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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 low-

and 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 for diabetes and non-

communicable diseases is denied to low 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 low-

and 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 non-

communicable 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 non-

communicable 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 or unusable in many low- and middle-income

countries.

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 non-

communicable 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.