REDUCING THE IMPACT OF DIABETES ON THE

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1 REDUCING THE IMPACT OF DIABETES ON THE WORLD S POOR THE ROLE OF THE WORLD HEALTH ORGANIZATION IN GENEVA AND HOW PARTNERS MAY SUPPORT ITS WORK SOME KEY MESSAGES ABOUT DIABETES 1. Diabetes is a life-threatening condition 1.1. Worldwide approximately 3.2 million deaths are attributable to diabetes, similar in number to deaths from HIV/AIDS Thus approximately 1 in 20 of all deaths are attributable to diabetes. In the age group 35 to 64 years at least 1 in 10 deaths worldwide are attributable to diabetes, with as many as 1 in 4 deaths being attributable to diabetes in this age group in some populations Thus diabetes contributes substantially to premature adult mortality. 2. Diabetes is common and it frequency is increasing rapidly 2.1. At least 171 million people worldwide have diabetes Due to a combination of population growth and ageing, and changing lifestyles, the number of people worldwide with diabetes is likely to more than double by The number of people with diabetes in low and middle income countries is likely to increase by 150% by A full and healthy life is possible with diabetes 3.1. The risk of diabetes related complications can be substantially reduced through a combination of good health care provision and empowerment of people with diabetes. 4. Many cases of diabetes can be prevented 4.1. While the prevention of Type 1 diabetes remains an objective for the future, the prevention of Type 2 diabetes is possible Modest weight loss and increased levels of physical activity have been shown to be very effective in preventing or delaying the onset of diabetes in people with impaired glucose tolerance A real impact on the rising prevalence of diabetes will require population wide measures aimed at reducing overweight and obesity and increasing levels of physical activity.

2 INTRODUCTION It is no exaggeration to describe diabetes as one of the major contributors to ill health and premature mortality worldwide. Diabetes is a silent epidemic that has the potential to overwhelm health services everywhere. Without substantial effective action its impact upon population health, particularly within low - and middle - income countries, will increase markedly over the coming quarter of a century. It is for these reasons that diabetes is designated an organization-wide priority by the World Health Organization (WHO). In common with many other groups at WHO, the Diabetes Unit is highly dependent on externally provided funding for many of its activities. The aim of this short document is to provide an overview of the role and activities of the WHO diabetes unit in Geneva and to provide potential donors with an idea of areas of work that could benefit from their support. The World Health Organization The World Health Organization is the United Nations Specialized Agency for health. It was established on the 7 th of April WHO's objective is the attainment by all peoples of the highest possible level of health. It is governed by 192 Member States through the World Health Assembly, which meets in May of each year. The main tasks of the World Health Assembly are to approve the WHO programme, the budget for the following biennium and to decide major policy questions. The Secretariat of WHO is headed by the Director-General, who is nominated by the Executive Board and elected by Member States for a period of five years. Dr LEE Jong-wook took office as Director- General of the World Health Organization on 21 July WHO's Secretariat is staffed by health professionals, other experts and support staff working at headquarters in Geneva, in the six regional offices and in countries. The regional offices have a considerable degree of autonomy, and the relationship between them and WHO headquarters in Geneva is based upon the development of shared objectives. WHO has officers in over 140 countries. They are often located within national Ministries of Health and have a unique role in supporting and advising national governments on health policy and its implementation. The activities of WHO are supported by an international network of collaborating centres. A WHO collaborating centre is a national institution (or department or laboratory within an institution) that has been designated to carry out activities in support of WHO s mandate for international health work and its programme priorities. The use of the title, logo and official letterhead of "WHO collaborating centre" is strictly regulated and limited to matters directly related to WHO collaborative activities. 2

3 WHO REGIONS AMRO: REGION OF THE AMERICAS AFRO: AFRICAN REGION EURO: EUROPEAN REGION EMRO: EUROPEAN REGION SEARO: SOUTH EAST ASIA REGION WPRO: WESTERN PACIFIC REGION THE DIABETES UNIT AT WHO GENEVA The Diabetes Unit is based within the Department of Chronic Diseases and Health Promotion, which is headed by Dr Robert Beaglehole. This department encompasses the surveillance, prevention and management of chronic diseases, including cardiovascular diseases, chronic respiratory diseases, cancers and diabetes. The Diabetes Unit works closely with the International Diabetes Federation, and with over 25 collaborating centres throughout the world. In addition much of our work within the organization is in collaboration with colleagues in other departments. All these partnerships add considerable value and impact to our work. Some key points about diabetes, which provide part of the background and rationale for the Unit's work, are shown in the box on the first page. More details can be found on our website THE GOAL AND CORE FUNCTIONS OF THE WHO DIABETES UNIT The overall goal of the diabetes Unit is: To improve health through stimulating and supporting the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low - and middle - income countries. This overall goal is addressed by focusing on the following core functions. These functions are in close alignment with the core functions of WHO. 1. To oversee the development and adoption of internationally agreed standards and norms for the diagnosis and treatment of diabetes, its complications and risk factors. 2. To promote and contribute to the surveillance of diabetes, its complications and mortality, and its risks factors. 3. To contribute to building capacity for the prevention and control of diabetes. 4. To raise awareness about the importance of diabetes as a global public health problem 5. To act as an advocate for the prevention and control of diabetes in vulnerable populations. 3

4 WORK PLANS FOR THE DIABETES UNIT 2004 TO 2006 DIABETES ACTION NOW - Advocacy, awareness raising and guidance on the prevention of diabetes and its complications Diabetes Action Now is a major programme of work being undertaken in partnership with the International Diabetes Federation (IDF). It receives funding from World Diabetes Foundation and from WHO. It began in September 2003 with the initial funding for three years. Further funds will be sought to maintain its activities beyond this period. A booklet produced by the programme is available on request and can also be downloaded from our website: Diabetes Action Now encompasses five main work areas. These are described below. 1. Work to achieve a major increase in awareness about diabetes, its complications and prevention, particularly among international health policy makers and those in low - and middle - income countries. This work is being conducted in collaboration with the IDF Diabetes Awareness Task Force. 2. Projects to collect and disseminate new knowledge on awareness about diabetes and its economic impact in low - and middle - income countries. Activities are planned initially in four sentinel sites, two concerned with awareness raising and two assessing the economic impact of diabetes. Work on the economic impact of diabetes is being planned with the IDF Health Economics Task Force. 3. The production and dissemination of a new scientifically based review on the prevention of diabetes and its complications. This will be a much needed update of the 1994 WHO technical report on the prevention of diabetes. Work has begun on this and publication is planned for February The production of upto-date practical guidance for policy makers in low and middle income countries, on the contents, structure and implementation of national diabetes programmes. This work is being undertaken with colleagues at WHO, IDF and collaborating centres. 5. The development of a web-based resource for policy makers to support the implementation of national diabetes programmes. 4

5 ASSESSING THE BURDEN OF DIABETES - current prevalence and trends, mortality attributable to diabetes, assessment of diabetes related complications The most widely quoted publication of the WHO Diabetes Unit is its estimates of global diabetes prevalence, and projections for the future. Also very widely quoted is WHO's guidance on the diagnosis and classification of diabetes and other forms of impaired glucose regulation. Both of these areas of work require constant revision as new evidence comes to light. There are three main areas currently being addressed. 1. Assessing the contribution of trends in obesity to the global epidemic of diabetes Current estimates of the increase in diabetes prevalence over the next quarter of a century take into account projected changes in population size and age structure, and trends in urbanization in low - and middle - income countries. Taking into account trends in urbanization will allow for some of the current trends in obesity but not all. Work is underway to provide a better assessment of this. 2. Estimates of global mortality attributable to diabetes. Current official estimates of diabetes mortality are known to grossly underestimate its real impact, not least because death certification practices are poor at recording when diabetes contributed to death. Work to provide more realistic estimates is well advanced. 3. Guidance on the classification and assessment of diabetic complications. Since 1980 WHO has provided the international gold standard on the diagnosis and classification of diabetes and other forms of impaired glucose regulation. What has been missing is guidance on the assessment and classification of diabetes related complications. The preparation of this guidance is well advanced. In addition to the activities described above WHO frequently receives requests for help with surveys to measure the prevalence of diabetes, its risk factors and complications. 5

6 EXAMPLES OF WAYS TO SUPPORT THE WORK OF THE WHO DIABETES UNIT There are several areas within our current work programme for which we are seeking additional support. These include: 1. Specific awareness raising activities, including for example, translation and adaptation of our booklet Diabetes Action Now to regional and national needs and awareness raising campaigns within specific regions and countries. 2. Support for work with sentinel project sites, on such areas as surveys of awareness about diabetes, studies of the economic impact of diabetes, and surveys of the prevalence of diabetes and its risk factors. 3. Support for the development of guidance for health policy makers in low and middle income countries on the contents and implementation of national diabetes programmes. Support is needed to hold expert, consensus building workshops, to produce and pilot materials, and to develop online support. 4. Support for work on assessing the current global burden of diabetes and future trends. 5. Support for the production of the report on the assessment and classification of diabetes related complications. In addition to the above we are happy to discuss other ideas for pieces of work so long as they are related to the core functions of the Diabetes Unit. For further information and discussion please see the contact details at the end of this document. CURRENT SPONSORS OF WHOS WORK ON DIABETES AT HEADQUATERS We gratefully acknowledge support from the World Diabetes Foundation (who support Diabetes Action Now) and Novo Nordisk, who continue to support work on estimating the burden of diabetes. 6

7 THE WHO DIABETES UNIT The current WHO Diabetes Unit consists of: Claire Duchesne, Secretarial Assistant Claire has been working for WHO since 2004 as a bilingual (French and English) secretarial assistant first for the Parasitic Diseases department and more recently for the Diabetes team. Her duties include a range of administrative tasks, document dispatch and maintenance of the web site. Amanda Marlin, Technical Officer Amanda has studied psychology and public health. Her main interest is in ensuring that medical and scientific information reaches those who need it. Recent work has included coordinating the publication of scientific reports, a mass media launch of "Diabetes Action Now" and the development of various web sites. She has worked for the past six years for the World Health Organization and before that for a nongovernment health organization in her home country, Australia. Gojka Roglic, Technical Officer Gojka is a medical doctor who trained in clinical diabetology and epidemiology. Having worked in her native Croatia during the war, she has experience in the management and public health aspects of diabetes in disasters. She joined the World Health Organization in 1999 and her main responsibilities are global numerical estimates of diabetes prevalence, complications and mortality. Nigel Unwin, Medical Officer Nigel is a medical doctor who trained in epidemiology and public health. Prior to joining the World Health Organization in October 2003 he worked for 10 years with the Diabetes Group at the University of Newcastle, UK. He has collaborated on diabetes related work in Cameroon, Tanzania and several other low and middle income countries. His main responsibility at WHO is the overall coordination of the joint WHO-IDF programme, Diabetes Action Now. FOR FURTHER INFORMATION For further information please see our website and feel free to us at diabetes@who.int. To speak to a member of the team call Claire Duchesne on +41 (0) or call the main switch board (+41 (0) ) and ask for a member of the diabetes team by name. 7