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Lecture delivered by Filiz Hyusmenova at a round table entitled “Diabetes Mellitus in Bulgaria—Challenges and Policy” held in St. Petersburg hotel, Plovdiv, February 2-February 3 2008
EUROPEAN INITIATIVES IN THE FIELD OF DIABETES MELLITUS
Already in the 1980s European society became concerned with diabetes and its growing rate of occurrence. The first steps for establishing control of the situation were made at a meeting of health ministers and representatives of patient organizations from all European states in October 1989 in St. Vincent, Italy. At the meeting, delegates supported the idea that diabetes is a major and growing European problem, a problem of all ages and all states. Diabetes was reported to threaten at least 10 million European citizens, and it was agreed that states and their health-care ministries could provide conditions for mitigation of this grave health hazard. For this purpose, the states have to formally acknowledge diabetes as a problem and invest resources for its solution. Participants also pointed out the need for drafting plans for prevention, diagnosis and treatment of diabetes and its complications on a local, national and European regional level. The meeting ended with the adoption of a Declaration which outlines general and five-year goals for combating diabetes on a European and national scale.
Problems of patients suffering from diabetes became priority once again under Austrian presidency of EU in 2006. It was pointed out that the EU had 25 member states with a total population of about 450 million, of whom 25 million suffering from diabetes. Diabetes was recognized as a grave threat but the member states still lacked strategies to control it and exchange of knowledge was inadequate. The need of framework programs, prevention and other special programs was pointed out. To draft recommendations and joint strategies, the presidency held a conference with the Austrian Health Institute in Vienna. The conference issued a declaration which called on the EU to make diabetes its priority, to work out a joint European strategy for combating it, and to submit a draft of recommendations to the EU for diabetes prevention, diagnosis and control. Diabetes and cardiovascular diseases were declared a hazard to the individual and to national economies.
The protection of patients suffering from diabetes continued under Portugal’s presidency of the EU in the second half of 2007. It initiated a conference titled “Health Strategies for Europe.” Besides the plenary session, parallel sessions were held and one of them was on diabetes. The Portuguese presidency included the discussion of specific strategies for different diseases such as cancer, heart diseases, diabetes, obesity, tuberculosis and others in its priorities in the field of health care.
In January 2008, Slovenia as the first country from the newly accessed member states took over EU presidency. Slovenian presidency will continue the implementation of joint priorities and commitments adopted through the 18-month framework program by the Austrian-Portuguese-Slovenian presidency. Slovenian presidency will also focus on reducing cancer incidences, supporting a healthy way of life, reducing alcohol abuse and its effects, developing information technologies for the health-care sector, producing optimal medicines accessible to everyone. Another area will be work on providing health-care services that will guarantee high-quality and safe health-care services to European citizens.
Today, specialists unequivocally regard diabetes as an epidemic. They believe that the growing number of epidemics in Europe, its aging population and sedentary way of life have led to a burst in the spread of diabetes in the EU, especially Type II diabetes. At an average growth rate of 7.5% in Europe and an envisaged rate of 16% by 2025, and at up to 50% of non-diagnosed cases of diabetes, the crisis is a reality today. A recent study has found out that a mere 11 of 25 member states have a national framework or action plan and even these differ significantly. The governments of member states must take urgent measures to curb the dramatic rise of the cost of diabetes. Currently, diabetes costs account for 2.5 and 15% of the total health-care expenditures of EU member states, i.e., about 50 billion Euro per year. The implementation of policies for coping with diabetes epidemic has a cost, but lack of action is also costly. The treatment of diabetes patients is at least twice more expensive than the treatment of a patient with controlled diabetes. Diabetes must be recognized as a priority of European public health and this requires a coordinated, integrated and sustainable European strategy for public health.
Despite its relatively limited competence, the European Commission has launched several initiatives, which have laid the effective basis of a concerted and dynamic European policy of public health. These activities recognize the shared responsibility for public health of the EU and its member states. The EC recommendations are addressed to the member states and to the EU as a whole. They provide for the EU to do the following:
- Declare diabetes a priority in Europe and encourage cooperation among member states.
- Study current epidemiological data on diabetes in the EU through common criteria for collection and comparison.
- Report on the availability and implementation of national plans of action for combating diabetes and prevention programs.
- Alleviate and assist diabetes studies by general, clinical, and humanitarian health sciences.
- The member states must:
- Collect, register, monitor, and manage regularly comprehensive epidemiological data on diabetes based on common measurement criteria, as well as on direct and indirect expenses for diabetes prevention and control.
- Establish diabetes as a priority of national health policies through drafting and implementing national diabetes prevention plans. These plans should get adequate financial support.
- Draft and implement programs for information and early prevention directed towards the entire population and to people at risk of diabetes.
- Draft and implement target and systematic programs for primary examination and diagnosis and secondary prevention programs aimed at revealing complications of diabetes patients.
- Provide comprehensive and recognized training of health-care workers at all levels and in all areas related to the disease.
The Commission’s proposal for a Community Program for action in the field of health care and consumer protection (2007—2013) is aimed at “improving the health of citizens in all walks of life, improving health as a human right and encouraging health investments” and points clearly at “supporting policies that lead towards a healthier way of life, contributing to curbing the spread of major diseases.” What is more, the European Parliament commission on the environment, health care and food safety has recently agreed to change the Program, demanding from the Commission to “submit a proposal for the Council’s recommendations regarding prevention, diagnosis and control of major diseases.
Such EU recommendation should support a clear direction of work of member states for improving prevention, diagnosis and control of diabetes and its promotion as a priority of public health.
The Council also joined the combat against diabetes on a community level. A European council of health ministers was held in June 2004 at which they were informed about the need of a European strategy on diabetes similar to the existing strategies for cancer and cardiovascular diseases prevention. The Council’s concluding information message to ministers says in part that the rapid growth rate of diabetes in Europe must be recognized as a problem of European public health demanding more attention than simply knowing about it… A European strategy for diabetes prevention could greatly contribute to reducing public health expenditures of all 25 member states.
In November 2004, during the European Diabetes week, Commissioner Marcos Kyprianou and former Commissioner David Byron adopted a declaration appeal towards European leaders. The declaration appeals to the EU to adopt urgent measures for developing a European Council recommendation for diabetes prevention, diagnosis and control. Commissioner Kyprianou stated that he will devote his attention to the growing diabetes epidemic and that he will assess in what way the European Commission could play a positive role to support the member states in coping with this problem.
In October 2007 the European Commission adopted a new Health Strategy titled “Together for Health: a Strategic Approach for the EU 2008—2013.” It is aimed at providing for the first time a strategic framework covering major problems of health care and its inclusion into all politics and global health problems. It directs future work in the field of health care on a European level and also envisages mechanisms for coordinated work with member states. The strategy is focused on four principles and three major topics for improving the EU citizens’ health. The principles include introducing a value-oriented approach, recognizing the relationship between health and economic growth, including health care in all policies of the Union, and enhancing European support to world health. The major topics include boosting good health in aging Europe, protecting its citizens from health hazards, establishing dynamic health systems and new technologies. Besides the above initiatives, the European Parliament also took action in protecting diabetes patients. In April 2006, it adopted a written declaration urging the Commission and Council to make diabetes a priority of the European health policy and to encourage member states to draft national plans for action against diabetes, The EP called on the Commission and Council to develop an EU diabetes strategy and draft an EU Council recommendation for diabetes prevention, diagnosis and control. International specialized and non-governmental organizations admired the adoption of the declaration. They stated that such high-level support is a rare occurrence and is indicative of the clear awareness, of the inter-party and international concord on the need for urgent measures against the growing diabetes epidemic in Europe.
In the early 2007, the European Parliament once again directed its efforts towards guaranteeing healthy environment and habits to its citizens. Concerned with the problems of public health caused by overweight, it adopted a report on prevention of overweight, obesity and chronic diseases. The encouragement of healthy diets and physical activity, especially at schools, is a key Parliament recommendation, since in some European countries half of the adult population is overweight and one of every five children suffers from obesity. The MEPs insisted that combat with obesity become a political priority for the EU.
On November 14 2007 – the World Diabetes Day – MEPs from the Movement for Rights and Freedoms met in Strasbourg with Victoria Pavlova, a 15-year old student from Varna Commercial High School. We discussed the need of an information campaign on diabetes among young people. That is why my presence at this forum today is not accidental but shows my commitment to the problems of diabetes patients and their effect on society. Today, more than 31 million European citizens suffer from this disease for which no radical treatment is believed to be available. Close to 10% of health care funds in the EU member states are spent on treating diabetes complications. I congratulate the round table initiators for this idea, as every member state must make the necessary efforts to supports citizens in need.
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