{"subscriber":false,"subscribedOffers":{}} Who Will Finally Put Diabetes On The Global Health Agenda? | Health Affairs

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Who Will Finally Put Diabetes On The Global Health Agenda?

Doi: 10.1377/forefront.20240209.538528
A close-up image with a woman sitting down at a table and pricking her finger with a small device, as a glucometer device sits in front of her.

In 2021, the world marked the 100th anniversary of the discovery of insulin, a major feat that has no doubt saved millions of lives since. Yet, a century later, millions of people around the globe are living with diabetes and have no or inadequate access to the vital drug. Prevalence of the disease is on the rise; the number of people living with diabetes has quadrupled over the past 40 years. More shocking is the fact that it is the only major noncommunicable disease for which the risk of early death is increasing, rather than decreasing. On top of the direct medical and physical consequences, diabetes also increases the risk of other health complications.

Simply put, diabetes prevention efforts and adequate diabetes treatment and care could have an incredible ripple effect for other positive health outcomes. It should be considered an epidemic that must be addressed immediately with bold commitments and policy change.

Unfortunately, diabetes is not prioritized on the global health agenda. Instead, the international community has tried to appease the diabetes community through tokenism, as demonstrated by the Global Diabetes Compact announced in early 2021. The goals of the Global Diabetes Compact include garnering political commitments and action to make insulin more accessible and affordable, among other measures to reduce the risk of diabetes and improve diabetes management. The initiative aims to implement sustained improvements in diabetes prevention and care worldwide, with a particular focus on supporting low- and middle-income countries. The compact is bringing together national governments, United Nations organizations, non-governmental organizations, private-sector entities, academic institutions, philanthropic foundations, people living with diabetes, and international donors to work on a shared vision of reducing the risk of diabetes and “ensuring that all people who are diagnosed with diabetes have access to equitable, comprehensive, affordable, and quality treatment and care.”

Coinciding with the compact, in May 2021 the World Health Assembly agreed on a resolution on “reducing the burden of noncommunicable diseases through strengthening prevention and control of diabetes.” It calls on member states to prioritize the prevention, diagnosis, and management of diabetes and recommends action in several key areas including increasing access to insulin and creating pathways for reaching targets for diabetes prevention and control.

Delegates at the assembly asked the World Health Organization (WHO) to consider potential targets, establish recommendations, and provide support for strengthening diabetes monitoring and surveillance within national noncommunicable disease programs. This also includes recommendations on the prevention and management of obesity, a leading cause of type 2 diabetes. In August 2021, the WHO established a Technical Advisory Group of Experts on Diabetes (TAG-D) to act as an advisory body to further the WHO’s leadership in promoting and monitoring action against diabetes. The group’s mandate is to identify challenges to the WHO’s work on diabetes, advise on strategic priorities, advise the WHO on developing global documents, and propose other strategic interventions.

Two Years Later—Where Are We Now?

The Global Diabetes Compact sounded promising and offered hope at the time of its launch. As perhaps the first global compact of any kind targeted specifically at diabetes, health advocates and diabetics, this author included, were thrilled to see that diabetes would have a space on the global health agenda.

To my dismay, however, this compact has provided lip service only, and barely that. While intentions may be good, and perhaps the compact has at least increased awareness of the issue, the past two years have seen no real commitments, targets, or advancements to improve health outcomes for people living with diabetes nor to address the increasing incidence of the disease. Since August 2021, the TAG-D has met only five times. A technical advisory group can meet and discuss and make recommendations over and over again, but without the political ability to move any of that forward, what good does it do? Where in the compact are there clear plans for implementing actual change, rather than just talking about it, reporting on it, and watching the issue worsen?

As is the case for many disease responses and global health challenges, the issue lies not with a lack of science or know-how but rather a lack of political will and financial commitments. We have at our fingertips the science and knowledge for implementing type 2 diabetes prevention initiatives (type 1 cannot be prevented) but lack the political commitments and financial resources to implement them. Just the same, we have the science and technology to treat and manage diabetes (both types 1 and 2), and yet millions go on without access to insulin, the most basic and fundamental resource for managing diabetes.

Meanwhile, diabetes prevalence is on the rise. A recent article from The Lancet reports that “more than 1.31 billion people could be living with diabetes by 2050 worldwide. That’s 1.31 billion people living with a disease that causes life-altering morbidity, high rates of mortality, and interacts with and exacerbates many other diseases.” This will have severe implications for both local and national health systems, national economies, and the global economy.

Today’s global health development and financing landscape often requires health advocates to convince developed countries to fund responses to diseases that are no longer prevalent in those countries, such as tuberculosis and polio. But diabetes is not such a disease; it’s killing people in the richest countries and the poorest. Type 1 and type 2 diabetes are both woefully global issues, requiring a global response. In a post-pandemic world in which many countries have moved on from their COVID-19-era calls for solidarity in the face of global health challenges, all countries should be alarmed by the increase in diabetes prevalence and take urgent action.

What Can We Do?

The good thing about efforts to avoid reaching the projected 1.31 billion people with diabetes in 2050 is that, as mentioned earlier, we have the knowledge and technical know-how to do so. We do not need large drug developers to spend dozens of years and billions of dollars on research. We do not need private donors to fund long-term research on prevention or treatment methods. We have this information readily available for us to use. We have, within our reach, the ability to save millions of lives, significantly improve the lives of people living with diabetes, and prevent millions of other diseases that might arise as a result of poor diabetes care.

The WHO must take action to improve upon this initiative, which has already used up time and resources with little to show for it, to set stronger norms and drive real change that will actually improve people’s lives. The WHO must urgently speed up the work of its technical advisory group on diabetes and identify clear and specific time-bound targets for expanding access to diabetes diagnosis and treatment tools, including pushing for universal access to insulin. The WHO and noncommunicable disease advocates alike must also demand action and accountability from our national leaders.

The WHO may lack the real power necessary to implement change and hold governments accountable, but the organization still has a critical role to play in setting global norms and agendas for key global health issues and pushing for change. Private funders of the WHO, including the Bill & Melinda Gates Foundation (which is alone responsible for more than 88 percent of the total amount donated by private foundations to the WHO) must be willing to spend and allocate the dollars necessary to drive these plans. For the WHO to truly live up to its mandate, it absolutely must partner with other global health institutions, national governments, and local partners to implement a global diabetes management and prevention strategy that pays more than just lip service.

Globally, diabetes caused 6.7 million deaths in 2021. On average, that is one person every five seconds. While you have been reading this article, some 72 people have died due to diabetes—a disease that is, with the right degree of access to treatment and care, completely manageable. Only when we give diabetes a legitimate spot on the global health agenda will we make meaningful progress in halting the growing global burden of diabetes and reducing the toll of diabetes on those living with it.

June 2024 Reimagining Public Health