Australian Obesity – missing the fat target. Queensland policy may be forecasting a shift in National Healthcare Policy

An article today in the Courier Mail is trying to come to terms with the fact obesity is directly costing the Queensland State Government $5 billion a year. On top of that, another $22 billion is being eaten away in lost productivity as a result of chronic diseases linked to obesity.

But what’s the plan? A user-pays healthcare system for obese people. Yes that’s right, NO education, NO prevention: if you’re fat, you pay.

Surely this is a huge misalignment with Federal policy, since the Federal government announced in March 2007 that close to $1 billion would be spent on preventing obesity and type-2 diabetes? If the QLD Government aren’t going to expand education and awareness to prevent obesity, and the they are negotiating a new funding arrangement this year with the Federal government – could this be a sign of the Federal Government stepping back and not touch chronic diseases and obesity?

This policy would serve no purpose but revenue-saving. It would put Australians into dire situations where they cannot pay for needed treatment to make them healthier again – what a farce!

Australia: World’s Fattest Nation

It comes as no surprise that Australia is one of the fattest nations in the world. But to be the fattest shocks me, as it does to most Australians, but probably not to the 26% that are now officially overweight.

That’s right, Australia has now overtaken the United States in the proportion of adults that are overweight or obese. 26% of Australia’s adults are overweight, compared to 25% of Americans.

A report, Australia’s Future Fat Bomb (by the Baker IDI Heart and Diabetes Institute), shows that the middle-aged population are driving this epidemic, with 7/10 men and 6/10 women aged 45 to 64 now being the holders of a BMI of 25 or more.  Yes, that’s 65% of people between 45-64 being officially overweight.

An analysis of the data shows there will be an extra 700,000 heart-related hospital admissions in the next 20 years due to obesity alone.

Continually disturbing is the fact that 650’000 Australians have Type-2 Diabetes. Another 650’000 estimated to have Type-2 diabetes, but are undiagnosed. With such a serious trend towards obesity, this number is going to rise, not fall.

The report has called upon subsidising gym memberships for overweight people. However, it takes will-power, not Government spending to change this trend. The reason why people are overweight in the first place is because of their lifestyles and their unwillingness to change them. So why would they then go to the gym if you get 20% off a membership?

New.com.au reported that “Wait lists for surgery could be prioritised on the basis of weight loss”, another move towards rewarding people for being overweight. WHAT!? Healthier people should be rewarded with shorter waiting queues, not punished. Seriously, if i was going in for elective ankle surgery (or anything else), why not slap on 15 extra kilo’s and get pushed up the queue?

The contradictions in the Federal Government’s obesity strategy are widespread:

• Subsidising Gym memberships for lazy & obese people: because that will work!
• Pushing overweight people ahead of healthy people in surgery waiting lists: because that’s rewarding the other 74% of healthy Australians for taking care of themselves.

It’s time the Federal government woke up and realised that these plans will reward overweight people.

Means-testing the subsidies for Insulin pumps & contradictions.

So our Federal budget awarded $5.5million towards subsidising insulin pumps for Under-18 year-olds. However, the Federal government also announced in a broad policy that Private Health insurance is no logner compulsory. Will people with diabetes fall into a very large hole?

But how is this money to be distributed? The subsidy, awarded up to $2’500, does not do much to help struggling families who are competing with the costs of diabetes.

Changing Diabetes – what is it about?

We always talk about “Changing Diabetes”, and changing people’s perceptions and making them aware of the problems diabetes causes, especially in the hope to prevent the onset of Type-2.

Being with the Novo Nordisk Changing Diabetes Bus in San Francisco for the American Diabetes Association Scientific Sessions was one of those times when everything comes together – and i finally saw the reward from the work we do. Believe it or not, it was through talking with a 7-year old boy.

(Are you) going to San Francisco…

So i’m off to San Francisco on Wednesday to be with the Novo Nordisk Changing Diabetes Bus. It will be at Pier 39 as part of the American Diabetes Association 68th Scientific Sessions. It’s a huge congress, very well respected with information, new products, new research being released and lots of advocacy updates.

The bus was launched in September 2006 in Copenhagen which i was lucky enough to help launch, and then travelled to Germany, The Netherlands, Belgium, France, South Africa, Australia, Japan, China, Canada, USA (stationed in NYC for World Diabetes Day 2007) and India. I’m sure there are some countries i’ve left out!

I’ll be reporting each day wih a short post, and you can also find our reports here.

Happenings!

Well i know i’ve been slack with updating my blog, and for that my apologies!

We’ve recently had a change in Federal Government here in Australia, which poses a few issues. The previous Howard government promised $22million towards increasing access and reducing the outlay prices of insulin pumps (which here, un-covered by insurance, cost around $US10’000) each. The obvious strain on families and/or the person with diabetes is significant, on top of the ongoing costs of insulin and consumables (even though they are funded by PBS and the NDSS respectively).

The ongoing argument remains: does a government pour money into subsidising insulin pumps, which some people say would be a luxury healthcare item? I beg to differ to those arguing the no, which is the case taken up by so many governments over the world.

You see, without an insulin pump, a type-1 diabetic can only go so far without feeling like a pin-cushion. A basic basal/bolus regime using insulin pens (or syringes) will cause the person with diabetes to be injecting up to 8 times a day to have proper, controlled care. Even then, the variations in BGL’s can still be extreme, causing a higher overall HBA1c, and putting the person with diabetes at a much higher risk of future complications.

But this point is overseen by governments and private healthcare insurance providers. They fail to realise that a person with diabetes can not have ‘perfect’ care on insulin pens/syringes alone, despite how effective the insulins may be.

The subsiding of insulin pumps is an investment, quite plainly. Insulin pumps make it easier for people with diabetes to take better care of themselves, reducing the risk of further complications. Now what does this do? This helps reduce the risk that in the future, governments will be paying for the kidney dialysis, the post-op amputation care and rehab, the constant heart monitoring and eye checks, and possible eye/laser surgery.

Unfortunately, governments, cabinets and ministers/secretaries alike fail to realise that spending now prevents larger spending in the future.
This effect is further compounded by the double-whammy effect of having a diabetes pandemic – with more and more people with diabetes, this will lead to more and more people with diabetic complications; causing further strain on Medicare and similar systems.

So the solution remains clear; Invest now to prevent imminent social and financial hardship, not only for people with diabetes and their families, but for healthcare and Medicare-related systems.

Halle Berry – A fairly confused ‘advocate’ for diabetes..

Halle Berry, diagnosed with Type-2 diabetes in 1989, is possibly one of the most famous persons living with diabetes. However, this fact is coming under scrutiny.

Berry is in a perfect position to be a global advocate and ambassador for people with diabetes. Beautiful, well-known and a person with diabetes herself, there is no limit to the effect she can make with her words. However, that all depends on the words that actually come out. In the past, she has shown diabetes in an accurate light. In an article with the Daily Mail, she explains her usual day living with diabetes.

"Diabulimia" – lack of psychological care & counselling.

Something that has caught my eye recently has been the sudden media exposure of a situation most common amongst young diabetic women as ‘diabulimia’ – the practice of lowering or completely omitting insulin as a way of losing weight and staying ‘healthy’.

I came across this article, from the ABC from back in June this year which explains the fight to have diabulimia recognised as a phycological and medicla condition. Whilst eating disorders are usually classified as a psychological condition, it’s time diabulimia be seen as a medical condition on top of this. The article claims that women with Type-1 diabetes are twice as likely to develop an eating disorder than those without Type-1 diabetes.

India: Nayana Eye Care & WDF

As part of my role with the International Diabetes Federation (IDF) and Novo Nordisk, I volunteered to go to rural Karnataka (southern India) for 10 days to see the Nayana eyecare clinic in action. The clinic is part of a wide range of care and outreach programs funded by the World Diabetes Foundation (WDF) in India. These include footcare, diabetes camps, eyecare and diagnosis. The WDF also funds many projects in other developing nations around the world.

The clinic runs as part of the Vittala International Institute of Opthalmology (VIIO), and is supported by the WDF. The aim of the clinic is to take care and expertise into rural Karnataka in an effort to diagnose, treat and educate local doctors and patients about diabetic eye care.

The clinic itself is housed in an Ashok Leyland van, carrying vital laser, fundus cameras, ultrasound and plenty more equipment. It is also equipped and prepared to do Fundus Angiograms. The van travels for around 25 days a month, visiting rural towns and villages treating patients.

VIIO recognised that part of the problem in India is that the only care for people with diabetes is located in state capitals such as Bangalore (the centre for VIIO). Travel costs, accomodation costs, lost income from days spent away from work and a general fear of large cities and unknown doctors prevents nearly every patient from following up in the traditional model of care. Originally, when VIIO was stationary in Bangalore, their referred patients from rural Karnataka would have a 100% drop-out after the first consultation. Patients could not simply go back 3 months later for the above reasons. As such, they could not follow up with care, significantly effecting the chances of saving their own vision.

However, with the Nayana mobile eye care clinic, the doctors from VIIO and Prabha Eye Hospital (both based in Bangalore) are able to travel with the clinic and treat patients in their local towns. The VIIO & Prabha doctors act as consultants, and educate the local doctor(s) in eye treatment using lasers and other tools on the van. In tricky situations, the consultants will often do the treatment, with the referring doctor viewing the procedure through modified instruments specially made for the clinic.

The clinic used to visit 8 districts, but has now grown to 13, with plans for further expansion soon. On average, around 30-45 patients would be consulted per day, with around 20 needing treatment – with that treatment being delivered the same day.

Subbakrishna Rao, the project manager for Nayana, explained that “the main success of this program has been around the recruitment of the local doctors. They get a financial benefit from referring the patients to us, and the patients get treated quickly and without any hassles from going to Bangalore.” He explains the simple model to us, that when patients pay for treatment, the clinic keeps 30%, and the local referring doctor keeps 70%. Those who cannot pay for care do not have to. The financial benefit has been the main incentive for most of the local doctors. “Without the incentive, why should doctors refer patients to us?” Rao says. The bonus is also for the patients, and with the education the doctors receive while attending the clinic with their patients, they can then convey this on in future to their patients. “There is a big problem, and that is that some patients do not like other doctors or doctors they do not know. At least here they can be treated and cared for by their own doctors”.

The success of such a project is hard to guage, as Rao identifies. Whether it be financially sound, socially equitable or about saving vision, Rao does not talk of any of this when talking of a target. He says that the way to show that this project is succeeding is that “by next year, it [Nayana] will be self-sustainable.” The bonus of this is obvious; “We can continue our work, keep expanding and most of all offer the care that is so urgently needed”.

Alex

WDD November 14 and YOU!

As we gear up for the first ever UN-recognised World Diabetes Day (WDD), there are a number of activities happening around the world that you can be part of. Making as much noise, exposure and awareness of WWD is integral for the success of the Unite for Diabetes campaign.

So what can you do? Write, talk, yell, and now walk for the occasion! If you’re short on finding out what’s happening in your area, visit the WDD Official events page and get into it! If in the unlikely scenario that there isn’t a local event for you, by all means organise a walk, colour something in Unite for Diabetes blue, or form a circle with anything you can and send in photos! It doesn’t have to be a huge thing, just something to show that you beleive in uniting for diabetes.

Alternatively, contact the local patient organisation from your country and see if they are doing anything – a whole list can be found on the International Diabetes Federation’s website here.

Get into it!

Alex