Let­ting the Young Lead

An in­no­va­tive Cal­i­for­nia pro­gram seeks to wipe out type 2 di­a­betes in young peo­ple via po­etry and ac­tivism.

Diabetic Living (USA) - - Contents - WRIT­ING DEB­BIE KOENIG

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.


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.


“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.


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

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