The European Diabetes Leadership Forum: Opening session

26/04/2012

Ministers, Ladies and Gentlemen, distinguished guests

It is a great pleasure to welcome you to the European Diabetes Leadership Forum on behalf of the Organisation for Economic Co-operation and Development. I am especially pleased to see many representatives from community organisations, the private sector, governments and the research community.

Some people may find it strange that the OECD is so interested in diabetes that it has organised this conference along with our colleagues at the Danish Diabetes Federation. But I am sure that people in this conference all understand the reason why. Diabetes is not just a personal misfortune. If we do not address it in a timely and appropriate way, it will be an economic disaster.

The challenge we face is huge. Estimates suggest that 83 million people had diabetes across OECD countries in 2010. But the rates are much higher in some countries: nearly one in 10 people in Portugal, one in 11 people in Germany and nearly one every 12 in Turkey live with the condition. High rates of new cases in children are especially a cause for concern in some OECD countries.

Chronic diseases such as diabetes have high cost for the economy and society. Health expenditure to treat and prevent diabetes and its complications may have been as high as EUR 89 billion in Europe in 2011. We have been hit by the economic crisis, and health budgets are under even more pressure than before. We must improve efficiency in chronic care management, in order to prevent and control non-communicable diseases such as diabetes.

High health expenditures are only one of the problems caused by our failure to address chronic diseases properly.
•   They also reduce employment opportunities and earnings.
•   People who have diabetes are more likely to have depression and find it more difficult to follow treatment guidelines.
•   There are vast hidden cost for families and caregivers.

We must take quick action to address these serious challenges. But this is no task for governments alone. Civil society and the private sectors have a role to play. I would like in the remaining of my talk to suggest three main directions for action.

First of all, we need to step up effective prevention to reduce or delay the onset of Type 2 diabetes -- a largely preventable condition.

We know that obesity is the single most important risk factor for diabetes and a main determinant of other Non-Communicable Diseases such as heart disease and cancer. Today, at least one in two people are overweight or obese in more than half of the 34 OECD countries. More than two out of three people will be overweight or obese in some OECD countries within ten years. Obese people are 8 times more likely to develop type 2 diabetes. Severely obese people are up to 60 times more likely to develop type 2 diabetes.

Severely obese people die 8-10 years sooner than those of normal weight. And the cost for health systems is huge. In the United States alone, obesity absorbs between 5 and 10 percent of total health expenditure.

These are alarming figures, but we already know some of the things we should be doing. More attention to prevention of obesity is one. Our own work at the OECD shows that in Western Europe an investment of solely 21 US dollars per person per year could buy effective measures, such as national health-promotion campaign through the mass media, food-labelling programmes, regulation of food advertising and fiscal measures involving a combination of food taxes and subsidies. Such prevention strategies are more cost-effective than treatment routinely provided by health services..

Many governments have boosted efforts to fight the root causes of the epidemic – including unhealthy diet and physical inactivity. Comprehensive primary care strategies involving communities and key stakeholders have been put into place -- with some results. Recent data suggest that the obesity epidemic slowed down during the past three years in Korea, Switzerland, Italy, Hungary and England, for example. But the real innovation is that several governments - Denmark, Finland, France, Hungary – have passed legislation taxing foods rich in fat and sugar. These initiatives can change eating habits and generate important revenues – an attractive measure in time of tight fiscal constraints.

Let me move now to the management of chronic dieses such as diabetes.

Community-based care must be at the heart of strategies to manage diabetes. Disease management programmes, supported by nurses and primary care physicians, and programmes to encourage patients to control their conditions, have been introduced with great success in some countries.

Payment systems should reward good outcomes and continuity of care. For example, the Netherlands has experimented with a bundled payment system for diabetes care, along with some other chronic diseases. This will encourage providers to deliver integrated care and to stick to protocols of good clinical practice.

Pay for performance is another innovative area. Experience from Germany, France and the United Kingdom suggests that it is possible to encourage providers to deliver better care by paying them for outcome improvements. In all these countries, incentive payments encourage physicians to follow evidence-based guidelines for diabetes management.

Some such approaches seem to work better than others. Some may work only in specific systems or for specific conditions. Some may not work at all. All will take time and may need to adapted over time to address unwanted consequences – for example the risk that providers focus only on what they are specifically paid for, neglecting co-morbidities. However, all of these innovations have one thing in common: they change the practices of providers, purchasers and patients in order to increase value for money in chronic care management. We must encourage providers, the private sector and community groups to experiment with new ways of delivering diabetes care.

My last point is that we must monitor the quality of diabetes care. Data collected by the OECD show that there are large variation in admission rates for uncontrolled diabetes across OECD countries. Spain and Israel, have low admission rates, while Austria and Hungary, have rates that are double the OECD average. Finland, Sweden and Denmark, have considerably higher male admission rates compared to females.

We still know too little about what explains these cross-country variations, and how practice on the ground can make a difference to outcomes. It is my hope that this Forum will offer an opportunity to learn more about useful practices across Europe.

To conclude, the obesity epidemic and the surge in related chronic diseases, including diabetes, is a major economic challenge, especially in the current economic context. Lower employment, lower wages, and higher health care costs will result unless we take action now. And when I say ‘we’, I do not just mean governments, though they are, of course, a main focus of our attention. We also need changes in schools, workplaces, community groups, the food and beverage industry, medical practices and hospitals – and in individual behaviour. This is a challenge for all society. But, if we succeed in preventing and controlling diabetes, our societies and economy will be healthier. I look forward to the outcomes of this Forum and wish you a very productive two days.