Economics of controlling an epidemic
Sunday, 14 November 2010
Introduced in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to growing concerns about the escalating health threat that diabetes as imminent epidemic, World Diabetes Day (WDD) is celebrated every year on November 14. The day engages millions of people worldwide in diabetes advocacy and awareness. World Diabetes Day became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225 moved by Bangladesh. Bangladesh Diabetic Samity (BADAS), a non-government association, through the Government of Bangladesh became instrumental in campaigning for this resolution to draw attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. The WDD logo was also adopted in 2007 to mark the passage of the United Nations World Diabetes Day Resolution. The logo is the blue circle - the global symbol for diabetes which was developed as part of the Unite for Diabetes awareness campaign. The significance of the blue circle symbol is overwhelmingly positive, portraying the unity of the global diabetes community in response to the diabetes pandemic. Across cultures, the circle symbolizes life and health. The colour blue reflects the sky that unites all nations and is the colour of the United Nations flag.
Each year WDD is centered on a theme related to diabetes. Topics covered in the past have included diabetes and human rights, diabetes and lifestyle, and the costs of diabetes. This year sees the second of a five-year campaign that will address the growing need for diabetes education and prevention programmes. The campaign slogan for 2010 is 'Let's take control of diabetes, Now.' The day itself is celebrated on November 14, to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1921.
WDD is celebrated worldwide by the over 200 member associations of the International Diabetes Federation in more than 160 countries and territories, all member states of the United Nations, as well as by other associations and organizations, companies, healthcare professionals and people living with diabetes and their families.
Understand Diabetes And Take Control: Diabetes Education and Prevention is the WDD theme for the period 2009-2013. The campaign calls on all those responsible for diabetes care to understand diabetes and take control.
For people with diabetes, this is a message about empowerment through education.
For governments, it is a call to implement effective strategies and policies for the prevention and management of diabetes to safeguard the health of their citizens with and at risk of diabetes.
For healthcare professionals, it is a call to improve knowledge so that evidence-based recommendations are put into practice.
For the general public, it is a call to understand the serious impact of diabetes and know, where possible, how to avoid or delay diabetes and its complications.
The key messages of the campaign are (a) Know the diabetes risks and know the warning signs (b) Know how to respond to diabetes and who to turn to and (c) Know how to manage diabetes and take control. The objectives for the 2009-2013 campaign were framed by the Working group of the Federation's Consultative Section on Education and its Task Force on Epidemiology and Prevention. The objectives were further adopted by the World Health Organization's 'Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases : 2008-2013.'
The campaign goals are to:
l Encourage governments to implement and strengthen policies for the prevention and control of diabetes and its complications.
l Disseminate tools to support national and local initiatives for the prevention and management of diabetes and its complications.
l Illustrate the importance of evidence-based education in the prevention and management of diabetes and its complications.
l Raise awareness of the warning signs of diabetes and promote action to encourage early diagnosis.
l Raise awareness of and promote action to reduce the main modifiable risk factors for type 2 diabetes.
l Raise awareness and promote action to prevent or delay the complications of diabetes.
Diabetes-is a group of metabolic diseases, clinically known as Diabetes mellitus, in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. Glucose is vital to human health because it's the main source of energy for the cells that make up muscles and tissues and that is why it is the main source of fuel of the body. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).
If anyone has diabetes, no matter what type, it means he has too much glucose in his blood, although the reasons may differ and too much glucose can lead to serious health problems. There are three main types of diabetes: Type 1 diabetes: it results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
Type 2 diabetes: it results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
Gestational diabetes: it is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM. All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and retinal damage. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.
Startling Statistics: In the base year 2000, according to the WHO, at least 171 million people worldwide were suffering from diabetes, or 2.8% of the population. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will almost double.
Prevalence of diabetes worldwide
Study shows that Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Eastern Mediterranean (180%), Africa (160%) and Asia (155%) region, where most patients will probably be found by 2030. The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at the moment.
The Centers for Disease Control has termed the change an epidemic. The National Diabetes Information Clearinghouse of the USA estimates that diabetes costs $132 billion in the United States alone every year. About 5%-10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs. Most of this difference is currently neither understood nor analysed. The American Diabetes Association cite the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion that one in three Americans born after 2000 will develop diabetes in their lifetime.
History: The term diabetes was coined by Aretaeus of Cappadocia, was derived from the Greek verb diabaínein. In 1675, Thomas Willis added the word mellitus, from the Latin meaning "honey", a reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. Diabetes mellitus appears to have been a death sentence in the ancient era. Hippocrates makes no mention of it, which may indicate that he felt the disease was incurable. Indian philosopher Sushruta identified diabetes and classified it as Medhumeha. The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (Madhumeha).
In his 14 volume medical encyclopedia The Canon of Medicine, (1025) Avicenna (980-1037) provided, for the first time, a detailed account on diabetes mellitus, "describing the abnormal appetite and the collapse of sexual functions," and he documented the sweet taste of diabetic urine. Avicenna recognized primary and secondary diabetes and also described diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times. Avicenna also "described diabetes insipidus very precisely for the first time", though it was later Johann Peter Frank (1745-1821) who first differentiated between diabetes mellitus and diabetes insipidus.
The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not further clarified until 1921, when Sir Frederick Grant Banting ( 1891-1941) and Charles Herbert Best (1899-1978) led to the availability of an effective treatment-insulin injections. For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923; both shared their Prize money with others in the team who were not recognized, in particular Best and Collip. Banting and Best made the patent available without charge and did not attempt to control commercial production.
Insulin production and therapy rapidly spread around the world, largely as a result of this decision. Banting is honoured by WDD which is held on his birthday, November 14. Despite the availability of treatment, diabetes has remained a major cause of death. For instance, statistics reveal that the cause-specific mortality rate during 1927 amounted to about 47.7 per 100,000 populations in Malta.
The Bangladesh scenario: The International Diabetes Federation (IDF) estimated that 7.2 million or 4.8% of people living in Bangladesh had diabetes in 2007 and by 2025, that number is expected to grow to 9.2 million or 6.1% of the population. This explosion in diabetes prevalence will place Bangladesh among the top ten countries in terms of the number of people living with diabetes in 2025. At that date, 80% of all diabetes cases will be in low-and-middle income countries.
The increase in diabetes in Bangladesh is expected to follow global gender patterns, whereby more women than men will live with diabetes. IDF and WHO predict that the number of women in the world with diabetes will double in less than 20 years.
In Bangladesh the number of women with diabetes will grow from the current 2.0 million to 4.0 million by 2025. During the same period, men with diabetes will rise from 1.8 million to 3.4 million. Recent empirical studies shows the urban population with diabetes in Bangladesh is expected to increase dramatically over the next 20 years. This is due to a combination of urbanization and migration from rural to urban areas.
Professor AK Azad Khan, President of the Bangladesh Diabetic Samity (BADAS), observed, while talking to 'Unite for Diabetes' reporter Kerrita McClaughlyn on November 17, 2006, that, 'people all over the world, especially in developing countries, have the impression that diabetes is a disease of the rich. That is NOT the case. Diabetes is rising faster in developing countries like Bangladesh. There are many reasons for the increases, but a key reason is that lifestyles are changing faster in developing countries. This change is related to urbanization and globalization. You can't stop it, it is part of civilization. What is of concern is that with this increased urbanization people are getting less physical exercise. Even if they want to exercise, there's less space to do that. Workplaces, schools and colleges have few or no facilities for physical activity.'
The Bangladesh Diabetic Samity (BADAS), established in 1956 with the initiative of Late National Professor Dr M Ibrahim (1917-1989), has a declared motto - look after all people with diabetes irrespective of their ability to pay, status or other factors. BADAS has developed several institutions/projects and inspired a large number of affiliated associations all over the country to fulfill the mission. BADAS is self-reliant and not donor dependent. BADAS is the pioneer, model and first success story of Public Private Partnership (PPP) development in Bangladesh; it has developed infrastructure through partnerships with the government. BADAS provides services to the affluent and to people who don't have diabetes and through a policy of cross-financing, and then help those living with diabetes with the surplus capital that it generates.
BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) is the central institute of BADAS which provides comprehensive diabetic healthcare to the people. It is a unique creation of the BADAS and has been acclaimed as a model institution in Asia and the Pacific. The institute has: (a) 650 in-patient beds (b) A large out-patient programme. BIRDEM has about 0.4 million registered diabetic patients, more than 4,000 people visit every day here and out of these patients 75-100 are new patients. In review of this influx of patients treated everyday, BIRDEM has been adjudged as a unique and successful health service provider across the globe.
BADAS adopted a decentralized model and has spread care throughout the country. There are 57 affiliated associations in Bangladesh - almost one in every district. They are all affiliated to the BADAS. They have to follow certain standards - they must be democratic, transparent, must be run by social workers, and must be non-for-profit. In that BADAS has been able to create comparatively excellent diabetes awareness. Bangladesh is a developing country, but in terms of awareness of diabetes it is far ahead of some developed countries. Here people in general are aware of the need to act to soften the possible impact of the diabetes epidemic
BADAS is more than a typical diabetes association. Usually the main task of other Diabetic Associations is 'advocacy' and they work as a pressure group for the policy makers and heathcare providers, in addition to creating awareness among people. In contrast, apart from its role in advocacy and awareness, BADAS (and its affiliates) is the major provider of diabetes care in Bangladesh and, in fact, the largest overall comprehensive health care provider in the country next to the public sectors.
At the moment BADAS is looking after about 24% of all people with diabetes in Bangladesh and hopefully it will over 50% by 2020. BADAS is within close proximity with Government Health Services in making the aware of the need for high quality diabetes care. BADAS is ensuring that diabetes and endocrinology are included in the courses taught at medical colleges; it has successfully convinced the Ministry of Health to create posts for endocrinologists in public medical colleges.
Research is another area where BADAS puts great emphasis and this is unlike many other associations particularly in developing countries. Research is a tool for generation of context-based knowledge and also generation of skilled manpower. Recognizing the contribution of BADAS in this sector, in 1982 the WHO declared BIRDEM as a Collaborating Centre for Research on Prevention and Control of Diabetes.
Bangladesh wanted a UN Resolution on diabetes: BADAS played a pioneering role in both moving and campaigning for the adoption of UN Resolution 61/225 in 2007 in the premise that as in developing countries, healthcare is geared towards episodic care, which needs to change to a chronic care model that integrates the healthcare system, the community, and self-management support. A United Nations Resolution on diabetes certainly helps change this mind set. The UN Resolution has been a tremendous help in raising awareness. It has made controlling of diabetes job easier. It would also make policymakers, donors, and civil society aware of the problem.
Many in developing countries with diabetes face discriminations in getting jobs. Awareness could go a long way towards ending this. More people should know that type 2 is, to a large extent, preventable. The future need not be gloomy; a full and healthy life is possible with diabetes. That is a very important message for all affected by diabetes. The developing countries typically focus on communicable diseases. Non-communicable diseases like diabetes have been neglected. More attention is required urgently before these countries are overwhelmed by the diabetes epidemic.
The writer is a former Secretary of the government of Bangladesh and a former Chairman of National Board of Revenue (NBR). He can be reached at e-mail: mazid1273@hotmail.com
Each year WDD is centered on a theme related to diabetes. Topics covered in the past have included diabetes and human rights, diabetes and lifestyle, and the costs of diabetes. This year sees the second of a five-year campaign that will address the growing need for diabetes education and prevention programmes. The campaign slogan for 2010 is 'Let's take control of diabetes, Now.' The day itself is celebrated on November 14, to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1921.
WDD is celebrated worldwide by the over 200 member associations of the International Diabetes Federation in more than 160 countries and territories, all member states of the United Nations, as well as by other associations and organizations, companies, healthcare professionals and people living with diabetes and their families.
Understand Diabetes And Take Control: Diabetes Education and Prevention is the WDD theme for the period 2009-2013. The campaign calls on all those responsible for diabetes care to understand diabetes and take control.
For people with diabetes, this is a message about empowerment through education.
For governments, it is a call to implement effective strategies and policies for the prevention and management of diabetes to safeguard the health of their citizens with and at risk of diabetes.
For healthcare professionals, it is a call to improve knowledge so that evidence-based recommendations are put into practice.
For the general public, it is a call to understand the serious impact of diabetes and know, where possible, how to avoid or delay diabetes and its complications.
The key messages of the campaign are (a) Know the diabetes risks and know the warning signs (b) Know how to respond to diabetes and who to turn to and (c) Know how to manage diabetes and take control. The objectives for the 2009-2013 campaign were framed by the Working group of the Federation's Consultative Section on Education and its Task Force on Epidemiology and Prevention. The objectives were further adopted by the World Health Organization's 'Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases : 2008-2013.'
The campaign goals are to:
l Encourage governments to implement and strengthen policies for the prevention and control of diabetes and its complications.
l Disseminate tools to support national and local initiatives for the prevention and management of diabetes and its complications.
l Illustrate the importance of evidence-based education in the prevention and management of diabetes and its complications.
l Raise awareness of the warning signs of diabetes and promote action to encourage early diagnosis.
l Raise awareness of and promote action to reduce the main modifiable risk factors for type 2 diabetes.
l Raise awareness and promote action to prevent or delay the complications of diabetes.
Diabetes-is a group of metabolic diseases, clinically known as Diabetes mellitus, in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. Glucose is vital to human health because it's the main source of energy for the cells that make up muscles and tissues and that is why it is the main source of fuel of the body. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).
If anyone has diabetes, no matter what type, it means he has too much glucose in his blood, although the reasons may differ and too much glucose can lead to serious health problems. There are three main types of diabetes: Type 1 diabetes: it results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
Type 2 diabetes: it results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
Gestational diabetes: it is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM. All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and retinal damage. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.
Startling Statistics: In the base year 2000, according to the WHO, at least 171 million people worldwide were suffering from diabetes, or 2.8% of the population. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will almost double.
Prevalence of diabetes worldwide
| Region | 2000 | 2030 (incidence increase %) |
| Africa | 7,020,000 | 18,234,000 (160%) |
| Eastern Mediterranean | 15,188,000 | 42,600,000(180%) |
| Americas | 33,016,000 | 66,812,000 (102%) |
| European | 33,332,000 | 47,973,000 ( 44% ) |
| South East Asia( Bangladesh) | 46,903,000(3,196,000) | 119,541,000 (155%)(11,140,000) (149%) |
| Western Pacific Region | 35,771,000 | 71,050,100 (99%) |
| World Total | 171,000,000 | 366,000,000 (114%) |
Study shows that Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Eastern Mediterranean (180%), Africa (160%) and Asia (155%) region, where most patients will probably be found by 2030. The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at the moment.
The Centers for Disease Control has termed the change an epidemic. The National Diabetes Information Clearinghouse of the USA estimates that diabetes costs $132 billion in the United States alone every year. About 5%-10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs. Most of this difference is currently neither understood nor analysed. The American Diabetes Association cite the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion that one in three Americans born after 2000 will develop diabetes in their lifetime.
History: The term diabetes was coined by Aretaeus of Cappadocia, was derived from the Greek verb diabaínein. In 1675, Thomas Willis added the word mellitus, from the Latin meaning "honey", a reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. Diabetes mellitus appears to have been a death sentence in the ancient era. Hippocrates makes no mention of it, which may indicate that he felt the disease was incurable. Indian philosopher Sushruta identified diabetes and classified it as Medhumeha. The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (Madhumeha).
In his 14 volume medical encyclopedia The Canon of Medicine, (1025) Avicenna (980-1037) provided, for the first time, a detailed account on diabetes mellitus, "describing the abnormal appetite and the collapse of sexual functions," and he documented the sweet taste of diabetic urine. Avicenna recognized primary and secondary diabetes and also described diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times. Avicenna also "described diabetes insipidus very precisely for the first time", though it was later Johann Peter Frank (1745-1821) who first differentiated between diabetes mellitus and diabetes insipidus.
The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not further clarified until 1921, when Sir Frederick Grant Banting ( 1891-1941) and Charles Herbert Best (1899-1978) led to the availability of an effective treatment-insulin injections. For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923; both shared their Prize money with others in the team who were not recognized, in particular Best and Collip. Banting and Best made the patent available without charge and did not attempt to control commercial production.
Insulin production and therapy rapidly spread around the world, largely as a result of this decision. Banting is honoured by WDD which is held on his birthday, November 14. Despite the availability of treatment, diabetes has remained a major cause of death. For instance, statistics reveal that the cause-specific mortality rate during 1927 amounted to about 47.7 per 100,000 populations in Malta.
The Bangladesh scenario: The International Diabetes Federation (IDF) estimated that 7.2 million or 4.8% of people living in Bangladesh had diabetes in 2007 and by 2025, that number is expected to grow to 9.2 million or 6.1% of the population. This explosion in diabetes prevalence will place Bangladesh among the top ten countries in terms of the number of people living with diabetes in 2025. At that date, 80% of all diabetes cases will be in low-and-middle income countries.
The increase in diabetes in Bangladesh is expected to follow global gender patterns, whereby more women than men will live with diabetes. IDF and WHO predict that the number of women in the world with diabetes will double in less than 20 years.
In Bangladesh the number of women with diabetes will grow from the current 2.0 million to 4.0 million by 2025. During the same period, men with diabetes will rise from 1.8 million to 3.4 million. Recent empirical studies shows the urban population with diabetes in Bangladesh is expected to increase dramatically over the next 20 years. This is due to a combination of urbanization and migration from rural to urban areas.
Professor AK Azad Khan, President of the Bangladesh Diabetic Samity (BADAS), observed, while talking to 'Unite for Diabetes' reporter Kerrita McClaughlyn on November 17, 2006, that, 'people all over the world, especially in developing countries, have the impression that diabetes is a disease of the rich. That is NOT the case. Diabetes is rising faster in developing countries like Bangladesh. There are many reasons for the increases, but a key reason is that lifestyles are changing faster in developing countries. This change is related to urbanization and globalization. You can't stop it, it is part of civilization. What is of concern is that with this increased urbanization people are getting less physical exercise. Even if they want to exercise, there's less space to do that. Workplaces, schools and colleges have few or no facilities for physical activity.'
The Bangladesh Diabetic Samity (BADAS), established in 1956 with the initiative of Late National Professor Dr M Ibrahim (1917-1989), has a declared motto - look after all people with diabetes irrespective of their ability to pay, status or other factors. BADAS has developed several institutions/projects and inspired a large number of affiliated associations all over the country to fulfill the mission. BADAS is self-reliant and not donor dependent. BADAS is the pioneer, model and first success story of Public Private Partnership (PPP) development in Bangladesh; it has developed infrastructure through partnerships with the government. BADAS provides services to the affluent and to people who don't have diabetes and through a policy of cross-financing, and then help those living with diabetes with the surplus capital that it generates.
BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) is the central institute of BADAS which provides comprehensive diabetic healthcare to the people. It is a unique creation of the BADAS and has been acclaimed as a model institution in Asia and the Pacific. The institute has: (a) 650 in-patient beds (b) A large out-patient programme. BIRDEM has about 0.4 million registered diabetic patients, more than 4,000 people visit every day here and out of these patients 75-100 are new patients. In review of this influx of patients treated everyday, BIRDEM has been adjudged as a unique and successful health service provider across the globe.
BADAS adopted a decentralized model and has spread care throughout the country. There are 57 affiliated associations in Bangladesh - almost one in every district. They are all affiliated to the BADAS. They have to follow certain standards - they must be democratic, transparent, must be run by social workers, and must be non-for-profit. In that BADAS has been able to create comparatively excellent diabetes awareness. Bangladesh is a developing country, but in terms of awareness of diabetes it is far ahead of some developed countries. Here people in general are aware of the need to act to soften the possible impact of the diabetes epidemic
BADAS is more than a typical diabetes association. Usually the main task of other Diabetic Associations is 'advocacy' and they work as a pressure group for the policy makers and heathcare providers, in addition to creating awareness among people. In contrast, apart from its role in advocacy and awareness, BADAS (and its affiliates) is the major provider of diabetes care in Bangladesh and, in fact, the largest overall comprehensive health care provider in the country next to the public sectors.
At the moment BADAS is looking after about 24% of all people with diabetes in Bangladesh and hopefully it will over 50% by 2020. BADAS is within close proximity with Government Health Services in making the aware of the need for high quality diabetes care. BADAS is ensuring that diabetes and endocrinology are included in the courses taught at medical colleges; it has successfully convinced the Ministry of Health to create posts for endocrinologists in public medical colleges.
Research is another area where BADAS puts great emphasis and this is unlike many other associations particularly in developing countries. Research is a tool for generation of context-based knowledge and also generation of skilled manpower. Recognizing the contribution of BADAS in this sector, in 1982 the WHO declared BIRDEM as a Collaborating Centre for Research on Prevention and Control of Diabetes.
Bangladesh wanted a UN Resolution on diabetes: BADAS played a pioneering role in both moving and campaigning for the adoption of UN Resolution 61/225 in 2007 in the premise that as in developing countries, healthcare is geared towards episodic care, which needs to change to a chronic care model that integrates the healthcare system, the community, and self-management support. A United Nations Resolution on diabetes certainly helps change this mind set. The UN Resolution has been a tremendous help in raising awareness. It has made controlling of diabetes job easier. It would also make policymakers, donors, and civil society aware of the problem.
Many in developing countries with diabetes face discriminations in getting jobs. Awareness could go a long way towards ending this. More people should know that type 2 is, to a large extent, preventable. The future need not be gloomy; a full and healthy life is possible with diabetes. That is a very important message for all affected by diabetes. The developing countries typically focus on communicable diseases. Non-communicable diseases like diabetes have been neglected. More attention is required urgently before these countries are overwhelmed by the diabetes epidemic.
The writer is a former Secretary of the government of Bangladesh and a former Chairman of National Board of Revenue (NBR). He can be reached at e-mail: mazid1273@hotmail.com