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Social determinants of diabetes

Chronic disease key target for reducing health inequalities

Posted in Government action on 4 July 2010

The Lancet’s special issue on diabetes (26 June – 2 July) coincided with the 70th Scientific Sessions meeting of the American Diabetes Association (ADA) in Orlando. One of the featured articles in the edition addressed the issue that diabetes is widely perceived as a disease of affluence, exacerbated by the fact that  international development policy such as the UN’s Millennium Development Goals (MDGs) omitted to mention diabetes and other chronic diseases. However, the majority of people with diabetes live in low- and middle-income countries, and in high-income countries type 2 diabetes prevalence is frequently highest among poor people. There is a scarcity of data from low- and middle-income countries, but data that is accessible suggests that although diabetes prevalence is usually highest in the wealthiest proportion of the population the distribution is reversing in middle-income countries.

The paper argues that the omission of diabetes and other chronic diseases from the MDGs has created the illusion that communicable diseases seen as being the most pressing to address can be dealt with without also addressing the increasing prevalence of diabetes. However, an integrated approach is required, especially in light of the fact diabetes is associated with a three-fold increased risk of tuberculosis. Diabetes is the only major risk factor for tuberculosis that is projected to grow substantially in the coming decade, meaning that with diabetes on the rise tuberculosis control would be increasingly difficult. Approximately one in five cases of new smear-positive pulmonary tuberculosis in India is thought to be attributable to diabetes. The paper’s authors placed great emphasis on prevention, and held hope that the UN General Assembly summit on non-communicable diseases in September 2011 was evidence of ‘emerging, effective, international action for their prevention.’

For more information on the MDGs and chronic disease, see the C3 discussion paper on 3FOUR50: http://www.3four50.com/NCD-development/

Source: The Lancet, 26 June-2 July 2010.

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