Local diabetes fighter goes global with Discovery Health Channel documentary

Dr. Francine Kaufman has seen the incidence of diabetes skyrocket in the last 30 years. The pediatric endocrinologist is director of the Comprehensive Childhood Diabetes Center at Childrens Hospital Los Angeles, and she says the disease’s local increase is part of a worldwide phenomenon.

In Los Angeles, the number of adults with diabetes stands at about 600,000, or 8.6 percent of the population, up from 6.6 percent in 1997. Nationally, 20.8 million children and adults — about 7 percent of the population — have diabetes. Worldwide, more than 180 million people are estimated to have diabetes, a number expected to double by the year 2030.

The author of “Diabesity: The Diabetes-Obesity Epidemic that Threatens America and What We Must Do To Stop It,” Kaufman has been on the front lines of fighting these escalating numbers as a clinician, researcher and a former president of the Diabetes Association of America.

Now Kaufman is turning to the small screen to bring attention to this global epidemic in a one-hour, commercial-free Discovery Health documentary narrated by actress Glenn Close, “Diabetes: A Global Epidemic,” on Sunday, Nov. 18.

Kaufman spent six months visiting every continent except Antarctica to explore the challenges of diabetes as well as the success stories. Logging about 150,000 air miles, she visited clinics, met with government officials and spoke directly with patients.

“There’s a common theme: Diabetes can potentially devastate people’s life anywhere, both the countries with tremendous resources and the countries with almost no resources,” Kaufman told The Journal. “It knows no boundaries.”

Diabetes is an inability of the body to use or produce insulin, a hormone that regulates blood sugar. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. Ninety percent of people with diabetes worldwide have Type-2 diabetes, which is largely the result of excess body weight and physical inactivity. Lifestyle changes can delay or prevent its development, which is why Kaufman is so passionate about the issue.

Kaufman’s journey began in December 2006 in Capetown, South Africa, during the 19th World Diabetes Congress. Traveling to the city’s outskirts, she saw the poor living in shacks that lacked running water or electricity. She visited a residential hospital where children receive care because their families cannot provide it. While some don’t believe in Western medicine, others suffer due to unreliable insulin delivery or a lack of resources to refrigerate the perishable animal hormone.

At each destination she visited, Kaufman found cultural factors that impact diabetes:

  • In Los Angeles, she focused on the largely Latino patient population, whose genetics and dietary customs pose problems. “I was raised on rice, beans, tortillas, meat and cheese,” explains one woman, whose weight had once reached more than 300 pounds.
  • In India, a country with a history of starvation, the populace largely perceives obesity as a sign of health and wealth. Street vendors sell fried foods on every corner, and the bikes that Kaufman had seen on her previous visit have been mostly replaced by scooters and cars. The cultural practice of bare feet poses particular challenges because diabetics often lose sensitivity in their feet. As a result, small cuts can go unnoticed until they become infected or gangrenous.
  • In Australia, a country associated with physical fitness, Kaufman learned that citizens are now more likely to watch sports than participate in them. And the country’s Aboriginal population, whose bodies are hardwired to store calories, have an astounding 50 percent prevalence of diabetes.

    However, Kaufman also saw some successes.

  • In Helsinki, Finland, the government’s proactive approach to prevention showed that those at high risk of developing diabetes could decrease their risk by 58 percent. Peka Puska, director general of the National Public Health Institute, told Kaufman, “We have to change the environment so the healthy choice is the easy one.”
  • In India, Kaufman visited a comprehensive clinic that treats 100,000 patients and addresses every aspect of diabetes care. In one location, patients see specialists such as dentists, dieticians and opthalmologists, and can purchase items including medication, food and special shoes.

“I would love to be able to replicate that in Los Angeles,” she said.

While Kaufman did not visit Israel as part of the documentary, she said she was there last month for a symposium hosted by D-Cure, an Israeli nonprofit organization that funds diabetes research and collaborates with research projects around the globe.

“With its focus on healthcare and technology, Israel is likely to emerge as an international player in finding solutions [to the diabetes epidemic],” Kaufman said.

At the same time, Israel’s rate of diabetes is 7.8 percent.

“It’s a struggle there like it is for all of us from cultures that intermingle nourishing with nurturing,” she said. “It’s hard to overcome how we were raised, where our grandparents were starving, and overweight was a sign of health.”

Whatever a nation’s specific challenges relating to diabetes, the disease is universally devastating when not managed, Kaufman said. She does, however, have the prescription.

“To manage it, you need a government that can give resources; a health care system that is focused on it; the environment in which you live supporting a healthy lifestyle; and, ultimately, your own personal choice of whether you’re going to do everything you can to combat this or not.”

“Diabetes: A Global Epidemic” will air on Discovery Health, Nov.18, 9 a.m. For more information, see http://health.discovery.com/centers/diabetes/diabetes.html and


Q and A With Dr. Francine R. Kaufman


Obesity has reached record rates among children and adults, bringing with it increased risk for developing diabetes and related health problems. In addition to the more than 18 million Americans currently living with diabetes, another 41 million are considered prediabetic, and are likely to develop the disease unless they take action.

In her new book, “Diabesity: The Obesity-Diabetes Epidemic That Threatens America — And What We Must Do to Stop It” (Bantam), Dr. Francine R. Kaufman describes how reversing these trends requires efforts from all levels of society.

The immediate past president of the American Diabetes Association and the head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, Kaufman spoke with The Jewish Journal about the magnitude of the problem, its causes, and strategies for changing the course of this epidemic.

The Jewish Journal: How have rates of obesity and diabetes changed over recent years?

Dr. Francine R. Kaufman: There’s been such a huge increase that we’re now calling it an epidemic. And it’s not only affecting adults, but also children. The number of overweight children has tripled since 1970. Cases of Type 2 diabetes among children have grown from a negligible number in the early 1990s to about 25 percent of new cases today.

JJ: Why are we seeing so much weight gain among children and adults?

FK: Our lifestyles have markedly changed: The amount of physical activity has markedly diminished in the community setting, in homes and in schools. The amount of sedentary behaviors — such as television, computers, video games and instant messaging — has markedly increased. And the quality and quantity of food is markedly different.

JJ: You advocate applying the strategies used by the anti-tobacco movement to purveyors of fast food and junk food. Where does personal responsibility fit in?

FK: The fundamental difference between the anti-tobacco campaign and this issue is that everyone has to eat but no one has to smoke. In both cases, personal responsibility is important. People need to be concerned about their health and motivated to get active and eat appropriate amounts of quality food.

However, there are lots of people who don’t have the option to make these healthy choices. It’s not realistic to expect a woman who’s on welfare, has three kids and is working two jobs to go to the Whole Foods store — which she can’t afford — and have the luxury to cook this wonderful meal — which she doesn’t have time to do — and then go exercise with her children.

We have to be able to fit healthy behaviors into our daily lives rather than segment them out. Our work places, our communities, our schools and our faith-based organizations must allow us to make healthy food choices and engage in physical activity.

For example, it’s not easy to be healthy at most workplaces. Employee cafeterias offer fare that’s high in salt, fat and sugar. Vending machines sell sodas, candies and chips. Stairwells are dingy and hard to access. It doesn’t have to be this way. Workplaces could [offer incentives to] employees to be active, serve healthy snacks in their cafeterias and vending machines or subsidize employee gym memberships.

JJ: In your book, you describe how your Grandma Sadie, who eventually developed diabetes, grew up undernourished in Russia. Her diet changed when she came to American and was exposed to abundance for the first time. How does your grandmother’s experience parallel the experience of our society?

FK: In Los Angeles, there are still a lot of new immigrants who [don’t] have an abundance of food like we see here. After starving or having tremendous food insecurities, they come here and overindulge. My Grandma Sadie hid food. If she went to a restaurant, she took home all the rolls and the sugar. She couldn’t shake the mentality of scarcity.

The grandmas of my patients have tremendous impact on the health of their children and their children’s children — just like Sadie did for us. They don’t want to limit the amount of food their grandchildren can have and don’t understand why they should.

Also, many children in this country live in communities where all they see are liquor stores, convenience stores and fast food restaurants. It’s not the equivalent of living on the Westside. It’s hard to find a grocery store in some parts of town. The quality of the produce is not equivalent. The produce is more expensive and people have less money to spend.

JJ: These are formidable obstacles…

FK: I think there’s movement afoot to address these problems: The federal government, originally led by Health and Human Services Secretary Tommy Thompson, has promoted the message. Congressional leaders have become aware that we need to improve the health status of America. Locally, I chaired a task force for the Los Angeles County Board of Supervisors, who are putting the recommendations into action. And Los Angeles Unified School District’s ban on selling soft drinks was a clarion call to the nation.

JJ: So there’s hope.

FK: I’m very hopeful. There is positive change. We have to make these changes. If not, diabetes will devastate us. In 2002, diabetes cost the nation $132 billion. One in three children born in the year 2000 will develop diabetes in his or her lifetime. The New England Journal of Medicine just published and article projecting that this generation will not live as long as the previous one because of obesity-related diseases.


But Can She Sew?

As Jewish private school seniors prepare for graduation and commencing college in the fall, we face our greatest and most nightmarish challenge of all.

No, I’m not talking about AP exams and finals; as seasoned AP biology, AP English and honors scholars, we will tackle those with ease.

What frightens us most is the looming specter of untended piles of dirty laundry, soon to take up what little floor space is available in our future freshman dorm rooms.

Yes, to many academically advanced Jewish private school students, the delicate art of doing the laundry represents a mind-boggling proposition. Too many of us are simply stupefied by the provocative challenge of sewing on a button and anxiety-ridden over the physical adroitness required of using the dishwasher.

My school has trained us for the academic rigors of a university. However, it has failed in preparing us for the necessities of the real world, or what my grandmother calls the “nuts and bolts of life.” We aren’t alone. Today, this lack of practical skills among high school seniors is an epidemic. Web sites across the Internet list instructions for college students on everything from how to use a dishwasher to balancing a checkbook.

As more educated scholars ponder the philosophical questions of the world at the greatest universities, fewer and fewer students know how to just separate their darks and whites.

Perhaps this domestic ignorance is one of the negative results of Western feminism and our elitist, prep-school educational system in general. In previous generations, male students were required to take wood shop and auto-repair courses, while their female counterparts were required to engage in cooking and sewing classes. But as the 1970s unraveled and women admirably yanked off their bras and screamed for equality, one consequence was the neglected kitchen. The career-oriented world looked down upon housewives, and girls were just … too politically empowered for cooking.

This year, Milken High, which I attend, added a vital mandatory senior seminar on Israel and the Middle East. But how can we be asked to iron out the horribly divisive questions of the Middle East, when we can’t even iron our own shirts?

It is written in Baba Metzia that we must first help our household, then our community and then the world. Well, before we spend our days crusading against pollution to fulfill community service hours, perhaps we should take a couple of minutes to examine our own not-so lovely hygienic habits.

To illustrate, simply inspect my student lounge.

Domestic gods and goddesses we are not.

As we of the class of 2004 leave behind a legacy of hard-working student government leaders, newspaper editors, calculus experts and econ gurus, we humbly advise that Jewish private schools provide their students an opportunity to excel not only in the classroom, but in life by offering — even mandating — a home economics class.

Indeed, in this brave new world of 2004, high school graduates are not plagued by nightmares of failing a final, rather, we wake up dreading the Sisyphus-like fate of forever pressing the small buttons on the ugly brown microwave, stymied by the thought of actually planning, preparing and cooking a six-course Shabbat dinner, let alone changing a flat tire without calling the Auto Club.

Michele Goldman is a writer, pianist and graduating senior at Milken Community High School.

Hidden Impact of Sweatshop Laws

Is your image of a sweatshop a black-and- white photograph of Jewish garment workers marching for labor rights 100 years ago, or the Triangle Shirtwaist Company fire in 1911, in which hundreds of Jewish workers were trapped inside a burning building in New York (see sidebar)? If so, then you should update it: As of 2003, Los Angeles is leading the nation in sweatshop labor.

A coalition of activists under the title of No More Sweatshops, headed by former state Sen. Tom Hayden, is currently pushing legislation through the Los Angeles City Council, the Los Angeles School Board and the California Legislature to fight the illegal labor practice of sweatshops and to ensure these government bodies do not purchase any items with city or state funds that are produced by sweatshops.

On Sept. 9, the Los Angeles School board will hear advocates testimony on behalf of anti-sweatshop legislation to ensure that no school board funds are used to purchase sweatshop-produced uniforms. Similar hearings with the L.A. City Council and the Legislature are expected to follow in the coming months.

While no one exactly advocates sweatshops, critics of the activists say that legislation might target the only income source of an already vulnerable illegal immigrant community depends on sweatshops for their livelihood and that garment manufacturers would simply move their operations overseas rather than reform. Critics charge that activists should instead work with sweatshops to change their labor practices rather than pass more legislation against them.

Sweatshops in the 1900s were fueled by immigrant labor — much of it Jewish. Today, immigrant labor still fuels sweatshops; only the immigrants are now primarily Latino and Asian. Today’s sweatshops are manufacturing centers in which few if any federal or state labor laws are observed. Laborers often work 16-hour days, seven days a week for far below minimum wage with little or no provisions to ensure their health and safety. Additionally, workers are often subject to physical abuse.

Sweatshops workers are often forced into a type of indentured servitude in order to pay off the people who smuggled them into the United States, often paying off thousands of dollars in debt while making only a few dollars an hour.

"It’s a form of slavery that’s alive and well," said Anat Tamir, program director of the Progressive Jewish Alliance, which is a key Jewish player in the No More Sweatshops campaign in Los Angeles. "It’s a chain of production that exploits the most vulnerable people, and everyone from subcontractors to CEOs of large corporations are setting the tone for this kind of abuse and exploitation for the sake of profit. It’s dehumanization at its worst."

The problem of sweatshops in Los Angeles has reached epidemic proportions. Los Angeles has approximately 140,000 garment laborers who are primarily Latino and Asian undocumented workers. According to U.S. Labor Department studies, only about one-third of L.A. garment factories follow federal and state labor laws that are designed to protect workers. Garment production is Los Angeles is currently a multi-billion dollar business.

The cheap labor that sweatshops provide, however, is part of a system that fills a critical role in the clothing-production process. Garment manufacturers do not usually physically produce the clothes they make. The manufacturers take orders from retailers, design the clothing, market the label and then contract with independent garment factories to make the clothing. These subcontracted companies may use sweatshop labor without the manufacturer’s knowledge. All in all, consumers and manufacturers have difficulty ensuring that their clothes are "kosher."

Stan Levy, chair of the Labor and Public Affairs Committee with the California Fashion Association, has been working with manufacturers for 10 years to avoid worker exploitation. Levy pointed to legislation that responsible manufacturers have helped pass in recent years, such as 1999’s Assembly Bill 633, which allows workers who have not been paid by the subcontractors to file for payment on wages they did not receive. (This measure’s effectiveness is somewhat compromised by the fact that illegal immigrants fear deportation.) However, Levy pointed out that even with these safeguards, abuses can still occur.

"You have people with every good intention in the world who are horrified that workers are being exploited and want to help end the abuse of these people, but you are dealing with a problem that includes complicated cultural and economic issues," Levy explained. "Responsible manufacturers are trying to ensure this abuse does not occur, but we need government to offer better supervision and control."

Arthur Lujan, state labor commissioner, was unavailable for comment, but several people with knowledge of the workings of the commissioner’s office said they are not properly staffed or funded to oversee the garment industry.

Levy pointed to two independent monitoring agencies, Cal Safety Compliance Corporation and Apparel Resources, which offer certification that a garment factory is sweatshop free. However, Levy said they are only effective for registered companies.

"There is a whole garment underground," Levy noted. He added that it is unlikely for some subcontractors to stop using sweatshop labor without heavy governmental enforcement.

Richard Appelbaum, co-author of "Behind the Label: Inequality in the Los Angeles Apparel Industry" (University of California Press, 2000) and a professor at UC Santa Barbara, thinks it is possible to balance profits and fair labor in the industry.

"Labor cost is probably 6 percent of the retail price," Appelbaum said. "Even increasing the wages 50 percent would only subtract marginally from the profits. There’s a lot of profit in the industry, and there are significant profit margins. By cutting slightly into those profit margins, manufacturers could ensure a fair environment for workers."

Appelbaum also said he believes that most consumers would be willing to pay slightly more for garments that were not manufactured by sweatshops.

"Just like you pay extra for kosher food or bottled water, people would pay extra to know that their clothes are sweatshop free."

Levy said he thinks Appelbaum’s assessment doesn’t account for the complexities of garment productions.

"There is what it actually costs to make the product and then what it costs to sell that product in the store," Levy said. "Design, sales, production, advertising — all of those must come from the price as well. It may cost $5 to make and $50 in the store, but the actual profit the manufacturer makes is $5."

The quick closure of sweatshops is also too simple a solution in Levy’s eyes.

"No one wants to see abuse, but if you close down these companies completely, you’re going to have a lot of people deported and losing their jobs," Levy said. "You would create a huge crisis in a very vulnerable community, and all the people who are dependent of the workers to support them. And the abuse wouldn’t necessarily stop, it would just move overseas. That’s part of the anguish of this situation — as we try to ensure the fair treatment of workers it becomes a very difficult issue in light of the global economy. We need to work with the companies that are here to ensure fair labor practices."

Although the realities of sweatshops are complex, activists still believe than an idealistic approach is needed to solve this problem.

"Seventy-five years after the Triangle Shirtwaist fire tragedy, the language of immigrant sweatshop workers has changed from Yiddish to Spanish and Chinese," wrote the PJA and No More Sweatshops in a prepared statement. "But our intimate history as Jews rising from the sweatshops of New York and our strong tradition of social justice work demand that we once again fight egregious sweatshop abuses to protect a new generation of exploited low-wage workers."