Just when I thought it was safe to watch tv and hang about on social media my twitter feed became festooned with comic book images of super-heroes “beating” diabetes and the tv news was throwing about words like ‘diabesity’, ‘epidemic’ and ‘complications’.
What fresh hell was this? I knew it wasn’t World Diabetes Day (14th November) or National Diabetes Week (July) or even World Sight Day (2nd Thursday of October). No it was an ordinary Thursday in April. This time it wasn’t a diabetes organisation directly but another public health institution. In their wisdom the World Health Organisation decided to jump on the diabetes bandwagon and dedicate World Health Day to diabetes.
I found the day confusing and I’m still not sure what it was on about. The comic book graphics are colourful but what do they mean? What the heck do we mean by “beating” diabetes? Who are the messages being aimed at (are governments likely to be swayed by super-heroes?) and what is the outcome WHO are hoping to achieve?
In fairness, WHO’s media releases (as distinct from graphics and tweets) did attempt to comment within a government policy framework, albeit it was heavy on statistics and very light on policy recommendations. They did acknowledge the importance of access to insulin.
“Access to insulin is a matter of life or death for many people with diabetes. Improving access to insulin and NCD medicines in general should be a priority.” Dr Etienne Krug http://www.who.int/mediacentre/news/releases/2016/world-health-day/en/
Unfortunately some of the diabetes organisations that jumped on the World Health Day bandwagon were much worse.
I found the following paragraph from IDF’s press release particularly facile:
Despite the alarming numbers, the real impact of diabetes can be too easily underestimated, misunderstood and ignored. … How about accompanying a child in a Rwandan village to a funeral? The child’s father died from diabetes complications before his 42nd birthday. How will that little boy survive without the USD$1.50 his father earned each day? http://www.idf.org/news/diabetes-takes-centre-stage-whd16
The answer to all this, according to IDF is greater public awareness. Seriously how many alarmist headlines will it take? I’ve got panic fatigue already.
What’s more does this panic actually achieve anything? Everyone is aware of the toll that poverty and economic underdevelopment takes in the third world and yet it continues to be a problem. What makes diabetes any different?
For an intelligent and informed view on diabetes in Rwanda, thankfully, we can turn to the patient-led and run charity Type1 International who featured an article about diabetes in Rwanda:
“However, diabetes meters and strips are not covered by insurance, and patient pays 10% for any other expense. For instance, one bottle of insulin (regular or NPH) costs 6,000 FRW ($9), and the patient pays 600 FRW. For both regular and NPH they would pay 1200 FRW, or 12,000 FRW ($18) without insurance. The cost of diabetes supplies varies from location to location and gets higher as one moves away from Kigali. These fees might sound low by developed country standards, but for the vast majority of patients who are either unemployed or live on subsistence agriculture without any money to spare, this amount is substantial.” http://t1international.com/insulin-access/interview-with-laurien-sibomana-more-on-diabetes-in-rwanda/
It doesn’t take an economic genius to work out public awareness isn’t going to do a hell of a lot for the Rwandan man whose wage barely covers a subsistence living for him and his family. He needs access to insulin to stay alive and the cost of that alone, let alone self-monitoring equipment, complications screening and care is simply prohibitive.
Economic development, food security, access to affordable medicines are complex issues and it’s ludicrous to suggest that public awareness will do anything to help this. To state the obvious, public awareness doesn’t achieve anything. If public awareness leads to action then it has served a purpose but the current campaigns from IDF smack of a hand-wringing, panic-inducing “won’t somebody do something for the children” without a single suggestion for implementable action.
Here’s some off-the cuff questions on this issue. What are the barriers to access to insulin for those who need it? What are creative ways to overcome these barriers? I’m not talking about paying money to multinational pharmaceutical companies to distribute the latest patented version of insulin. What about animal insulins? What about the one-shot a day insulins of old? What about generics? Are there cheaper means of production and distribution? Are there cheap oral drugs for type 2 that can be disseminated cost effectively to those in need? Are we delivering care and education in the third world in culturally appropriate ways or are we superimposing western notions of health and self-care onto people who view the world very differently?
There are a lot of questions than need to be asked about the ‘diabetes epidemic’ and I certainly don’t claim to have the answers although I’d bet my last vial of Humalog that public awareness isn’t one of them.
Am I being too harsh on organisations like IDF*? What do you think? What sort of questions and answers do you think are relevant in halting the “diabetes epidemic”?
*I do note that IDF conduct the Life for a Child program which does provide access to life-saving insulin to those who would be otherwise unable to afford it.