadors come at people from another direction.”

At each performance the performers are charged with motivating one person in the audience to join the organization. At an event at Marcus Garvey Park in Harlem this past summer, the routine was so well received that people from the Apollo Theater called and asked Jordan’s group to perform at the Luther Vandross tribute event.

“It’s going to take finding out what makes kids tick and then going into that population and starting from there,” Jordan said. “We are a media-based celebrity culture. And if it is suddenly hip and cool and useful then they might think about it more often.”

Damon Dash first discovered his diabetes when he was 15. That was less than 10 years before he made his mark on the hip-hop world as one of the founders of Roc-A-Fella Records and Rocawear. Dash is now the new ambassador for the American Diabetes Association.

By speaking publicly about his disease at the teen summit, Dash hoped to bring wider recognition and a greater understanding to the disease by using his name and brand. As he and his assistants handed out Rocawear headbands and dog tags, and raffled off 10 pairs of sneakers to the students, many of them shook his hand, fussed with the free gifts and hollered out questions about what it is like to live with diabetes.

While advocates agree that celebrities can further the cause among teens, the ultimate influence in their lives is from their peers. Much of what they eat and how they behave is based on what their friends are doing, or how they might look to their peers.

Francheska Segovia, a 16-year-old from Rockland County who attended the event, said the standard fare at her high school is pizza, French fries, and cookies – and there’s also the temptation of candy sold at a store in the lunchroom.

Reginald Miller, in charge of health education and outreach for Harlem Congregations for Community Improvement, a community organization dedicated to the holistic revitalization of Harlem, sees the solution requiring a societal shift. Portion sizes are bigger than they have been and foods that were consumed only at celebrations in the past are now eaten regularly, said Miller.

“A large part of it is a culture clash,” Miller said. “We’ve become victims of our own prosperity.”

The catch, say experts, is to start healthy habits early, preventing complications before they become unmanageable.

The thing about diabetes is that you have to be very proactive before you have problems,” Jordan said. “Once the problems start it’s like chasing a brush fire with a garden hose.”