Op-Ed for the World Health Day 2016

Diabetes is now a global problem requiring immediate attention

By Dr Dong-il Ahn, WHO Representative in Cambodia

PHNOM PENH, CAMBODIA, 07 April 2016 - One of the main goals of the World Health Day 2016 campaign is to create greater awareness about the rise of diabetes worldwide, and particularly in low- and middle-income countries. Diabetes is no longer a disease of predominantly rich nations. The disease has been on the rise everywhere, but the prevalence of diabetes has risen faster in low- and middle-income countries over the past decade than in high-income countries. This has prompted new commitments by the 194 WHO (World Health Organization) members states to pursue ambitious targets to reduce the four most common non-communicable diseases (NCDs). These include diabetes, cardiovascular disease, cancer, and chronic respiratory disease. The most recent of these commitments is the newly adopted Sustainable Development Goals (SDG) which are relevant and agreed targets by all countries worldwide. One of them is to reduce premature mortality from NCDs – including diabetes – by one third by 2030.

There is clear evidence that the burden of NCDs in Cambodia is increasing. Collectively diabetes, cardiovascular disease, cancer, and chronic respiratory disease caused 43% of deaths in Cambodia in 2014, up from 36% of all deaths in 2011, and this figure is projected to continue to rise. However, the reality on the ground for countries such as Cambodia is that they are still faced with a double burden from both communicable and non-communicable diseases. As of today, the prevalence of diabetes in Cambodia is still relatively low in comparison to many other countries around the world and in the Western Pacific Region. This has made the disease a relatively low priority for public health. There are recent signs among policy makers that this is changing, but it remains to be seen if change will come fast enough to avert the hard lessons being learned in other rapidly developing countries around the world. The greatest impact will only be realized by a two-pronged strategy. This includes supporting a rapid scale-e up of health sector services to provide early detection, treatment and essential medicines for those who already have the disease, and active engagement of non-health sectors of government, civil society, and people living with diabetes and their families. This is crucial in order to increase awareness and actions that can be taken for both the prevention and management of diabetes.

Understanding the disease itself and the main drivers behind its increase in the population is essential to formulation of strategies to address the problem. Diabetes occurs in three forms, including Type I (formerly called juvenile-onset diabetes) Type 2 (formerly called adult-onset diabetes) and gestational diabetes which can occur during pregnancy. In all types the manifestation of the disease is brought on by raised blood sugar (glucose), but the causes are complex, and varied with each type. Type 2 diabetes accounts for 90% of all diabetes worldwide. This type of diabetes is closely associated with lifestyle factors, such as lack of physical activity, unhealthy diet, and obesity. Cambodia’s rapid economic growth over the past decade is one of the contributing factors to these changes. Two examples are reduced physical activity due to increased use of motorized transport, and the rapid increase in the consumption of processed foods higher in total energy, sugar, salt and fats. These changes have been most evident in urban areas, as seen in results from the 2010 WHO STEPs Survey, which found the prevalence of diabetes was 2.4 times higher in urban than in rural populations (5.6% vs 2.3%), pointing to the need to design interventions specifically targeted to urban settings.

Another important feature of Type 2 diabetes is that while its symptoms are similar to those of Type 1 diabetes, these are often less marked or even absent for individuals with type 2 diabetes. Whereas a diagnosis for Type 1 diabetes is most often made due to the onset of acute symptoms, Type 2 diabetes may not be identified at an early stage unless picked up through appropriate screening at the primary care level. If left undetected, the disease is often not diagnosed until serious complications, such as damage to the heart, blood vessels, eyes, kidneys and nerves have already occurred. Delayed diagnosis and treatment of diabetes often impose catastrophic financial burdens for people with diabetes and their families due to out-of-pocket health-care payments, loss of family income associated with disability, and premature loss of life. Developing countries around the world are also discovering that diabetes-related health care costs are devastating for national health care budgets. The International Diabetes Federation (IDF) has estimated that total global health-care spending on diabetes more than tripled over the period 2003 to 2013.

No single policy or intervention alone will ensure success in meeting the SDG target to reduce premature mortality from NCDs. What is clear is that a whole-of-government and whole-of-society approach is needed. The World Health Organization is supporting both the development of a Multi-sectoral Action Plan for NCD Prevention and Control, and the development of early screening and diagnosis of diabetes at primary care level in Cambodia. Both will be needed to avoid the high cost that diabetes can cause to the nation and its people.

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