Speech to Diabetes NZ annual conference

Good morning to you all. Thank you for inviting me here today.

Diabetes NZ has had a strong history of effective support for people with diabetes. I understand that during Diabetes Awareness Week last year [2005] your website received so many hits it was ranked fifth in the “hitwise” website awards. Having been around since 1962 you have made a huge contribution to the community. Like many NGOs the health system is better for your presence. You also have huge cross-party support within Parliament and at parliamentary meetings. This quite clearly demonstrates the practical value that you bring to the health sector.

This practicality is marked by your contribution to research – I'm thinking of the reports done for you by PricewaterhouseCoopers. The 6 recommendations from the 2001 report, together with other research sources, have provided input into the considerable work programme that I will speak about later. I hope that we have time before morning tea to discuss that work and various initiatives.

So I want to acknowledge your work and thank you for the work that you carry out through your contracts with the Ministry of Health. But I also want to challenge you, because we are in a serious situation with diabetes in New Zealand. It is a significant cause of ill health and premature death. The costs are very high in terms of loss of life, loss of full enjoyment of life and the impact on friends and family. Much of this is preventable, and yet we have witnessed an explosion in the numbers of people affected by type 2 diabetes.

A widely acknowledged paradox is that as society becomes generally more prosperous, as we have greater access to energy-dense food and become less active, the adverse impacts fall more heavily on those in low socio-economic groups.

I challenge you to reach all people with Diabetes, but I would like you to know that I do not issue challenges to you alone. The actions needed to beat this epidemic will be across society and across agencies. The actions needed to support those with the disease must include everyone. Possibly a third of people affected don't even know they have the disease and of those who are aware of their status, not all are optimally managing their disease. How can we improve this situation? We cannot view the prevention, detection, and management of this disease as one-size-fits-all. Let's acknowledge the higher rates of type 2 diabetes facing Maori and Pacific people and those in low socio-economic groups.

This Labour-led government has a clear vision for health. There are several key documents that have created a foundation for this vision. Amongst them are: the New Zealand Health Strategy, the New Zealand Disability Strategy, He Korowai Oranga (the Maori Health Strategy) and the Primary Health Care Strategy.
I know that some of you have called for your own Diabetes Strategy similar to the Cancer Control Strategy or the Healthy Eating Healthy Action Plan (HEHA).

HEHA is the Ministry’s strategic approach to improving nutrition, increasing physical activity and reducing obesity for all New Zealanders. Implementing HEHA will help to reduce some type 2 diabetes and CVD, but also may assist in preventing some cancers and assist with alleviation of some symptoms of arthritis.

The documents I mentioned are not exclusive of the aims of Diabetes NZ. These documents have created the 'map' for how we can progress and deliver on better health for all. They are already delivering. The first of the 6 recommendations in the 2001 PricewaterhouseCoopers report asked for more appropriate, affordable and accessible services for people with type 2 diabetes. The Primary Health Care Strategy (PHCS) represents the most unprecedented investment in the primary health of this nation. In little over 14 months all New Zealanders will benefit from lower general practice fees and pay no more than $3 for most of their medicines. At this primary health community level there are many, many health promoting initiatives directly benefiting those with diabetes. Just a small sample includes: screening programmes, healthy shopping groups, walking groups, and podiatry clinics. The $2.2 billion dollar Primary Health Care Strategy invites a complete rethink of how we view health.

District Health Boards for the last 5 years have measured against three national indicators: diabetes detection, management and retinal screening. From 2007, Primary Health Organisations (PHOs) will introduce another diabetes-specific indicator. Another strategy would not necessarily deliver better outcomes.

The Ministry work programme around diabetes includes:
• The ‘three year diabetes/CVD Quality Improvement Plan’ for completion in July,
• A toolkit agreed and signed off for a ‘National Diabetes/CVD Self Management Programme’ also for completion in July,
• Health Information Strategy NZ Action Zone 7 – chronic conditions – is implemented with clinical support for completion in December, and
• The New Zealand Guidelines Group released the new guidelines for Assessment and Management of CVD Risk and Management of Type-2 Diabetes at the end of 2003. They are being translated into electronic decision support tools to assist GPs undertaking risk assessment and care planning.

Improving outcomes for people with conditions such as diabetes, cancer and heart disease are explicit priorities in current work. We want to take a health-promoting approach and prevent problems from arising through early detection of risk factors.

Prevention is key, but this government will not abandon people who have the disease. The leader of the second largest party in parliament is on record as saying that he questions whether we can give precious health services and resources to people with diseases attributable to lifestyle choices. The answer from this Labour-led government is we can and we do, but we are also working with New Zealanders to reduce the incidence of preventable disease.

It is crucial that we strongly communicate and internalise the message that lifestyle matters. It is staggering that about 11,000 people a year in New Zealand die from nutrition-related conditions. Of these 11,000 deaths, 8000 to 9000 are likely to be due to dietary factors alone, and the remaining 2000 to 3000 due to sub-optimal physical activity levels.

In response to the palpable hazard that modern lifestyles can be, the Ministries of Health and Education, as well as Sport and Recreation NZ (SPARC) have a three-way understanding about the importance of lifestyle messages.

Tomorrow Professor Norman Sharpe of the National Heart Foundation will be talking about the common underlying causes of cardiovascular disease and type 2 diabetes. The common lifestyle sources of these two conditions are fundamental to current government health policy. The evidence base for addressing improved nutrition and increasing physical activity to simultaneously minimise the impact of heart disease and type 2 diabetes is very sound.

Genuine community-level support must be there to help positive lifestyle changes. Healthier food choices, an environment conducive to physical activity, and the support of peers, are all essential in the lives of people with both types of diabetes.

Type 1 diabetes can’t be prevented, but it is crucial that it is well managed. Managing diabetes means better health, as well as saving vital health resources. Some simple self-management interventions – like looking at insulin adjustment – can improve quality of life within a year. Interventions like this show a 25 per cent reduction in overall complications. Costs associated with hospitalisation and other expensive health care can also be minimised through good management.

The 'Get Checked' programme is intended to bolster individual's management techniques. This free annual check for people diagnosed with diabetes ensures that potential problem areas – like eye and foot circulation, blood pressure and kidney function – are monitored, so trouble areas can be addressed as early as possible.

This conference is focusing on effective ways of managing existing diabetes. Confidence and knowledge, both in the early stages after diagnosis and continually as the condition evolves, are paramount to maintaining good levels of health. I wish you all well and thank you again for this invitation.

Ends

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