Diabetes feature: the politics of diabetes

By Tanya Hollis
Monday, 15 July, 2002

As well as the many clinical research projects looking for cures and better treatments, a major emphasis in stemming the level of adult-onset diabetes in Australia lies in education and awareness.

With two international studies last year demonstrating that lifestyle changes could halve the incidence of type 2 diabetes, specialists in the field are keen to implement a plan of attack. But it appears that politics could hamper genuine efforts to get the ambitious goal off the ground, as various groups disagree over priorities.

National Diabetes Strategy Group chairman Prof Don Chisholm says no country in the world has successfully implemented a plan to change entrenched lifestyle habits - such as overeating, inactivity and smoking - in such a way as to reduce diabetes risk.

"The intensity of effort needed to get people to change their lifestyle is very high," Chisholm says. "We know what to do, but the question is how best to do it and within the resources that are available and that's something we're actually grappling with at the moment."

The issue of resource allocation is one that fires up another member of the strategy group, Prof Paul Zimmet. Zimmet, who was also a member on a now defunct diabetes taskforce set up by previous Commonwealth Health Minister Dr Michael Wooldridge, believes the current advisory group does not have enough influence over how federal money is spent.

"The strategy group, to my feeling, is too much constrained by a direct relationship with the Department of Health, which is trying to run an agenda rather than taking into account the considerations of people in the diabetes world," Zimmet says.

"I think the department may have resented previously the influence the National Diabetes Taskforce had on deciding what ought to happen and now that influence is back with the department, they have the money and we have much less power."

Zimmet believes some of the initiatives being pushed by the department, such as the $80 million National Diabetes Incentive Program that rewards GPs who test patients for diabetes risk factors, are misguided. He says that while it was a good idea, it did not guarantee improvements to the care of people with diabetes, and he argues that the money could have been better spent.

He also expresses some concern that the absence of a committee with a direct line of communication to the minister means the new Health Minister, Kay Patterson, might not be properly briefed on the extent of what he terms a diabetes epidemic.

Zimmet says issues of concern include the fact that there is not enough funding to have newer diabetes medicines and insulins added to the Pharmaceutical Benefits Scheme list, and that organisations like Diabetes Australia have been unsuccessful in winning government funding for its Know Your Blood Glucose Level awareness campaign during National Diabetes Week.

Other leading figures in diabetes have echoed Zimmet's fears that Canberra could shift down a gear without a vigorous fight to keep the disease on the agenda, adding that it is time to stop producing reports and guidelines and time to put talk into action.

Chisholm maintains the GP initiative is money well spent, that diagnosis and management guidelines were working well and that education programs in schools were leading to healthier lifestyle choices. But he says more has to be done to target high-risk groups including indigenous Australians, people from non-English speaking backgrounds and those with an affected family member or other risk factors.

Chisholm says there is enough funding to support the advisory group through its planning process, expected to take a year, but concedes that what happens beyond that time remains unknown.

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