Why do we need to beat Diabetes?

Counties Manukau is experiencing a growing epidemic of diabetes. Currently there are more than 27,000 people in Counties Manukau diagnosed with diabetes and an additional significant number undiagnosed within Counties Manukau.

Globally and locally the prevalence rate of diabetes is increasing annually.

A disturbing feature of this epidemic is that it is no longer ‘contained’ to people aged between 40 and 64 years of age. The number of young people being diagnosed with Type 2 diabetes, while still small, is increasing. Children as young as 6 years old are now being diagnosed with Type 2 diabetes. Mothers with gestational diabetes or pre-diabetic conditions may be passing on an increased risk of diabetes to the unborn child. With more women in the childbearing age group at risk of diabetes, the risk to future generations is increasing.

Diabetes is also a major driver of health sector costs within both primary and secondary care. It is estimated that a person with diabetes generates hospital costs on average 2.5 times as much as someone without diabetes – and that the indirect costs are as much again (PriceWaterhouseCoopers, 2001). In 2008 it has been estimated that Diabetes costs the Counties Manukau District Health Board 57 million dollars each year. It is also estimated that as the number of patients with kidney failure grows (primarily due to the increasing number of diabetics and an ageing population), the need for new dialysis stations will grow at a level that within five years, a new satellite clinic with 20 dialysis stations would be required every year to keep up with demand (Ratanjee, 2004).

The cost of diabetes to the family and community is also significant and immeasurable. Diabetes robs us of our elders and the cultural richness and wisdom they bring to our society. With the increasing prevalence of diabetes moving down the age-spectrum, it is beginning to rob us of our future.

A major change to the health sector and our broader society is required to stop the diabetes epidemic. The Let's Beat Diabetes Programme is the catalyst for this change.

The Let's Beat Diabetes Programme

In February 2005, the Board of Counties Manukau District Health Board (CMDHB) endorsed the draft Let’s Beat Diabetes : A Five Year Plan to Prevent and Manage Type 2 Diabetes in Counties Manukau and a funding envelope of $10 million over five years to support its implementation. This funding provides the base funding for Lets Beat Diabetes (LBD) but importantly the Programme is supported by funding and resources from partner organisations.

LBD is now in year three of a five year, district wide strategy aimed at long-term, sustainable change to prevent or delay the onset of diabetes, slow disease progression and increase the quality of life for people with diabetes in Counties Manukau. There is a significant amount of activity that exists to prevent and manage diabetes. The role of LBD is to create a long term vision to align existing activity and provide a context for new investment, based on evidence and best practice. Fundamental to the plan is the principle adopted by LBD to utilise the “whole society, whole life course-whole family/whanau’ approach to preventing and managing diabetes. Annual operational plans outline the interventions/initiatives that will be implemented by CMDHB and the partner organisations in order to achieve the long-term outcomes identified in LBD: A Five Year Plan.

Strategic Approach

A range of interventions/initiatives are proposed in the LBD: A Five Year Plan and Operational Plan 2005/2006, guided by the concept that a ‘whole society, whole life course, whole family/whanau’ approach is required to beat diabetes, and that focused effort will need to be sustained over decades.

• Whole society – Acknowledgment that we cannot beat diabetes without the motivation and support of the communities, institutions and businesses that make up the social fabric of Counties Manukau.
• Whole life course – A focus on supporting health and preventing and managing diabetes at all stages of disease progression.
• Whole family/whanau – Acknowledgment that an individual is part of a family/whanau (or household) which has a direct influence on environmental risks, choices and decisions. Wherever possible, working with families is central to the plan.

Guiding Principles

The principles of Partnership, Participation and Protection form the constitutional foundations of New Zealand through the Treaty of Waitangi. These principles are also fundamental to the practice of modern public health.

• Partnership – Institutions, organisations, communities, families and individuals must work together to beat diabetes. The scale of social response required for diabetes means that formal partnerships based on aligned goals and civic responsibilities will need to be developed and actively sustained.
• Participation – The prevention and control of chronic disease is enabled through self management and via the ongoing participation of family, community and health professionals in the lives of people with diabetes. Also, for strategies to be successful, families and communities must be able to participate in service design, development and governance.
• Protection – The current diabetes epidemic has been created by a new environment of obesity. The ‘obesogenic environment’ is a threat to the health and wellbeing of our children and families. There is an obligation on behalf of government, business and community leadership to protect citizens from this environmental hazard.

Enablers

Eight enablers underpin the Let's Beat Diabetes plans to ensure they can be implemented in a sustainable manner. They are:

• Increased consumer involvement
• Maori as a priority
• Pacific peoples as a priority
• Aligned funding environment
• Learning and evaluation
• Sustainable governance
• Supported organisational development
• Improved information systems