From yesterday to tomorrow: making a difference to global diabetes

Date: 22 October, 2009 Speaker: Jean Claude Mbanya, President, International Diabetes Federation Location: World Diabetes Congress, Montreal

Distinguished guests, ladies and gentlemen, Eyamo Zang Alexandre did not choose to be born in Cameroon. He did not choose to have type 1 diabetes. He did not choose to be a street child either. Motherless since the age of six, Eyamo was left by his father and relatives to fend for himself when the cost of his diabetes care became too heavy a burden to bear. One night in his own home, Eyamo fell into a coma. He was hungry but there was no food in the house. Eyamo did not wake from his coma; he was only 16. We are here today because of Eyamo and the millions like him. As we meet in this comfortable auditorium at the end of the 20th World Diabetes Congress, buzzing with ideas and energy, a battle is being waged in the outside world. The numbers indicate that we are on the cusp of losing the battle to contain diabetes. Diabetes will kill four million people in the coming year. This puts a heavy responsibility on my shoulders as the new president of the International Diabetes Federation. I will need all your help.

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The numbers are alarming. The latest edition of the IDF Diabetes Atlas—released in this venue just three days ago— gave us the dismal news that some 285 million people live with diabetes today. Low and middle-income countries continue to bear the brunt of the disease. Soon, 4 out of every 5 people with diabetes will live in developing countries. And the men and women most affected are of working age – the breadwinners of their families. In two decades, the total number of people with diabetes is likely to swell to nearly 440 million!... to put that in context, that’s more people than the current population of North America. Despite the growing numbers, people newly diagnosed with

diabetes can find themselves alone on a path that can lead them towards crippling complications, depression, poor mental health and early death. We will need to increase awareness and deliver health education to make sure that diabetes is detected early and to make sure that the newly diagnosed are guided along a path of treatment and informed self-care that empowers them to avoid or delay the potentially devastating consequences of the disease. We need to provide guidance that will help alleviate the stress of dealing with diabetes and help people develop the coping skills to travel the diabetes journey, whatever it may bring, and we need to let them know that they are not alone. We will need to make sure that appropriate care is available to all people with diabetes. And we will need to make sure that more
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evidence-based diabetes education is available so that people with diabetes play an informed and central role in their own care. If we can deliver on the promise to put diabetes care and education within reach, we will have gone far. Regretfully, however, we will need to do more. We will need to expand our remit to the area of health promotion. With millions more people developing diabetes and with no guarantee that the total funding available for global health will be expanded sufficiently to meet the growing need, we have to be more active in prevention. We will need to stop people before they start the diabetes journey. We have to act early before people develop the disease. This will be a huge challenge. Affecting the required behavioural change and creating healthy environments will require unparalleled cross-sector collaboration. We will need to overcome powerful social, cultural and market forces to make sure that healthy life choices are available and affordable. But beyond that we will need to break through the paradox that leaves many of us knowing what the healthy choice should be, but making the less healthy choice regardless. The marketing machine that is driving the epidemic of type 2 diabetes and other non-communicable diseases is committed to a full frontal assault on all our senses.

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The compelling images of consumerism are a constant attraction. Advertising jingles make up the soundtrack to our lives. Indeed, it often seems that the marketers of calorific excess have all the best tunes and have learned to speak in a seductive voice that promises fun and attainable freedom. Unhealthy is delivered well-packaged, straight to your door, every time, at a price that you can afford. Unhealthy has fast become an incredibly successful, global brand. It will not be easy to fight these forces, but it is a battle that we will all have to fight. The choice is simple. Either we spend all our time mopping the floor, or we get up and turn off the tap. Earlier this year, the United Nations Secretary-General Ban ki-moon declared that diabetes and other non-communicable diseases now present a greater threat than infectious diseases such as HIV/AIDS, malaria and tuberculosis. The UN Secretary General described the situation as … “a public health emergency in slow motion”. Turning around the diabetes epidemic will not be easy; it will not happen overnight. Governments, civil society and international organizations must intervene now with preventive and cost-effective measures if people with diabetes and those at risk are to have a better tomorrow. Treatment and technology currently exist for people with diabetes to manage their disease successfully and enable them to lead full, productive lives. Yet, the reality is that, for millions of people with diabetes, modern treatment and technology is but a dream, and the

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right to live a full life has been denied through ignorance, lack of resources and education, and inadequate health infrastructure. Indeed, in my part of the world, the economic burden of having a child with diabetes is such that families prefer the child to die so that other members of the family may live. The world cannot afford to lose the battle against diabetes. As I speak, parents are losing children, children are losing mothers, families are losing breadwinners. Much of this tragic loss of life is preventable. If losses on this scale were occurring in a military conflict, the international community would react swiftly. But sadly, there does not seem to be the same sense of urgency in the battle against diabetes.

No country is immune to diabetes and no country has all the answers to this common enemy that we confront. No country has yet managed to reverse the trend of rising prevalence. Defeating diabetes will take every ounce of commitment and ingenuity that we can summon. It is time to think creatively and to break down old paradigms. Studies show increasingly strong linkages between diabetes and many other diseases, such as heart disease, tuberculosis and HIV/AIDS. The way forward is to address the common challenges together of optimal healthcare, low-cost treatment, access to care and medications, and improved training and education. Further investment in the health of our children and grandchildren will bring greater political, economic and social security in many countries.

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I would like to pause here to pay tribute to the groundbreaking work of outgoing IDF President Martin Silink, my colleagues who have served with me on the IDF Board of Management and Executive Board over the past triennium, and the numerous individual champions within the IDF family who have given us such a legacy to build on. When we met in Cape Town at the last World Diabetes Congress in 2006, UN Resolution 61/225 on diabetes had not yet been passed. Old timers in the international system shook their heads and said we would never get a UN Resolution on diabetes. It was too political—or not political enough. Diabetes was just not a global priority. But together we changed that and under Martin Silink’s inspired leadership went on to achieve the adoption of a UN Resolution on diabetes in just 11 months. If you don’t know Martin, then you should know that beneath his quiet and polite exterior lies a determination of steel. When one path to the UN Resolution was closed to him, he found another. When a barrier was erected, he broke through it. Ladies and gentlemen, please join me in applauding the work of our colleagues, in particular our inspiring leader during the last triennium, Prof Martin Silink. Under Martin’s leadership, we secured UN Resolution 61/225. It laid the foundation for global change and gives us our mandate in the coming years. Our task is to ensure that the political promise made by the world’s governments becomes a reality for all the men, women and children living with diabetes.
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Looking forward, I believe that the coming triennium will be as significant for diabetes as the last. Building on the UN Resolution, we will continue the good work we are doing in successful programmes such as our Life For A Child program that supports the care of children with type 1 diabetes in 19 countries. The program meets the children's immediate needs - insulin, syringes, monitoring and education. It builds local capacity and lobbies governments to establish sustainable solutions. We have already begun the process of expanding this programme to bring care and life to thousands more children around the world. Today, the International Diabetes Federation continues to advocate for several specific demands at global level. We are strengthening our alliances with international organizations representing heart disease and cancer, forging new ones and leading the way in global advocacy. We have joined together this year with our sister federations—the World Heart Federation and the International Union Against Cancer—to call for a United Nations General Assembly Special Session on non-communicable diseases. Such a session would build on the foundation laid by UN Resolution 61/225 and help kick start the political momentum we need to turn promises into action. We see this alliance as adding to the voice of the diabetes community in support of our common objectives. Together, the three federations represent 730 national member associations in over 170 countries—now that, ladies and gentlemen, really is ‘people power’.
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IDF supports the WHO Non-communicable Diseases Action Plan, 2008-2013, which recognizes diabetes as a development issue. Policy-makers have to understand that the economic, social and human burden of the diabetes epidemic has already shifted to lowand middle-income countries and will begin to reverse gains in prosperity and health in those countries. The IDF Diabetes Atlas highlights the evidence that shows that diabetes does not distinguish between rich and poor; that it is not a disease of just the elderly; and that in many cases it can be prevented. We have always given our full support to the UN Millennium Development Goals, which include targets for maternal and child health. But we ask that those goals be taken seriously and not literally. Right now, much-needed funding to for low diabetes and non-

communicable

diseases is denied

and middle-income

countries because the word ‘diabetes’ is not mentioned in these goals. There are indications, however, that this is changing. We have called for the 2010 review of the Millennium Development Goals to consider adding an indicator for non-communicable diseases. This call was supported two months ago in a formal declaration made by Heads of States in the Caribbean. Momentum is growing. We have called for the international community to allocate funding urgently to diabetes and other non-communicable diseases in lowand middle-income countries. A first step must be to fund essential medicines and technologies for diabetes.

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Most of the essential medicines needed are off-patent and cost just pennies to produce. Funding essential medicines for noncommunicable diseases need not be expensive and can literally save millions of lives and save millions from serious complications. Again, we have seen support growing for this very recently. I believe that some international agencies have recognized the need to win the battle against diabetes and that within this triennium we will see the beginning of a shift in funding for diabetes and noncommunicable diseases and an increase in spending on global health. And an increase in spending is indeed required. If we look at how much is currently invested in health, we see that a significant number of countries invest very little in the health of their population. This puts a particular responsibility on all of us. For years we have argued that funding should be provided for diabetes. If and when that funding becomes available, we need to ensure that it is well used and reaches the people who need it most. We can learn important lessons from HIV/AIDS. When funding for HIV/AIDS medications became available, many countries were not ready. We saw examples of medicines stored away in warehouses in capital cities as people died in rural areas. We need to be ready for the day when funding becomes available for people with diabetes in low resource settings. We will need affordable and accessible technologies to deliver those medicines effectively. Many of the diagnostic and monitoring technologies developed in high-income countries are either

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unaffordable countries.

or

unusable

in

many

low-

and

middle-income

While there has been innovation—like solar-powered blood pressure meters and refrigerators—much more innovation is needed to either adapt existing technologies or develop new ones that would be both affordable and accessible in different settings. We also need to be ready with effective models for delivering diabetes care, education and prevention. The power of a federation is that we can learn from one another. We already have programmes in place in IDF to facilitate such learning and, of course, the World Diabetes Congress enables the diabetes community to network and share experiences. But we can do more. In the next triennium, we intend to strengthen the relationship between the IDF Executive Office, our regions and member associations. Effective models of diabetes prevention, education and

management are being developed in all parts of the world, in countries rich and poor. Good practice can come from anywhere and it is the job of our Federation to make that knowledge accessible to all. We also know from the AIDS experience that it is possible to distort health systems by funding one particular disease and not others. Martin Silink tells the story of a man he met in Cambodia who told him, “I wish I had AIDS and not diabetes.”

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The man made that remarkable statement because there was a state-of-the-art clinic funded by international money in his area with free treatment for HIV/AIDS patients but no treatment facility for diabetes. Disproportionate funding distorts health systems. If we look, for example, at the World Health Organization’s budget for 2008 to 2009 we see a picture of disproportionate allocation of funds. Here in the WHO budget, we see that all NCDs receive a fraction of the money available to address the infectious diseases. And this funding is shared between NCDs, mental health and injuries. This imbalance in the funding is a story that is repeated across health budgets worldwide. It is a scenario that plays to the detriment of an integrated and coordinated response to global health. At IDF, we are therefore asking for diabetes and the other noncommunicable diseases to be integrated into existing health systems, particularly at the primary care level. This makes economic sense and is based on the principle that the health system should treat the whole person, often with multiple conditions, and not compartmentalize treatment by disease. In addition, resources within a health system should not be perceived as being in competition between non-communicable and communicable diseases. The objective should be for all of us to work across the board to develop a health system that can offer optimal care to all those who
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need it. Our aim is to achieve sustainable health systems as called for in United Nations Resolution 61/225, and to catalyse funding that is committed to helping health systems develop sustainable, cost-effective measures for prevention and care. We know from many studies that certain social and ethnic groups will be the hardest to reach with programmes for both treatment and prevention. In each society, we cannot be effective unless we understand the social determinants of health and access to healthcare. In the next triennium, IDF will be looking explicitly at these issues, including discrimination against people with diabetes, depression and mental health in diabetes, and the rights of people with diabetes. This will strengthen the moral foundations for our work. IDF policy and strategy will centre on the person with diabetes, and those at risk. The success of our work must be measured by an improved quality of life for the person with diabetes. Our history has seen us grow in strength and become a thriving Federation of more than 220 diabetes associations in more than 160 countries and territories. In the next three years, we must strengthen our regional structure. We must help our regions to drive programmes that will develop and equip member associations to be powerful advocates and equal partners in building sustainable and effective health systems in their countries.

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IDF will work harder with our current partners and enlist new and non-traditional partners to further national, regional and global advocacy. We must work in partnership to improve the quality of life of people with diabetes everywhere and to combat the rising prevalence of diabetes. Our Federation has an obligation as the global advocate for people with diabetes to ensure that no child should die of diabetes from lack of insulin, that no person should suffer needlessly from complications such as the diabetic foot because of the lack of proper care and medication, and that no family should carry the heavy financial burden of the disease from lack of resources. Many of our member associations represent people with diabetes and I predict this trend will continue. Our 221 national member associations represent over two million individual members—an impressive number, but still small compared to the 285 million people with diabetes today. We need to focus on bringing more people with diabetes into our IDF movement so that we remain truly representative of the people we speak for. Our Federation rests on the strength of its member associations and the partnerships we can forge. In less than a month, monuments around the globe will light up in blue as part of our World Diabetes Day campaign. Here we take grassroots community action to a global platform. As President of the International Diabetes Federation, I am prepared to lead but I am also ready to listen and learn. I thank my
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powerhouse, my pillar of support, my friend and my spouse, Dora; our four children and our families for being there for me. When I look around this auditorium and see people wearing the blue circle pin, I feel proud to be part of global movement that is ‘uniting for diabetes’. I hope we will all leave Montreal energized and ready for the challenges ahead. We have to act together to ensure that accidents of geography and history do not determine who should live or die. We have to act today to make a difference for people with diabetes tomorrow. For many, that day cannot come soon enough. It is time to remember Eyamo Zang Alexandre. It is time to reverse the epidemic of diabetes. And that, ladies and gentleman, would be the greatest gift we could give to our children. God bless you. Thank you.

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