Interviewees: Akiko Maeda, Sector Manager, Health, Nutrition and Population, MENA region Michael Englegau, Senior Public Health Specialist, South Asia region Firas Raad, Health Specialist, MENA region The regional Diabetes Conference -held in Riyadh, Saudi Arabia, November 3-5, 2007 - is co-sponsored by the World Bank in collaboration with the World Health Organization (WHO), the World Diabetes Forum, the Gulf Cooperation Council and the World Diabetes Council. This conference is part of an overall initiative that aims to disseminate the findings of the DCP II publication. Talking to the experts about Diabetes in the MENA region, here is what they said: Why Diabetes, why now? In almost all regions across the world, Diabetes is a serious health problem that is manifesting on the health and economic risk radar. Current global estimates by the WHO and the World Diabetes Forum reveal that there the number of Diabetes cases will reach 370 million in 2030 representing an increase of 62 % in 30 years. The highest concentration of the disease will be in sub-Saharan Africa, the Middle East and North Africa and South Asia. Four out of the top 10 countries with the highest number of Diabetes cases are GCC countries. These are the United Arab Emirates, Bahrain, Kuwait and Oman. Diabetes is reaching epidemic proportions in certain parts of region. Financing pressures on health systems and households can no longer be overlooked. For many, the prevailing perception is that diabetes is only a problem for developed countries and rich people. How valid is this perception? In truth, most of the worldwide diabetes burden is in developing countries. This is not only the case for Diabetes - it is true for other non-communicable and chronic diseases, such as heart disease and hypertension. The global experience finds that both prevention before disease appears and treatment among those already affected can be cost effective. Moreover, a significant diabetes burden is becoming more evident across different socioeconomic quintiles from top to bottom. Affected people die younger, their productivity is affected and they suffer the long term consequences related to heart disease, visual impairment, renal failure and other complications associated with Diabetes. What is the nature of the risk in MNA? Across the MENA region, ministries of health and policy makers are paying attention to a second wave of health reform. Diabetes is an illustration of how risk manifests itself in various forms at various stages of life clearly illustrating those challenges and opportunities. It is important to recognize that Diabetes affects the young and the elderly. Unless effectively managed, Diabetes can adversely affect employment opportunities and labor productivity with economic impact on households and state economies. This is an expensive disease. What are the reasons contributing to the “Diabetes epidemic” in MNA? As you know, the region is going through an epidemiological transition that is influenced by globalization, urbanization and changing lifestyles. These influences create great opportunities but also introduce new health risks. Governments, families and individuals need to be prepared. Are specialized institutions such as National Diabetes Treatment Institutions, enough to manage the disease? The experience of National Diabetes Institutes has been a mixed success. While centers of excellence can deliver top level care, their capacity is such that they will fall short of generating a population impact. With Diabetes reaching epidemic proportion in some countries there is a large need to extend beyond the capacity of these institutions. A major impact will come from emphasizing changes in lifestyle and interventions at the primary care and community level care, as well as health systems improvements more generally. How does Diabetes manifest as a shock/health crisis? Non-communicable diseases including Diabetes are a burden, not only at the individual level – where among poor people one third of the household income can be spent on treatment - but also are a burden on the national economy. Money spent on disease-associated complications, in addition to reduced productivity not to mention the costs of disability and the social problems linked to that. At the country level, health systems can be overwhelmed with costs of care for complications associated with Diabetes. Countries are currently more geared to caring for maternal and child health and communicable diseases and less so for diabetes and other chronic diseases. . What are the initial necessary steps to mitigate Diabetes as a health risk? The first step will be to understand the magnitude of the problem. Conducting a needs assessment of the “what”, the “where” and “how much” is critical to determine the level of prevention most appropriate at the community level. Cost effective interventions exist that can reduce the burden and that are good investments. Mitigation plans need to be based on improvements in the community-base primary care - rather than building specialized Diabetes Centers. The second level of intervention will be for countries to identify community structures that can be part of Diabetes early prevention and early care programs. In many instances, Diabetes is linked to lifestyle changes that have provided higher access to unhealthy food, more sedentary lifestyles and new socioeconomic trends that promote such unhealthy behavior. Education is key to promote good nutrition and physical exercise, particularly among young populations across the region. Have “population screening programs” been effective in curbing the disease? In most instances, population screening programs – may not be the best place to start. Health care systems across the world tend to already be overburden care for their current diabetes case load. A flood of newly diagnosed cases through mass screening may overwhelm the system even further and paradoxically worsen diabetes case. Having said that, early detection among “high risk” groups that are already attending clinic, what we call “opportunistic screening” – may have some value – but is unproven in developing countries. What is role of the World Bank on the Diabetes agenda? The World Bank is currently emphasizing the link between its projects and non-communicable diseases as they impact national health systems. We have learned much from developed countries – where they have already dealt with many of these issues. While there are no clear goals spelled out on the Millennium Development Goals agenda relating to non-communicable diseases, the associated risks can hinder efforts toward poverty reduction goals. Studies have revealed that 30-40% of a household income is spent on costs of care for one Diabetes patient in poor families. In MNA, the World Bank is currently engaged in providing technical assistance and knowledge support to a number of middle income countries in the region on health issues and the economics involved in its management. What is the nature of the cooperation with the WHO on the Diabetes agenda? We work closely with the WHO as the lead health organization setting the standards and procedures for addressing the disease. The experience that the World Bank contributes to this collaborative effort is based on the linkages we can foster through our work in other sectors, including education, social protection, poverty reduction and economic development. We operate across different parts of the world and there are many lessons, challenges and opportunities that we can share with our partners. . “What next” after the regional conference? The conference agenda and the intended follow up dialogue with MNA governments will highlight the economics of good Diabetes management while focusing on the cost of doing nothing and the cost of effective interventions. The level of commitment across the region is promising and we are hoping that the Riyadh Declaration that will be announced at the conference is included in the UN declaration on Diabetes. Contributed by: Dina Elnaggar, Senior Communications Officer, World Bank MNA region |
RSS