To tackle diabetes, strengthen primary health care and empower families

Diabetes is a significant threat to public health across the WHO South-East Asia Region. An estimated 91 million people in the region suffer from diabetes. Around 49 million – more than half – are unaware they have it, reads a press note issued by the World Health Organisation (WHO). Undiagnosed or poorly controlled type 1 or type 2 diabetes can lead to heart, kidney, nerve or eye damage, the press note reads, adding that it can also lead to premature death, which in the region accounts for just under 50 per cent of all deaths caused by noncommunicable diseases (NCDs). “Preventing and controlling NCDs is one of the region’s eight Flagship Priorities.”
As part of the region’s primary health care approach to tackling diabetes, families must be empowered to act. Families have an important role in creating awareness of the risks of diabetes, including overweight and obesity. They can also instill healthy habits like physical activity that help prevent diabetes, including its early onset, which in the region is high. In addition, family members are often the first to identify diabetes’ signs, symptoms, risks and complications. When complemented by access to quality primary health care, families are an important asset in the battle against diabetes.
The region’s member states are taking decisive action. All countries have developed national multisectoral NCD action plans. Each plan contains specific interventions to tackle diabetes. Their roll-out has occurred alongside member state efforts to strengthen primary-level NCD services, which will also help the region achieve its Flagship Priority on universal health coverage. Several opportunities exist for the region to sustain and accelerate its progress and achieve the ‘25x25’ and Sustainable Development Goal (SDGs) targets. Each of them should be grasped, the press note reads.
First, all families should have access to educational resources on diabetes. This can be done via social and behavioral change campaigns that highlight the family unit’s role as a first line of defense. Campaigns should also outline how families can work together to develop healthy habits. This is particularly important given most diabetes cases are type 2, meaning they can be avoided by healthy eating and adequate physical activity.
Second, access to healthy environments should be increased. The creation of green spaces and outdoor gyms will facilitate exercise and the weight management it brings. “So too will efforts to reformulate unhealthy food and drinks and enhance people’s ability to make healthy choices,” the press note reads, adding that though these measures go beyond the health sector, health authorities should act as nodal agencies, working across sectors to find high-impact solutions that also reduce health care costs.
Third, all families should have access to quality primary health care. Primary-level services must be equipped to detect diabetes, including the high and rising incidence of pre-diabetes. A reliable supply of quality medicines and medical products that can help manage cases should be on hand. Each of the interventions outlined in the Colombo Declaration on accelerating the delivery of NCD services at the primary level, which the Region adopted in 2016, must be fully implemented.
The region’s efforts to halt the rise of diabetes by 2025 and beyond must continue. It must also be scaled up. On World Diabetes Day, WHO reiterates its commitment to supporting member states tackle diabetes via a multisectoral, primary health care approach that empowers families, it reads, adding that together we must fight diabetes. “Together we can win.”
WHO’s South-East Asia region comprises the following 11 member states including Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.

Accelerate health equity for older people and advance universal health coverage

Populations across the WHO South-East Asia Region are ageing. Whereas in 2010 older people accounted for 8 per cent of the Region’s population, by 2017 they accounted for 9.8 per cent. That number will continue to rise, with older people expected to make up 13.7 per cent of the population by 2030 – or 289 million people – and a significant 20.3 per cent by 2050. Though the proportion of older people in the region is projected to remain below global levels, the speed of the region’s demographic transition is faster.
Action is needed to ensure all older people can access the health services they need, when they need them, without financial hardship. The health issues older people face are diverse. In addition to the increased risk of noncommunicable diseases (NCDs), older people encounter challenges around mental health – including dementia – and greater incidence of injuries and disabilities due to declining functional ability. As the number of older people grows, the demand for primary care services that can screen, assess and manage clinical and functional comorbidities is increasing. That is likely to continue as urbanization proceeds and family structures change. 
As the Region strives to achieve universal health coverage, which is one of eight Flagship Priorities, there is a clear need to accelerate health equity for older people. To do that, the Region’s Framework on Healthy Ageing must be fully leveraged, with a focus on several priority interventions.
First, health authorities should strengthen the capacity of primary level services to respond to the health needs of older people in an integrated manner. WHO’s Integrated Care for Older (ICOPE) People training manual provides comprehensive guidance on how primary health care providers can screen, assess and manage a range of health problems, including diseases, mental health issues and functional impediments. It is imperative the ICOPE is fully harnessed.
Second, when older people encounter complications or limits to their mobility due to falls, NCDs, dementia or nutrition-related problems, access to key services – including specialised care – is needed. While the focus should be on ensuring older people can stay independent and healthy in their homes, long-term care that is close to where they are from should be accessible and of adequate quality. The provision of palliative care, including end-of-life care, should be enhanced as a matter of priority.
Finally, to promote healthy ageing, advocacy campaigns should be developed and rolled out Region-wide. As people grow older they should be reminded that they can do so in a way that allows them to continue to contribute to society. In addition, increased focus should be given to building age-friendly infrastructure that promotes older people’s independence.
On the International Day of Older Persons, we must reflect on the need to accelerate health equity for older people and ensure their right to health is respected, protected and fulfilled and that society continues to benefit from their participation and input. WHO is committed to supporting the region’s member states achieve both outcomes and advance their quest to achieve universal health coverage and leave no one behind.

Families are the first line of defense in the battle to prevent and manage diabetes

Families that know the signs, symptoms, risks and complications of diabetes are best positioned to prevent the disease and seek medical care to manage it. Health authorities region-wide should harness this capacity given an estimated 91 million people in the WHO South-East Asia Region live with diabetes, with around 49 million unaware of their condition. Undiagnosed or poorly controlled diabetes type 1 and type 2 can cause heart, kidney, nerve and eye damage, as well as premature death.
The importance families have in creating awareness of the risks of diabetes – including overweight and obesity – and in preventing and managing it, is apparent. Families provide a ready-made means to instill healthy habits that last a lifetime, dramatically reducing the risk of diabetes type 2, which accounts for the majority of diabetes cases. They can also help ensure the disease is detected and managed effectively. Doing so will avoid complications and the costs it results in for individuals, families, communities and countries.
As part of the Region’s Flagship Priority of tackling noncommunicable diseases (NCDs) – to which diabetes is a major contributor – Member States Region-wide can empower families to address the disease and enhance health outcomes. That should occur at the same time as increasing access to services for diabetes and other NCDs at the primary health care level, as outlined in the Colombo Declaration adopted Region-wide in 2016. There are several ways to do this.   
First, health authorities should ensure all families have access to educational resources that help them better understand diabetes. This can be done via social and behavioral change campaigns that emphasise the family unit as a first line of defense, at the same time as highlighting how they can work together to develop healthy habits and diminish the risk of diabetes.
Second – and to enable this – health authorities can work across sectors to increase the access individuals and families have to healthy environments. The creation of green spaces and outdoor gyms in urban areas, for example, can facilitate exercise and the weight management it brings. So too can policies to decrease the amount of sugar and fat in foods and enhance people’s ability to make healthier choices.
And third, all families should have access to affordable diabetes medicines, medical products and care. This starts with ensuring services at the primary level are equipped to detect the disease and that a reliable supply of medicines and medical products used to manage it are on hand. It extends to ensuring those medicines and medical products are affordable to all and are of adequate quality.
Each of the Region’s Member States are dedicated to implementing National Multisectoral Action Plans to tackle NCDs and to prevent, treat and beat diabetes, including by applying the WHO Package of essential noncommunicable disease interventions (WHO PEN) at the primary level. This is commendable. WHO will continue to support all Member States empower families to tackle diabetes head-on, and to ensure all families everywhere can do so effectively.