Confronted with rising numbers of people with type 2 diabetes, a New Zealand health board forged a cross-sectoral alliance under the banner of Let's Beat Diabetes. Chris Mules, Chad Paraone and Paul Stephenson report
Type 2 diabetes has emerged as a critical international health challenge. The International Diabetes Federation estimates that diabetes currently affects 246 million people worldwide, a number that could rise to 380 million by 2025.
The situation in New Zealand reflects and may outrun these international trends. Given the growth of obesity, a key risk factor, the number of people with type 2 diabetes is forecast to rise from 125,000 people in 2001 to 180,000 by 2011.
Counties Manukau is a district in the Auckland region where the rising tide of diabetes could well become a flood over the next decade. In 2007, as many as 25,000 people in the area were estimated to have diagnosed diabetes, from a total population of 470,000 (6.6 per cent of the adult population). Around 9,000 more were thought to be undiagnosed. The area has high numbers of Maori and Pacific peoples, among whom diabetes is over-represented.
If no action is taken, the prevalence of diabetes is likely to double in Counties Manukau over the next 20 years, meaning as many as 15 per cent of the adult population could have diabetes.
Confronted with the current and projected toll of diabetes, Counties Manukau district health board initiated Let's Beat Diabetes, a district-wide strategy aimed at long-term, sustainable change to prevent or delay the onset of diabetes, slow disease progression, and increase the quality of life for people with the disease.
The initiative is a five-year plan working within a 20-year horizon. Fundamental to the plan is an approach that looks at the whole society, whole life course and whole family.
Underpinning this theme is an emphasis on reducing inequalities, with an explicit focus on Maori and Pacific people and low socio-economic groups.
The project began in 2005 with initial funding of $10m (£3.7m) over five years. Activities are organised around 10 action areas, encompassing more than 70 different community initiatives. The action areas are:
supporting community leadership and action;
promoting behaviour change through social marketing (see www.swap2win.co.nz);
changing urban design to support healthy, active lifestyles;
supporting a healthy environment through a food industry accord;
strengthening health promotion co-ordination and activity;
enhancing well child services to reduce childhood obesity;
ensuring children are active, healthy and ready to learn;
supporting primary care-based prevention and early intervention;
enabling vulnerable families to make healthy choices;
improving service integration and care for advanced disease.
The programme was developed through an intensive process of community engagement, with some 50 community meetings and workshops.
Although initiated by the district health board, Let's Beat Diabetes is a community partnership. Now in its third year, it has gained the active participation of such diverse players as primary healthcare, local government, diabetes NGOs, Pacific churches, the food industry, the regional sports trust, Maori organisations and regional offices of central government agencies.
Gains so far have included:
developing a base of community and organisational partnerships and capacity;
fostering changes to many food and physical activity environments by working with local partners (for example, substituting Sprite with Sprite Zero at McDonald's restaurants and improvements to food environments in schools and workplaces);
fostering the realignment of primary and secondary health services, including structured primary care programmes with specialist leadership and decision support systems.
What has made Let's Beat Diabetes different from many other strategies is its community-based foundations, links across professional and sectoral boundaries, focus on prevention and treatment, and structured long-term programme.
Further information can be found at www.letsbeatdiabetes.org.nz