Slide No 1 • •

A partnership for a healthy future Oxford Vision 2020:

Stig PrammingCambridge April 2004

Slide No 2 • •

Global projection: Growth of diabetes mellitus

250

200

150

100

50

02000 2010

Num

ber

(mill

ion

s)

Year

300

2025

Type 2 diabetes ~ 90%

140

280

“Diabetes will double

in 25 years”

Financial Times6 Nov 2000

Slide No 3 • •

Epidemiology: Burden of diabetes is increasing

• Increased childhood and adult obesity• Decreasing levels of physical activity• Increasing urbanisation• Increased longevity• Earlier diagnosis • A new patient is diagnosed with type 2 diabetes every 5 minutes

Epidemic(WHO, 1997)

Slide No 4 • •

• An aging, increasingly overweight and unfit population• Cultural adversity

• Uneven and inadequate distribution of services

• Complex health service

• Unpredictable demands on NHS with limited resources

• Fragmentation of services

• Lack of cohesive policy and planning

• Deficits in our knowledge – prevention / care / cure

• Deficiencies in ability to collect data – monitor process, outcomes and cost

Diabetes: A multitude of challenges (1/2)

Slide No 5 • •

• Strategy and implementation – main principles

• Reduce ineffectiveness through co-ordination/integration

• Awareness of DM - Consumer, provider and public

• Quality and effectiveness – prevention and care?

• Access – health care services

• Imperatives for change

• Identify and disseminate information

• Define and implement ‘best practice’

Diabetes: A multitude of challenges (2/2)

Slide No 6 • •

Obesity

PhysicalActivity

Hypertension

Dyslipidaemia

Macro-vascular Diseases

Diet

Depression

DIABETES

Smoking

The universe in which we operate

Slide No 7 • •

XXL Welfare PyramidTM

50% of

global mortality

3=4

Slide No 8 • •

Chronic conditions: Myth 1

“We must deal with AIDS/TB/Malaria first”

•No! You must deal with both and develop the health system accordingly. There is co-morbidity and some of the infectious diseases become chronic, eg, AIDS

Slide No 9 • •

“Economic growth will automatically improve all health conditions”

•No! Economic growth may exacerbate chronic conditions.

Chronic conditions: Myth 2

Slide No 10 • •

“Chronic conditions are individual failure and your own responsibility “

•No! Governments, industry and others play an important role.

Chronic conditions: Myth 3

Slide No 11 • •

“Chronic conditions are issues for the rich and old in the developed world, and a natural consequence of their lifestyle”

•No! Low socio-economic status leads to cumulative exposure and decreased access to quality medical care. One high risk group are 30-40 yrs old in developing nations.

Chronic conditions: Myth 4

Slide No 12 • •

“Treatment of chronic conditions will only benefit people with the specific diseases”

•No! Chronic conditions control benefits societies economically and, thus, us all.

Chronic conditions: Myth 5

Slide No 13 • •

“The health care system can deal with chronic conditions”

•No! Healthcare systems deal with acute diseases, not chronic. It was never designed but developed gradually and has no structure for prevention, which requires a multi-sector effort.

Chronic conditions: Myth 6

Slide No 14 • •

Who is responsible for policy response for chronic conditions?

Heads of state: Not in focus

Health ministries: Inadequate capacity and budget

WHO: Has tried for 48 years - 5% of budget vs. 60% of mortality

Academic health centres: Not a priority

Research institutions: Not funded in proportion to magnitude

International donors: Only for AIDS modest support against tobacco

World Bank, regional banks: Recognised but no increase in funding

Private-public partnerships: All on infectious diseases

Global NGOs: No support

Media: Little and conflicting interest

Research journals: Not proportionally

Pharmaceutical industry: Major contribution

Slide No 15 • •

Diabetes prevention programme

NCD Unit for prevention /control

National survey for hypertension

No surveillance system nationally

NCD policy

Budget line for NCD

Integrated primary care prevention

NCD info in annual report

Focus on chronic diseases? (167 countries)

Alwan 2001

Slide No 16 • •

"Oxford Vision 2020 has brought together a diverse group of influential people and organisations who have all acknowledged

the need for urgent action to address the growing problem of chronic disease. The commitment shown from the participants

suggests that action will follow”

Derek Yach Representative of the Director General

Noncommunicable DiseasesWorld Health Organization

Slide No 17 • •

Slide No 18 • •

Participants includedCorporate

• Bowker Media & Communications

• House of Monday Morning

• Institute for Alternative Futures

• International Business Leaders Forum

• Johnson & Johnson

• JP Morgan

• LIMIU Limited

• Memory Pharmaceuticals

• Merck Sharp & Dohme (MSD)

• Nestlé S.A.

• New Health Group

• Novo Nordisk

• PepsiCo

• Pharma Futures

• Strategy XXI Group LTD.

Government/Public health

• Centre for Disease Control & Prevention – USA

• Chinese Centre for Disease Control & Prevention

• Department of Health – UK

• Health Canada

• House of Commons

• Medical Research Council, South Africa

• National Treasury, Republic of South Africa

• UK Treasury

Slide No 19 • •

Participants includedUniversities

• City University - London

• Earth Institute, Columbia University

• Geneva University Hospitals

• OCDEM

• Stanford University School of Medicine

• Umeå International School of Public Health

• University of Brasilia

• University of California at San Francisco

• University of Geneva

• University of New South Wales

• University of Oxford/Radcliffe Infirmary

• University Potchefstroom

• University of Queensland, School of Population Health

• University of Sydney

• University of Toronto

• Vanderbilt Diabetes Centre

Organisations

• European Centre on Health of Societies in Transition

• Healthy Eating & Active Living HE+AL Partnership

• International Council of Nurses

• International Federation of Pharmaceutical Manufacturers Assoc.

• International Obesity TaskForce

• OECD

• SustainAbility

• The World Bank

• World Health Organization

• World Heart Federation

• World Medical Association

• European Association for the Study of Diabetes

Slide No 20 • •

oxfordvision2020.org