The global diabetes epidemic presents an urgent need for global leaders to consider innovative approaches and rethink policymaking, health systems design, and the delivery of healthcare services. To do this, a coordinated, comprehensive and innovative approach is necessary. This was a key point brought up by Ministers, government representatives and speakers at the Ministry of Health’s (MOH) inaugural Ministerial Conference on Diabetes.
2. The Conference was attended by over 300 participants comprising Health Ministers, senior government officials, officials from the World Health Organization (WHO), the World Bank, experts as well as delegates, from 18 countries and regions1. On the first day, the delegates discussed challenges and opportunities in diabetes prevention, management and control.
3. The Conference affirmed that diabetes is a serious public health concern globally. Globally, 425 million adults lived with the condition in 2017 and this number is expected to rise to around 629 million, or one in ten adults by 20452. Diabetes is the seventh leading cause of death globally, and has become the biggest epidemic of the 21st century.
4. In his opening address, guest of honour Mr Tharman Shanmugaratnam, Singapore’s Deputy Prime Minister and Coordinating Minister for Economic and Social Policies, emphasised three mindset shifts – at the government, employer and individual levels – which have to be catalysed in order to effectively tackle diabetes. This requires a coordinated and comprehensive approach by governments towards encouraging healthier lifestyles, promotion of good health by employers in the workplace, and adjustment of lifestyle habits and better decision making by individuals. Innovative solutions, in areas such as technology, policy or behavioural nudges, and stronger partnerships are paramount to achieve these mindset shifts.
5. The need for a coordinated, comprehensive and innovative approach to tackle diabetes at different levels was echoed by the keynote speakers at the Conference.
i) Dr Svetlana Axelrod, Assistant Director-General, Non-Communicable Diseases and Mental Health, WHO, highlighted that diabetes can be treated and in many instances prevented, and that tackling NCDs requires global and political commitment. As resources may be limited in some countries, there is a need to identify the most cost-effective interventions that will have the greatest impact in tackling NCDs quickly and effectively.
ii) Dr Sania Nishtar, co-chair of the WHO Independent High-Level Commission on Non-Communicable Diseases, emphasised that to mount an effective response and a societal transformation towards healthier lifestyle choices, a re-engineering of health systems for chronic care, new cross-government norms in trade, commerce and fiscal decision making, and a culture of cross-government and public-private partnerships are necessary. Noting that Singapore has shown other countries how to make headway in the war on diabetes, she highlighted Singapore’s success in catalysing systems change, using science and evidence as key to change, and leveraging a full range of policy levers to tackle diabetes.
iii) Professor Paul Zimmet, Professor of Diabetes, Monash University, shared that the “tsunami of diabetes” and its complications and co-morbidities pose huge social and economic problems to most nations in Asia and the Pacific, which could impede national and global development. He emphasised that a multi-pronged approach was necessary to tackle diabetes.
Key Discussions at Panel Sessions
A. Challenges and Opportunities
6. The challenges in tackling the rising prevalence of diabetes – such as an increase in the associated risk factors for diabetes, rising costs of complications, and access gaps to screening and care management – spur the need for a reform of healthcare systems, redesign of health services and financing, and the use of technology for better healthcare delivery. The delegates agreed that a holistic response, with solutions targeting prevention, screening and management of diabetes, is key to addressing the diabetes epidemic. Solutions raised by various panellists include population-based screening for diabetes and cardiovascular diseases, use of fiscal measures such as taxation on sugar-sweetened beverages, and intelligent regulation of digital health services such as telemedicine, which allows for greater flexibility for innovation.
B. Supportive Environment
7. The delegates noted that more can be done to foster a supportive environment that can support the adoption and maintenance of healthy living. Recognising that lifestyle is a key determinant for diabetes, a holistic and coordinated approach across government agencies and key stakeholders is required to address environment and social factors. Lifestyle interventions – in the form of promotion of healthier diets and physical activity, screenings, and tackling modifiable risk factors such as controls on tobacco, alcohol and sugar – are the cornerstone of effective disease prevention and management. The panellists also highlighted the need for governments to work with the industry to enable positive health efforts through the production, distribution, pricing and marketing of unhealthy commercial products.
C. Leveraging Technology and Behavioural Insights
8. Information technology can be a powerful tool to foster behaviour change, and is increasingly adopted for use in primary prevention, to complement existing measures to encourage individuals to make better health choices, and in self-management of chronic diseases to optimise healthcare delivery. Behavioural insights offer policymakers the power to appeal to intrinsic motivation to effect change. This enables governments and key stakeholders to develop new solutions, maximise public health impact, and gradually influence behavioural change over time.
9. At the MCOD, Minister for Health Mr Gan Kim Yong also met with Health Ministers from Vietnam, Finland and Hong Kong to exchange views on health priorities, including health promotion, primary care, manpower, and regulation of health services. He also met with Dr Svetlana Axelrod and Dr Sania Nishtar to discuss collaborations with the WHO on NCDs and the work of the High-Level Commission.