A Community-centered Approach to Diabetes in East Harlem

OBJECTIVE: Residents of East Harlem, an impoverished, non-white community in New York city (NYC), have up to 5 times the mortality and complication rates of diabetes compared with NYC residents overall. To determine potentially remediable problems underlying this condition, a community-based collaboration of health providers, community advocates, and researchers, surveyed East Harlem residents with diabetes to assess their knowledge, behaviors, barriers to care, and actions taken in response to barriers. DESIGN: Telephone interviews. SETTING: The 3 hospitals and 2 community clinics serving East Harlem. PARTICIPANTS: Nine hundred thirty-nine of the 1,423 persons (66%) with diabetes identified from these 5 healthcare sites with 2 or more ambulatory visits for diabetes during 1998 who lived in East Harlem. RESULTS: While most respondents (90%) said they know how to take their medicines, between 19% and 39% do not understand other aspects of their diabetes management. Many limit their diabetes care due to concerns about money (16% to 40%), and other barriers, such as language and transportation (19% to 22%). In multivariate analyses, Latinos (relative risk [RR] = 0.77; 95% confidence interval [95% CI] 0.63 to 0.91) and those who do not keep a diabetic diet due to concerns about money (RR = 0.85; 95% CI 0.70 to 0.99) had poorer health status. CONCLUSIONS: A community-based coalition was able to come together, identify areas of concern in diabetes care and assess the needs of adults with diabetes residing and obtaining care in East Harlem. The coalition found that even among those with access to care there remain significant financial barriers to good diabetes care, and a need to address and optimize how individuals with diabetes manage their disease

Breaking up time: negotiating the borders between present, past and future

This article sketches some of the recent evolutions in the study historical time. It proposes three issues that up to now have not received a lot of attention, but in our view deserve to be put on the research agenda. Three questions seem especially pertinent and urgent. First there is the question of how cultures in general and historians in particular distinguish ‘past’ from ‘present’ and ‘future’. We have a closer look at three historians as examples. Secondly, there is the question concerning the 'performative' character of temporal distinctions. Usually ‘the past’ is somehow supposed to ‘break off’ from ‘the present’ by itself, by its growing temporal ‘weight’ or distance – also in most philosophy of history. The article analyzes the distinguishing of the three temporal modes as a form of social action and proposes to regard the drawing of lines between the present and the past as a form of disciplinary ‘border patrol’ (Joan Scott). The third question concerns the political nature of the borders that separate these temporal dimensions. Following among others François Hartog we argue that time is not the entirely neutral medium that it is often believed to be, but that it is up to a certain degree, inherently ethical and political