The epidemic of diabetes is increasing inexorably, especially in Africa, under the combined effects of rapid urbanisation, modification of eating habits, increase in life expectancy, in addition to environmental changes.
According to the International Diabetes Federation (IDF), over 415 million people live with diabetes today, more than 77% of them in low and middle-income countries, for an estimated cost of USD 673 billion per year[1]. By 2040 this will increase to 642 million people, including more than 42 million in Africa. Every year, 5 million people die from diabetes, one every 6 seconds. Diabetes is also the first cause of blindness, of dialysis, and of non-traumatic amputation. Non-Communicable Diseases (NCD) which include diabetes are responsible for 69% of all deaths worldwide[2].
Despite the gravity of the situation, less than 2% of all global health funding[3] is dedicated to this major public health challenge. Under these conditions, how can the world address this epidemiologic transition with its multiple facets (human, social and economic) with the added challenge of the time bomb that are the spiralling health costs? How can we improve, in the most deprived continent, Africa, the already limited care for patients and sustain weak or failing health systems?
An international mobilisation is urgently needed to publicize this scourge that has been overlooked for too long, and more importantly to support and give back hope to mostly poor patients who are lacking access to care and to appropriate treatment. Support for social and medical innovation is also crucial to favour the evolution of health practices and to reinforce patients’ autonomy and the fight for their rights. The development of collaborative platforms, bringing together patient associations, researchers, public institutions, funders and the private sector is also necessary. It will strengthen the fight against the disease, improve general awareness, help carry the patients’ voice, and mobilise funders and multilateral organisations. The development of collaborative platforms will also push the pharmaceutical industry to rethink its strategy concerning the cost of treatment for chronic diseases in Africa, in order to guarantee greater access to patients, even the most deprived ones among them. For example, how does one justify the fact that insulin, the main treatment against type 1 diabetes, discovered nearly 100 years ago, is still inaccessible for the majority of patients in developing countries because of its price? In Africa, one year of insulin represents more than 17% of a family’s annual revenue[4].
It is not only a question of solidarity, but of justice and equity for patients. Diabetes and the other NCDs will impact more and more the living conditions of the poorest, especially in Africa. Investing today will not only prevent a worse catastrophe tomorrow, it will also give patients a pivotal power in the prevention and the fight against diabetes. It will also change the way global health is assessed and financed. To not prevent and slow down the emergence of NCDs in Africa is to take the risk to see already fragile health systems implode under the pressure and to also compromise the social and economic development of many countries.
While, for the first time in its history, the World Health Organization has a representative from Africa, Dr. Tedros Adhanom Ghebreyesus from Ethiopia, as its Director General, the rapid expansion of chronic diseases, especially in Africa, requires the immediate launching of a radical revolution in terms of global health, which is the responsibility of the African Leaders, the African Union and its sub-regional organisations, as well as the United Nations and international funders. Inspiration can be taken from the successes encountered in the universal fight against HIV, malaria and tuberculosis. Contrary to a new vertical approach by disease, it is important to favour the reinforcement of national health systems to make them more resilient. In the face of the rapid increase in NCDs, prevention as well as the promotion of a high quality integrated care for diseases and comorbidities, such as diabetes and tuberculosis, become central. It is surely the best way to envisage the development of the Universal Health Coverage demanded by the United Nations and to reach the Sustainable Development Goals (SDG).
This is why we are urgently calling for an international mobilisation around people living with diabetes, healthcare professionals, African and international leaders and all the world health stakeholders.
The priority is to:
- Recognize diabetes as a global scourge, especially in Africa and recognize the double burden of malnutrition also faced by Africa
- Adapt the organisation of care and services to respond to the challenges linked to NCDs and favour the development of more integrated and therefore more resilient health systems
- Reinforce the screening and the care for gestational diabetes which is not sufficiently considered in maternal and infant health policies.
- Develop an ambitious and innovative international response with an appropriate funding for diabetes and Non-Communicable Diseases.
First signatories:
Stephane Besançon (CEO NGO Santé Diabète), Pr Jeffrey Sachs (Economist), Pr Marion Nestle (Nutritionnist et writer), Pr Cynthia Fleury (Philosopher et psychanalyst), Dr Olivier Véran (Neurologist, CHU de Grenoble-La Tronche, France), Pierre Salignon (Head of Projects, Agence Française de Développement), Pr Naby Baldé (Endocrino-Diabétologist, Chair Africa, International Diabetes Federation), Dr Kaushik Ramaiya (Diabétologist Hôpital Hindou Mandal Dar-es-Salam, Tanzania) and Dr David Beran (Researcher, Geneva University Hospitals)
For those wishing to go further, a detailed pitch can be downloaded via this link: Pitch
[1] “International Diabetes Federation Diabetes Atlas, 7th edition”, 2015
[2] In Africa, diabetes is responsible for 10% of the deaths annually.
[3] Luke Allen. “Why Is There No Funding For Non-Communicable Diseases?” Journal of Global Health Perspectives. Octobre 2016.
[4] Bermudez-Tamayo & all “Direct and indirect costs of diabetes mellitus in Mali: a case study” Plos One May 2017