Letting the Young Lead
An innovative California program seeks to wipe out type 2 diabetes in young people via poetry and activism.
How one program empowers young people through poetry
Eddy Tumbokon weighed 13.3 pounds when he was born in Makati, Philippines. By age 16, a decade after his family had immigrated to Los Angeles, he weighed 260. That’s when he attended a spoken-word poetry workshop put on by The Bigger Picture, a program determined to shift the conversation around diabetes. His mother’s gestational diabetes had led to her type 2, which inspired him to write “Big Boy”: And for as long as I can remember
I have always been a big boy
Never known what skinny felt like
Never known what it was like to not look in the mirror and see deadweight To not hold my mother down
In a spoken-word music video of “Big Boy,” produced by The Bigger Picture, Eddy speaks directly to the camera, a low-key hip-hop beat in the background. The video cuts from real-life Eddy to scenes of actors re-creating his childhood and depicting his mother, Maria Rowena Tumbokon, struggling to manage her diabetes. Together his words, the music, and the reenacted scenes make a powerful connection between Eddy’s environment and his health.
The Bigger Picture, which to date has made over two dozen short films of young poets exploring their risk of diabetes, encourages this connection. The program uses spoken-word poetry to connect with young people on an emotional level, and to call out the societal root causes of the type 2 diabetes epidemic. It’s a novel approach, and one that might not exist were it not for an open-minded doctor searching for some outside-the-box ideas.
HEALTH POLICY THROUGH POETRY
In 2011, Dean Schillinger, M.D., was director of the California Department of Public Health’s Diabetes Prevention and Control Program. His goal was to slow the increase in new cases of type 2 diabetes, which had more than quadrupled in the last quarter of the 20th century. “The epidemic proceeded despite me, quite vigorously,” he says. In 2008, when he started his term, 18.8 million Americans had been diagnosed with diabetes. By 2011, that number had leapt to 20.7 million. Ninety-five percent of those cases were estimated to be type 2. Schillinger had seen this kind of rapid growth before—when he was at San Francisco General Hospital in the 1990s, the city was the epicenter of the AIDS epidemic. But unlike the AIDS crisis, which subsided in the U.S. within 25 years, the diabetes epidemic shows no sign of slowing down.
Frustrated by a lack of progress, Schillinger sought a way to help people understand the gravity of the situation. One night he attended a fundraiser for the San Francisco-based organization Youth Speaks, which helps young people to find their voices through the spoken word. Sixteen-year-old Erica McMath Sheppard performed a powerful poem about her weight and how diabetes had devastated her family. “It showed me how art, as told through the authentic voice of a young person of color, can just flip the switch,” Schillinger says.
He and James Kass, then the director of Youth Speaks, devised a workshop for young poets run by Youth Speaks and the UCSF Center for Vulnerable Populations (CVP), which Schillinger founded and where he now directs the Health Communications Research Program. They called it The Bigger Picture. Its goal was twofold: to use spoken-word poetry and video to help young people—particularly young people of color—understand how environments and social conditions can create a path to diabetes, and to transform those young people into active agents of change. The initial, weeklong pilot workshop with eight poets from Youth Speaks soon led to a full-fledged campaign.
STOPPING “SHAME AND BLAME”
“At workshops we’ll show a map of San Francisco and we’ll say, ‘Why are there no grocery stores in this part of town? Why are diabetes rates so much higher in areas that have more people of color and more people who are low-income? What’s going on here?’” says Sarah Fine of CVP, The Bigger Picture’s campaign director. Physicians and health communications professionals from CVP lead these initial discussions, to encourage the young poets to see the “bigger picture”—that type 2 diabetes can’t be blamed on individual choices when someone’s actions—say, where they shop or what foods they buy—are more a product of their surroundings and their income level. “The way you can actually influence behavior in young people is not by telling them what to do,” says
Fine. “It’s about harnessing their values and defiance for social justice and civic engagement.”
Over the course of five two-hour sessions, teenage participants learn about type 2 diabetes and work with Youth Speaks mentors—poets from local communities—to craft compelling, personal verse. The most potent poems are turned into polished, spoken-word videos set to music by Jamie DeWolf, a filmmaker associated with Youth Speaks. The poet appears in the video, and often their family members and neighborhoods, even their homes, are featured as well. (You can see them all at TheBiggerPictureProject.org.)
“The idea of the videos is that we’re engaging young people in the way that they’re used to digesting information,” says Brandon Santiago, Youth Speaks program director. “It’s helping young people specifically share their story around type 2 diabetes.” Each film pairs the poetry performance with visceral, illuminating visuals, turning the poets into influencers and educators for their peers. The Bigger Picture takes those videos—and often the poets themselves—into high schools, where they form the heart of assemblies about type 2 diabetes for hundreds of students at a time. Then 15 to 20 students who attended each school’s assembly participate in workshops, and the activism spreads.
“Talking about real experiences in a poem
just strikes people differently, especially young people,” says Ciera-Jevae Gordon, one of Youth Speaks’ poet mentors. “We don’t have enough town hall meetings that say, ‘What are the young folks thinking?’ But when it comes to poetry, everyone wants to hear.”
In 2016, The Bigger Picture expanded to seven other California regions hit hard by diabetes, working with Youth Speaks’ sister organizations. That’s when Eddy Tumbokon became involved. Workshops and poetry slams—performance competitions—were held in each area. That June, eight poets participated in The Bigger Picture Showcase, a poetry slam in Berkeley. Tumbokon’s piece, “Big Boy,” was the statewide winner.
For Tumbokon, participating in The Bigger Picture has been life-changing. Since learning about how his environment was shaping his diet, he’s pushed back, and in the process lost 100 pounds. Now a sophomore at Oberlin College in Ohio, he’s devoting his studies to public health issues and doing volunteer work in the health sector. He’s performed “Big Boy” for notables in public health including Kathleen Sebelius, who served as secretary of Health and Human Services during the Obama administration. “Honestly, all of my life aspiration right now is due to The Bigger Picture,” he says. The experience has changed his mom, Maria Rowena, too. “There’s always a fear with immigrants to go to the doctor—it’s a fear of deportation, of medical bills. But after the workshops there was an intense need on my end to push my mom to see health professionals,” he says. She is finally getting some help for her disease.
Rose Bergmann and Liliana Perez’s poem, “Monster,” was a runner-up in Berkeley. Both girls’ fathers rely on sugar-heavy energy drinks to get through their long workdays, so they wrote the poem together. Participating in The Bigger Picture made the girls recognize the risk their fathers were taking. “I realized that was his vice,” says Bergmann, who was 16 at the time. “That was what was going to get him.” The video for “Monster” ends with Bergmann’s father, Michael— portraying himself—waking up in a cemetery, dazed and confused. “Obviously, you would never want that for someone that’s so close to you and is so important in your life,” she says. Hearing his daughter’s poem and performing in her video changed his behavior: Rose has rarely seen her father with an energy drink in the last two years.
CHANGING THE CULTURE
When The Bigger Picture launched, the goal was to shift the blame for the type 2 diabetes epidemic away from individuals. The organizers wanted to help young people call attention to the environmental, social, and economic factors that leave people with little choice but to lead unhealthy lives, in order to motivate their communities to advocate for change.
“Type 2 diabetes at a disproportionate rate affects black and brown young people. But black and brown young people are never at the table when we’re talking about type 2 diabetes,” says Santiago. “So our initial tagline was Join the Conversation.” With this program, things are changing: so far more than 10,000 students have attended assemblies; the 27 videos have amassed more than 1.5 million views; and three county health departments in California have adopted the program.
The young poets have been involved in campaigns for a soda tax and fresh water stations, and they’ve performed at gatherings of movers and shakers in the health care industry. The program created an advocacy handbook for teens called The Pathways to Policy Playbook, which is downloadable for free on the website. “The Bigger Picture project created a whole cohort of teen activists who now have public health in mind, all over California,” says Tumbokon.
Based on these promising results, The Bigger Picture is expanding the goal. “We want to end type 2 diabetes in young people,” Schillinger says. “If we can do that by changing environments, policies, and social norms, I guarantee it will help older people too.” The program is embarking on a long-term project, where they’ll spend two to three years working in a handful of schools to reshape the local culture. “We want to make it cool to not eat Doritos and drink Coke for lunch, to activate more young people to become engaged,” he says.
Poet-mentor Gordon sums up the plan succinctly: “This is important and we’re going to be extremely loud about it until there’s change happening.”
A still of Liliana Perez & Rose Bergmann from a Youth Speaks spoken-word video created by filmmaker Jamie DeWolf.
Dean Schillinger, M.D., cofounder of The Bigger Picture
Brandon Santiago, Youth Speaks program director