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The UN Resolution on Diabetes: its impact and the need for implementation in the Commonwealth

Date: 23 Jul 2007
Author: Sir Michael Hirst, Vice President, International Diabetes Federation
Publication: Commonwealth Health Ministers Reference Book 2007

The Commonwealth, together with the rest of the world, is in the midst of a diabetes epidemic – prevalence rates are increasing in each member country. The recent adoption of a United Nations Resolution on Diabetes recognises this fact and calls on all 192 countries to take sustainable policy action in order to reverse this worrying trend. After such a significant step forward, the Commonwealth now faces the challenge of effectively implementing the Resolution. This paper outlines what the UN Resolution will do, how the Commonwealth countries will be affected, and the importance of building on the momentum of this Resolution by turning words into action.

On December 20th, 2006, the United Nations General Assembly took a significant step forward in the fight against diabetes by adopting a Resolution which recognises diabetes as a chronic, debilitating and costly disease associated with major complications that pose severe risks to the individual, society, and our economies. Governments set a precedent by acknowledging for the first time that a noncommunicable disease represents as serious a global threat as the infectious epidemics like HIV/AIDS.The adopted Resolution also marks the first time that the global diabetes community was brought together under one campaign – ‘Unite for Diabetes’. Led by the International Diabetes Federation, the coalition consisted of the world’s patient, professional and scientific diabetes societies, many charitable foundations and service organisations, and the pharmaceutical industry. Most importantly, the Resolution gave nations a mandate to take action to tackle the epidemic and to help the 246 million people who are currently living with diabetes around the globe.

The need for a UN Resolution

In recent years, communicable diseases such as HIV/AIDS have received considerable attention from the international community due to the depressingly high prevalence rates in developing countries. An obvious consequence of this focus is that other disease areas have become sidelined, as in the case of noncommunicable diseases like diabetes. However, there is now a clear recognition that the increase in noncommunicable diseases cannot be ignored and that appropriate action should be taken to tackle this growing threat to society.

Diabetes is often referred to as a one of the ’silent killers’ because awareness of the disease and its risks is so poor. However, such ignorance does not hide the alarming nature of the data from the World Health Organization (WHO) and the recently published IDF Global Diabetes Atlas (2006):

• There are 246 million people worldwide living with diabetes and, without action, by 2025 this total is expected to increase to 380 million people.
• Each year, another seven million people develop diabetes and more than three million people die from diabetes-related causes – this amounts to one death every 10 seconds.
• The complications of diabetes – primarily heart attack and stroke – kill many more, and it is currently estimated that more people die prematurely through diabetes than HIV, killing more and more people at an increasingly younger age.
• Diabetes is responsible for over a million amputations each year. It causes a large percentage of cataracts, and
  at least five per cent of worldwide blindness is due to diabetic retinal disease. It is also the largest cause of
  kidney failure in developed countries, leading to huge dialysis costs.
• The exponential growth of type 2 diabetes is affecting people at a much younger age; and in many developing
  countries, the growth of type 2 diabetes is adversely affecting the working population, in much the same way that HIV/AIDS has done.
• In 2007, the world is estimated to spend between US$215 billion and US$375 billion on the medical care
  costs of diabetes and its complications. Within a generation, these costs are expected to grow to between
  US$234 billion and a staggering US$411 billion.

These statistics speak for themselves but they set the context for why action is needed and why it merits attention at the highest level. Diabetes is often inaccurately reported as being a disease of the wealthy, but the evidence suggests otherwise, stating that by 2025, 80 per cent of all cases of diabetes will occur in low and middle-income countries.To compound this, those most affected by diabetes in developing countries are between 35 and 64 – an age group that should be economically active. This last point is a frightening consideration and the adoption of the UN Resolution is a clear recognition by governments that diabetes is a growing epidemic that threatens to overwhelm healthcare services and undermine economies worldwide – especially in developing countries.

The UN Resolution – what next?

The UN Resolution calls on all nations to develop national policies for the prevention, treatment and care of diabetes in line with sustainable development of their healthcare systems. It has also designated the current IDF World Diabetes Day, November 14th, as a United Nations Day to be observed every year starting in 2007.

An official UN day will raise awareness of the disease throughout the world. As a ‘silent epidemic’, it is crucial that the public is educated about the symptoms of the disease, and on the precautions that help to prevent type 2 diabetes, such as living healthier lifestyles. However, raising awareness can only be one part of the strategy, and it will be the policy measures taken by national governments that will really mark the progress made in each country.The UN has made all its relevant agencies available to help member states; and this is needed.

Recent studies carried out in Zambia, Mali and Mozambique highlight a stark reality: a person requiring insulin for urvival in Zambia will live an average of 11 years; a person in Mali can expect to live for 30 months; in Mozambique a person requiring insulin will be dead within 12 months. If the Millennium Development Goals are ever to be realised, it will be through sustainable polices and the creation of national infrastructures aimed at helping those who need it most.

The Commonwealth community

The important role played by Commonwealth members in securing this Resolution cannot be overstated.The
diabetes community pays tribute to Bangladesh for offering its support for the initiative from the outset and for sponsoring the draft resolution until it was accepted by the G77, the coalition of 133 developing and transitional
countries at the UN led by the Republic of South Africa. The ownership by this majority voting bloc convinced the
countries of the developed world to throw their support behind the Resolution, approval being by consensus.
The Commonwealth is a leading example of a large group of nations working together with diverse backgrounds. Unfortunately, one of the common bonds among the low-, middle- and high-income economies, is the alarmingly high prevalence rates of diabetes in all 53 countries. Consider Figure 1, which shows the prevalence rates in each Commonwealth country.These statistics are disturbing as they show a dramatic increase from previous data and point to a future where increasingly high numbers of 20-79 year olds will be affected by the disease. For sheer numbers, India, by 2025, will have nearly 70 million diabetes patients aged between 20 and 79 years of age; Pakistan will have nearly 12 million. By 2025, 20 members of the Commonwealth are predicted to have double-figure percentage prevalence rates, with Nauru having an astonishing 33 per cent and Singapore with just over 17 per cent – but none of these figures have taken account of the prevalence of diabetes in children. Looking at the figures provided, it becomes clear that diabetes is far from being a disease of the wealthy. By 2025, seven of the ten countries in the world with the highest prevalence rates for diabetes will be developing countries and this disease is known to hit the poor hardest. In the poorest countries, people living with diabetes and their families bear almost the entire cost of whatever medical care they can afford because many countries still lack an adequate healthcare infrastructure. In India, the poorest individuals with diabetes spend an average of 25 percent of their income on private health care. Most of this money is used to stay alive by avoiding fatally high levels of blood sugar.

Despite the diverse backgrounds of the 53 members of the Commonwealth, the organisation has shown that it
can work together to tackle major issues. Diabetes has become a priority and now, more so than ever, there
needs to be a willingness to work together to confront this disease. Just as the Commonwealth led on the issue
at the UN, it should do so again by ensuring that the appropriate infrastructures are progressively put in place
at a national level. At an international level, the Commonwealth should use its collective influence to
secure much greater priority among UN agencies like WHO for an increase in the resources necessary to build
healthcare capacity to cope more effectively with diabetes. In the European Union (EU), the European
Council of Ministers adopted a set of Conclusions on type 2 diabetes that called for a sharing of information
on prevalence rates and the different types of policy initiatives. Similar monitoring activities should be
established within the Commonwealth.

Raising the standard

This brings us to the effective implementation of the UN Resolution. Increasing levels of awareness on the
existence of diabetes and making true progress in preventing, diagnosing and managing the disease will take time, but the UN Resolution has given a mandate to all 192 member countries to take affirmative action. In this context and looking ahead, while it is of enormous importance that a UN Resolution on diabetes has been adopted, it will be in the implementation that its significance will be judged. Momentum has now been created and this must be capitalised upon before other issues start to limit the resources that must be made available to tackle the disease of diabetes.

The World Health Organization will play a fundamental role in the successful implementation of the Resolution. It will have to take a lead in tackling diabetes by ensuring that the necessary resources are made available to poorer nations and by helping to facilitate sustainable policy-decisions. In the past, the WHO – through no fault of its own but due to funding constraints – has been found wanting, with less than three per cent of its total budget being allocated to fighting non-communicable diseases and with limited human resources to support these efforts. The fact that diabetes is now a priority health issue requires an appropriate response from WHO to make a significant increase to the resources (both human and financial) for non-communicable diseases, and in particular diabetes. WHO has indicated that changes will be made and the global diabetes community looks forward to developing a constructive and active working relationship to ensure that this becomes a reality.

The global diabetes community does not however look to WHO to be the sole agency for tackling the pandemic. Much can be done to enhance diabetes services in the developing world through exchange of knowledge and best practice, and training support. An example of a successful training support arrangement was the initiative by a British team, supported by the World Diabetes Foundation, to train nurse specialists in diabetes in Sri Lanka. Facilitated by the Sri Lankan Diabetes Association and with the co-operation of the Sri Lankan Health Ministry, training was provided to at least one nurse from every hospital in Sri Lanka, with subsequent refresher and update courses provided by web-based education. In this way, at relatively low cost, training can be provided to developing countries. In mentioning the activities of the EU, a standard has been set which the Commonwealth is able to replicate. The sharing of best practice in all policy areas that affect diabetes would be a significant starting place. As with many of the non-communicable diseases, living a healthier lifestyle by exercising regularly, eating a balanced diet and not smoking will have a positive effect on a person’s health. Policies designed to encourage such activities range, for example, from better town planning to encourage people to walk, to an effective screening process for those population groups most at risk. At the same time, an audit should be done on the infrastructure available for tackling diabetes in all UN member states and a frank assessment made on what can be done to improve the situation in each country. The diabetes community, led by IDF, is more than willing to help monitor the progress of the UN members in tackling the disease and to share this information with the wider community. It already does this in part through the Diabetes Atlas, which publishes the global prevalence figures; and IDF is committed to doing what is necessary to support the diabetes cause. Only by collecting such information can the international community determine where resources are plentiful, stretched or non-existent, allowing global health policymakers to adapt their decisions accordingly. Aware of the impact which the Global Funds for HIV/AIDS, Malaria and Tuberculosis have had to drive effective action on these diseases, and acknowledging the huge challenge of tackling diabetes effectively, IDF is now undertaking a feasibility study of a Global Fund for Diabetes. This work is at a very early stage and the outcome is uncertain, but it does confirm the seriousness of IDF as the global diabetes organisation to ensure that action will match the words of the UN Resolution.

Resources and cooperation

The economic costs of diabetes challenge the achievement of the Millennium Development Goals. The healthcare costs of diabetes are enormous and cgrowing but so too are the consequential costs ofpeople of working age succumbing to diabetes and its complications, and being unable thereby to contribute to the economy.The support of the 53 Commonwealth members was essential in raising this issue, leading to the adoption of a UN Resolution on diabetes. It is clear that all countries of the Commonwealth face the same diabetes epidemic and the urgent need to reduce prevalence rates of the disease. For this to happen and to build upon the celebrations of December 20th, 2006, the most important part of the campaign is to focus on the effective implementation of the Resolution. It means that the WHO must devote the necessary resources to be at the forefront of activities. It means too that UN member countries and the global diabetes community must work together to make sustainable progress in raising awareness, and in parallel developing policies that improve the prevention, diagnosis and management of the disease.Today, there are 250 million reasons why action must be taken now in all UN member countries; and by working together we may yet avoid there being 350 million in 2025. Sir Michael Hirst was elected Vice President of the International Diabetes Federation at the Cape Town Congress in December 2006. He was previously deputy chairman of the International Steering Group for the UN Resolution project. Sir Michael has had an interest in diabetes since his youngest child was diagnosed at the age of five with type 1 diabetes twenty years ago.Then a Member of the British Parliament, he campaigned for improved care and treatment of those with diabetes. He became a trustee of Diabetes UK, Europe’s largest patient organisation, and was its first non-medical chairman from 2001 to 2006.

The International Diabetes Federation (IDF) is a worldwide alliance of 200 diabetes associations in 158 countries, who have come together to enhance the lives of people with diabetes everywhere. For over 50 years, IDF has been at the vanguard of global diabetes advocacy.The Federation is committed to raising global awareness of diabetes, promoting appropriate diabetes care and prevention, and encouraging activities towards finding a cure for the different types of diabetes.

International Diabetes Federation (IDF)
Avenue Emile De Mot 19, B-1000 Brussels
Belgium
Tel: +32 2 538 5511 Fax: +32 2 538 5114
Email: info@idf.org
Website: http://www.idf.org/

Private office:

Sir Michael Hirst
4 Eyre Place, Edinburgh EH3 5EP, Scotland
UK
Tel : +44 (0)131 556 0770 Fax: +44 (0)131 558 9463
Email: michael.hirst@pagodapr.com

 

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