22 March 2012
This week marks the six month anniversary of the UN High-Level Summit on Non-Communicable Diseases (NCDs).
WHO Director General Margaret Chan called it a "watershed event" in the opening plenary and PAHO Director Emeritus Sir George Alleyne heralded it as "the dawn of a new era for NCDs". But six months on, many Summit skeptics question whether all the effort was worth it and if global political commitments will ever translate into better health and lives for people on the ground.
It seems a long time since we were at the United Nations counting Heads of State and comparing notes on commitments made and commitments we were hoping would be made. After the excitement of New York and pressure to ensure that every word in the Summit Political Declaration advanced our position, the real hard work began to turn government promises into action.
We are impatient for change. Millions of people with diabetes are paying with their lives for political lethargy, and millions more endure immense personal suffering and financial ruin when we have cost-effective solutions for diabetes.
We know how to manage it, we know how to prevent life threatening and damaging complications and we know how to delay and prevent diabetes when that is possible. We must never stop being impatient for change and social justice but at the same time, persistent and sheer determination are our greatest weapons in the fight against diabetes. There are no overnight solutions for this epidemic. It took decades for this diabetes epidemic to take hold, there is still much that we do not understand about its spread and causes. Numbers affected will reach half a billion people within 20 years and it will take decades to put it right. We will not see significant change in six months, or even in 6 years. IDF launched the first ever Global Diabetes Plan 2011 – 2021 for the Summit which looks to the medium term and as a community we need to grasp a 50 year time horizon, and consider that what we do today is protecting future generations more than our own.
I believe that history will say that the UN Summit was the tipping point for diabetes we were hoping for. Political leadership has been the key to accelerating global progress in many other health and development issues, and the Summit provided a forum to generate political awareness and commitment for diabetes and the other NCDs. We are already seeing a new sense of seriousness about diabetes and the other NCDs. We see it everywhere – in governments seeking solutions, in businesses concerned about the health of their employees, and in international organisations recognising diabetes and not dismissing it as many certainly were when I took up this job three years ago.
The Summit has also led to action behind the scenes that will change the landscape. In 2012 every government in the world, all 193 UN member states, will agree upon the first ever set of global NCD targets. And every government will have to report against those targets to show progress and indicate change. The work to scope these targets has been less glamorous than cocktail receptions at the UN Summit but this hard work behind the scenes will drive progress. As Margaret Chan said in April last year, ‘what gets measured, gets done” and for the first time, many governments will have to confront the fact they don’t know how many people have diabetes, let alone how many of those people are diagnosed and receiving treatment. None of this would have happened without a Summit.
IDF President Jean Claude Mbanya and Professor Stephen Colagiuri have been representing IDF at negotiations to ensure that diabetes is represented meaningfully in global targets and indicators which must cover all 4 NCDs and their common risk factors. This is highly political and technically complex at the same time. I am pleased to say that since forming the NCD Alliance in 2009 we are working with our colleagues in cancer, cardiovascular and chronic respiratory diseases - we are comrades in the same battle for health and well-being, not competitors.
But six months on, we can also say that the Summit left a lot of unfinished business that we as a global diabetes and NCD community need to tackle together. We need to prove to policy makers that while prevention may have no political constituency, governments will not be let off the hook until real investment is made in changing the way we live, work and play for the benefit of future generations. We need to face up to the challenge of operationalising NCDs on the ground - both in terms of there being no one-size-fits-all for countries of different resource levels and understanding how we ensure diabetes does not get lost. We need to continue to fight the uphill battle for increased resources for diabetes and probe bilateral aid agencies further when they say that they are funding diabetes through their health system strengthening programmes, as one agency recently said to me.
Above all, we need to catalyse the people's movement for diabetes - a new level of diabetes activism rooted in our impatience and outrage. Type 1 diabetes only kills children in poor countries. It is not a killer in the rich world. 90 years on from the discovery of insulin that is an outrage – where are the voices of the general public and the media? Governments still need to hear people, very large numbers of people from all walks of life, saying in unison that neglect of diabetes is an outrage that we will not tolerate for our own generation or for generations yet to come.