Health Delivery

Diabetes has become a global health problem, reaching epidemic proportions worldwide with serious implications for health and well-being. The International Diabetes Federation estimates that by 2025, almost 350 million people will have diabetes. People who are most vulnerable to this chronic disease include those living in developing countries, and members of minority ethnic groups and socio-economically disadvantaged people in developed countries.

As the number of people with diabetes continues to rise worldwide, huge increases in the prevalence of the condition are expected in Asia. Hospital and outpatient care for people with diabetes in the central Asian Republic of Uzbekistan, with a population of over 26 million people, is provided at state-funded healthcare centres. However, people with the condition have to pay for their insulin and other essential diabetes supplies out of their family income. Diabetes-

According to the federal statistics agency of the Russian Federation, the country’s population is in a phase of negative growth and currently stands at around 143 million. There are 2.3 million people registered with diabetes, 2 million of whom have type 2 diabetes. However, according to recent epidemiological research, there may be some 8 million people living with the condition in Russia. Success in addressing the problems relating to diabetes and its complications largely depends on the effective organization of diabetes care at regional and national levels.

The 10-year National Diabetes Programme in Finland (DEHKO) has been up and running for 6 years. The formal evaluations carried out to date indicate that the Programme continues to have a positive impact in a number of areas of diabetes care in Finland. Moreover, prevention of type 2 diabetes and cardiovascular complications remain the principle objectives of DEHKO. Timo Saaristo and Leena Etu-Seppälä report on FIN-D2D (2003-2007), the DEHKO project to implement primary prevention of type 2 diabetes in five regions – potentially affecting 1.5 million people.

It is estimated that about half of all homeless people suffer from chronic medical conditions. Unfortunately, these people frequently encounter many more barriers to care than the general population – exacerbating their health problems. The plight of homeless people with diabetes is particularly severe, since managing the condition requires adherence to a demanding care plan.

In Africa, there is said to be one traditional healer to every 200 people; an estimated 80% of people in the continent turn to traditional medicine as a source of primary care, including those with diabetes. In settings that are characterized by shortcomings in healthcare provision resources, traditional healers are making selective use of biomedical knowledge and language to enhance the perceived effectiveness of their treatments.

Ten years ago, without evidence to suggest otherwise, diabetes was not considered a public priority in Cameroon; the emphasis of Government health policy was on tackling the HIV/AIDS epidemic and attempting to eradicate communicable diseases. Efforts had been made to set up centres specializing in diabetes and hypertension, but without the backing of a national diabetes programme, most of these closed within a few years. The lack of data on non-communicable diseases constituted a major roadblock to the development of any such programme.

The rise in the number of people with diabetes in Morocco reflects current global trends. In step with the sharp and ongoing increase in levels of obesity in the urban populations, the prevalence of diabetes is rising. But while the threat of a full-blown diabetes epidemic in Morocco is growing, many people with the condition receive inadequate care as a result of shortages in human and medical resources, poor clinical facilities, and a lack of diabetes education.

Sudan is the largest country in Africa and one of the poorest in the world. Its population is estimated at around 37 million; the capital Khartoum, with approximately 6 million inhabitants, is growing rapidly. There are hundreds of ethnic and tribal divisions and language groups within the two distinct major cultures in Sudan – Arabs with Nubian roots and non-Arab Black Africans. The lack of effective collaboration among these groups continues to be a serious problem.

The burgeoning epidemic of diabetes in Africa will exact a terrible toll from the people and economies of the region. The costs of the condition and its complications are already unacceptably high. Every day in Africa, large numbers of children and adults die because they cannot pay for the insulin they need to survive; many more die before a diagnosis can be made. But diabetes can be controlled through relatively small investments and prevented entirely through simple cost-effective interventions.