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Home » Diabetes, EU Health

Let’s take ownership of this public health challenge

Submitted by on 30 Sep 2016 – 15:59

We will never entirely eradicate diabesity, but we can at least prevent a large portion of it. Francesca Colombo, Head, OECD Health Division, says it’s time we took ownership of this public health challenge as a starting point

Public health experts call it “diabesity” – the rapidly rising prevalence of obesity and type 2 diabetes impeding efforts to reduce the global burden of cardiovascular disease. The failure of health systems to curb this new epidemic has led to the deaths and disability of millions of people. Much of this is highly preventable.

Every OECD (Organisation for Economic Co-operation and Development) country has become more obese in recent years. Across OECD, the proportion of obese adults rose from 15% to 18% between 2000 and 2013. The United States is home to the OECD’s most obese population, which comprises more than a third of adults in the country.

Obesity and a sedentary lifestyle are recognised risk factors for type 2 diabetes, that are inflating the prevalence of the disease. Globally, an estimated 415 million adults have diabetes. This is almost 9% of the world’s population. (1) The United States also has the OECD’s highest number of adults with diabetes, and is the world’s biggest spender on diabetes-related prevention and care. (1) These numbers are expected to swell further in the coming years, unless more decisive action is taken.

The health consequences of diabetes are many, and can be catastrophic. Among them are foot and leg amputation due to damaged nerves, loss of sight, and renal failure requiring highly invasive and costly interventions like dialysis and kidney transplantation. In pregnancy, poorly-managed gestational diabetes increases the risk of miscarriage, premature birth, foetal death and other complications. There are also economic costs.

In the United States, the total estimated cost of diagnosed diabetes was USD 245 billion in 2012, including USD 176 billion in direct medical costs and USD 69 billion in reduced productivity. (2) An OECD analysis shows there can also be labour market consequences, with diabetes associated with a lower probability of employment, lower wages, and lower labour productivity. (3)

One of the most common consequences of diabetes is cardiovascular disease, which persists as the leading cause of death in OECD countries, accounting for almost one-third of all deaths in 2013. The good news is that deaths caused by cardiovascular disease have been declining in most OECD countries. The frustrating news is that rising levels of obesity and diabetes are hampering our efforts to capitalise on this and achieve further mortality reductions.

If we are to get serious about addressing cardiovascular disease, we need to tackle the global burden of diabesity with urgency. A multi-faceted approach should combine hard regulatory measures with softer tools such as education and health promotion campaigns.

An OECD analysis suggests greater access to healthcare resources improves outcomes. (4) Strengthening primary care and enhancing the role of general practitioners and nurses in coordinating care pathways is fundamental to optimising the prevention, diagnosis and management of diabetes. Primary care also needs to be data-driven, to monitor patient care and performance, improve adherence to evidence-based care, and help gauge an understanding of variation in the quality of care. High out-of-pocket costs and poor education may deter the more disadvantaged from seeking necessary care, leading to deterioration and avoidable complications and more costly care later.

Some countries have experimented with a sugar tax and/or fat tax to reduce the prevalence of diabetes. These taxes serve the public health goal of reducing the consumption of food containing high content of sugar and fat. These taxes have a stronger effect on low-income groups, which stand to benefit the most due to higher prevalence of obesity and risk factors. However, such taxes may not have the intended effects if consumers divert their consumption to other unhealthy products. France, Hungary and Mexico are among the countries that have imposed such taxes to various degrees.(5) The United Kingdom is the latest country to announce a sugar tax on soft drinks.

Other policy measures governments have at their disposal include regulation of food advertising to children, and compulsory food labelling. Softer policy levers include incentives and education programmes to make healthier choices more appealing. A combination of policies is likely to be most effective in reducing diabesity.

It is often said that prevention is better than cure. Yet health systems remain obsessed with the cure. In times of economic austerity, it may be tempting for governments to make prevention the first casualty in health budgets, in the misguided belief that it is inconsequential compared with curative care. OECD data indicates that while the biggest target for health savings has been pharmaceuticals, prevention has not been immune. The OECD average annual growth rate of health spending for prevention was 5.6% between 2005 and 2009. However, this was followed by an average annual decline of 0.3% between 2009 and 2013. It is indeed a sizeable cut when considering that budgets for prevention are usually modest to begin with.

We will never entirely eradicate diabesity, but we can certainly try to prevent a large portion of it. All of us should take ownership of this public health challenge. As a starting point, think of the millions of deaths we could prevent if each person was armed with the tools they need to take better care of their own health.

References:
1. International Diabetes Federation (2015), IDF Diabetes Atlas – Seventh edition, 2015. http://www.diabetesatlas.org/
2. American Diabetes Association (2013), “Economic costs of Diabetes in the US in 2012”, Diabetes Care, 36(4):1033-1046. doi: 10.2337/dc12-2625
3. Devaux, M. and F. Sassi (2015), The Labour Market Impacts of Obesity, Smoking, Alcohol Use and Related Chronic Diseases, OECD Health Working Paper No. 86.
4. OECD (2015), Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD Publishing, Paris. doi: http://dx.doi.org/10.1787/9789264233010-en
5. OECD (2010), Obesity and the Economics of Prevention: Fit not Fat, OECD Publishing, Paris. doi: http://dx.doi.org/10.1787/9789264084865-en