Panelists at Diabetes Question Time

On Tuesday 17 January, C3 Collaborating for Health, Diabetes UK and SilverStar co-hosted a Question Time-style event in Westminster Central Hall, in front of an invited audience of around 150 people. The event was funded by Novo Nordisk. The panel was made up of Grace Vanterpool (a specialist diabetes nurse), three members of parliament – Stephen Dorrell, Keith Vaz and Adrian Sanders – the chief executive of Diabetes UK Baroness Barbara Young, and Viggo Birch, vice-president of Novo Nordisk Europe. It was facilitated by Stephen Dixon of Sky News, and closed with a short presentation from Paul Burstow, minister of state for care services.

The audience was made up of health professionals, policy-makers and others – and both panel and audience included people with type 1 and type 2 diabetes. The event was covered on Twitter (#diabetesqt).

Questions at the event included:

• Will commissioning lead to fragmented care?
• Will the Outcomes Framework work as a catalyst to help people with diabetes or not?
• How can prevention methods be improved?
• How best to care for children with diabetes
• How to encourage sharing of best practice
• The problem of limited access to pumps

Voting at Diabetes Question Time

The audience were actively involved throughout the event. First, all those attending were asked to take part in two votes during the event:

• Will people be more involved in their care in the new system envisaged by the new Bill? (which saw a small majority who felt that people will be more involved)
• Will diabetes care have improved by 2025? (which also saw a ‘yes’ majority).

On arrival, the audience were all invited to participate in a short poll to ascertain views on what should be the top three priorities for the NHS in diabetes, and the results were illustrative of the need to ensure that people with the disease should be closely consulted:

• Among people with diabetes, supporting self-management was seen as the highest priority (40%), followed by identification and prevention (23%), education (23%), and specialist nursing (10%).
• Among those without diabetes, the priorities were different: identification and prevention (43%), reducing variations in access to care and services (23%), and supporting self management (19%).
• Averaged across the audience as a whole, the top three priorities were identification and prevention (37.5%), supporting self-management (25%), and reducing variations in access to care and services (17%).

The Dutch government banned smoking at workplaces since 2004 and in most public places since 2008.  This move was particularly unpopular with small bars and innkeepers, who mounted a grassroots campaign aimed at toppling existing smoking legislation.  As a result, the primary Dutch organisation responsible for campaigning against smoking, STIVORO, will lose its €2.7 million funding by 2013 and will need to raise funs to continue operation.  In addition, pharmaceutical nicotine patches, previously dispensed through the public health services, will no longer be available fre of charge.  Although smoking rates are slightly down from 2001 when an estimated 30 per cent of the population were smokers, smoking remains popular in the Netherlands; 27 per cent of the population were smokers in 2010.

According to the International Tobacco Control Policy Evaluation Project, Netherlands Survey, smokers in the Netherlands are the least well informed or concerned about both the hazards of smoking and the dangers of second-hand smoke exposure of the 12 countries surveyed.

Sources: The Lancet 379(9811): 121-2, 14 January 2012; The International Tobacco Control Policy Evaluation Project, Netherlands Survey, March, 2011 Report on Smokers’ Awareness of the Risks of Smoking and Second-hand Smoke; STIVORO, Annual Report 2009—2010.

The Lancet published an article recently about the prevalence and treatment of two major chronic conditions: hypertension and diabetes.  Interestingly, though the prevalence of chronic disease like diabetes, cardiovascular disease and some cancers is higher in urban areas, the article shows evidence that control and management of chronic conditions is better in rural areas and the Behyarz workers, who are well-trained community health workers, are largely attributed with developing and maintaining low rates of hypertension and diabetes in particular.  This community health model, which involves health education training of over two years, includes an emphasis on workers identifying new cases of disease and referring the new cases.

As is the case in many nations, the causes of death in Iran have shifted from infectious agents to NCD. Cardiovascular disease accounts for almost half of all deaths in Iran and cancer rates have soared; traffic-related deaths have also increased dramatically. The Lancet study shows the higher prevalence of CVD risk factors – hypertension and diabetes – in the context of urbanisation, increasingly sedentary lifestyles, changes away from a traditional Mediterranean diet and improved infectious disease control.  This study corroborates evidence from Ethiopia, Brazil, India and Bangladesh, which suggest that trained community health care workers and well-established guidelines can, in combination, be effective in NCD prevention and management.

Sources: F. Habibzadeh, The Lancet 379(9180):  6-7, 7 January 2012; Asgari et al., Iranian Journal of  Public Health (2009) 38, Suppl. 1: 119-22.

Tobacco, the world’s leading cause of preventable death, is estimated to be responsible for over 200,000 deaths each year in Brazil, including 45 per cent of heart-attack deaths and 30 per cent of deaths due to cancer. Smoking is the primary cause of many of the world’s preventable diseases, including cardiovascular disease, lung disease and cancers, killing 1/10 adults worldwide and is frequently the cause of the disease recorded as the cause of death, according to the WHO.  As Brazil is hosting both the 2014 Soccer World Cup and the 2016 Olympic Games, the nation has a crucial example to set through its leadership role on this issue.

Sources: The Washington Post, 15 December 2011; Campaign for Tobacco Free Kids, press release; Tobacco Free Center, Tobacco Policy Status (pre-ban) 12/2011; World Health Organization ‘Top Ten Causes of Death Fact Sheet’, June 2011.

Source: health.gov.au, 21 November 2011.

Recommendations include:

• the option for employers to hold a ‘protected’, without-prejudice conversation with employees about their condition, as many are afraid of being taken to an employment tribunal;
• expenditure to keep ill employees in work – e.g. medical treatment or rehabilitation – could attract tax relief;
• a proposal for an independent assessment service that would assess individual’s health after four weeks off work, and find ways to help them back to work; and
• a job-brokering service for those off work for 20 weeks or more, which could help those unable to return to work at their previous job.

Sources: Financial Times, 21 November 2011 and Health at Work: An Independent Review of Sickness Absence, published 21 November 2011.

Last April, the Australian government presented a proposal that involves requiring that all cigarettes sold be displayed without branded labels and in non-descript olive-green packaging, which smokers are reported to favour least, with graphic depictions of smoking-related illnesses.  Brand names will be displayed in a single, standard font and size. In October, Philip Morris, the cigarette manufacturer that holds eight of the top 15 selling brands, including the best-selling brand, Marlboro, lashed out at the proposal, and said they were preparing for legal battle if the plain-packaging bill becomes law.

The Financial Times reports that Hermann Waldeme, Phillip Morris’ CFO claims that there is ‘no evidence’ that removing logos from packaging reduces smoking either in general or among youth – a claim made in spite of evidence from studies demonstrating that plain packaging both decreases brand appeal and general pleasure derived from smoking.  Tobacco companies have raised challenges around the ‘forced removal of trademarks’ in terms of both commercial and intellectual property law, and international law.  But Prime Minister Julia Gillard says that she will not be intimidated by big tobacco.

Sources: Financial Times, 20 October 2011, BBC News online, 8 April 2011;  Sydney Morning Herald, 27 June 2011; Tobacco Control (BMJ,’Welcome to cardboard country: how plain packaging could change the subjective experience of smoking‘ (Melanie Wakefield, Centre for Behaviour Research in Cancer, Cancer Council Victoria, Melbourne, Australia)

The Declaration is grouped under a number of headings:

• Adopt better governance for health and development, including working across all sectors and levels of government, promote and strengthen universal access to social services, and provide access to affordable, quality medicine
• Promote participation in policy-making and implementation, including empowering local communities to contribute to policy-making, focusing particularly on health inequities faced by indigenous people, and sharing good practice
• Further reorient the health sector towards reducing health inequities, including maintaining and developing effective public health policies that address the social, ecoomic, environmental and behavioural determinants of health, strengthening health systems, and promoting dialogue and problem-solving across government
• Strengthen global governance and collaboration, including accelerating the implementation of the Framework Convention on Tobacco Control, taking forward the actions set out in the Political Declaration of the UN HLM on NCDs at local, national and international levels, and foster North–South and South–South cooperation in showcasing initiatives and transferring technology
• Monitor progress and increase accountability, including developing and implementing evidence-based measures of societal well-being, improving monitoring and sharing evidence

It ends with a ‘call for global action’, including urging developed countries to achieve the target of 0.7 percent of GNP for official development assistance by 2015.

1,200 people took part, with 120 countries represented at the meeting, with 60 health ministers present – a clear sign that this issue is rising up the agenda, with countries and even cities are beginning to take the ideas and make them their own, with Brazil having set up its own Commission on the Social Determinants of Health, Costa Rica soon to follow suit, and even the city of Lima in Peru is going to have its own commission. In the UK, London’s mayor, Boris Johnson, has launched a health inequalities strategy, supported by Sir Michael Marmot’s team, who worked on the international Commission on the Social Determinants of Health. Perhaps it is an idea whose time has come – as Sir Michael has put it: ‘every sector is a health sector’.

Sources: Rio Political Declaration, 21 October 2011; Bupa Foundation seminar on ‘Motivating change: working towards a healthier society’, 24 October 2011.

This has been met with considerable resistance, however. Of the 200 couples reached by the campaign, only a few promised to hold non-smoking ceremonies, because – even among social groups who are fully aware of the health threat from tobacco – they feared losing face, or parental opposition.

More awareness-raising is being planned, perhaps including having celebrities to champion the no-smoking cause, or broadcasting tobacco-free weddings on the internet.

While there is still a very long way to go – cultures change only slowly – even these small steps are to be commended in a country where the majority of men still smoke.

Source: Xinhuanet.com, 5 October 2011.

The Centers for Disease Control has awarded a $9 million grant to establish the programme, selected through the Patient Protection and Affordable Care Act, and it will be delivered by Veridian Health Management. Veridian will work with small, medium and large companies, using funds to assist each participating employer to implement a core set of WHP programme elements, and each employer will receive a full-service wellness programme for the two years of the intervention. Veridian’s president, Brenda Schmidt, noted that the project will also build community partnerships both to enhance programme activity and also to set up the knowledge transfer that will help to make the programme sustainable.

The Research Triangle Institute, based in North Carolina, will evaluate the programme, including capturing best practice and documenting challenges and strategies to overcome them.

Sources: Stone Hearth News, 4 October 2011 and CDC website (here: http://www.cdc.gov/workplacehealthpromotion/nhwp/index.html)