The coming generation - WDF includes people with diabetes yet to come

At the quarterly board meeting in June 2005 the WDF board of directors was presented with an analysis pointing out an imbalance between primary and secondary prevention of diabetes in the projects supported by the foundation.

The result surprised the board, who agreed on a new WDF focus area "the coming generation", which will lead to more support towards efforts in primary prevention in the future.

The analysis was part of a report conducted by two interns, Jeanette Pinnerup Jensen and Katrine Bech Jørgensen, as a part of their study in public health. The two master’s students analyzed 87 project applications received in the period of August 2002 to December 2004. The 39 projects approved were included, with the aim being to analyse the extent of primary prevention in the projects.

Where to focus

At present WDF operates with 4 focus areas, which are the diabetic foot, eye care, children with diabetes and women, pregnancy and diabetes. These current focus areas target the main problems in diabetes in the developing countries, and by supporting projects within these focus areas WDF lives up to its main goal to alleviate the suffering of people with diabetes in poor countries.

However, the focus areas are mainly related to secondary prevention. “Secondary prevention is aimed at people already living with diabetes and it includes proper management of the disease as well as prevention of complications. These are all problems there is a great and visible need to focus on, and this choice of focus is reflected in our analysis” says Jeanette Pinnerup Jensen.

The analysis showed that no running project focuses exclusively on primary prevention. Katrine Bech Jørgensen; “This fact caught our eye, coming from the area of public health, where there is great focus on the importance of primary prevention. Primary prevention can be seen to be even more important in developing countries where a growing burden of diabetes is associated with gloomy prospects for the already hard strained health systems“.

Secondary prevention came first

The activities in each project were assessed according to prevention level and categorised into four categories:
• “exclusively primary prevention”,
• “both primary and secondary prevention”,
•  “exclusively secondary prevention” or
• “neither primary nor secondary prevention”.

The analysis showed that out of 87 incoming applications only 4% of the projects were aimed at primary prevention and none of these were approved. To be fair 37% of the applications covered a combination of primary and secondary prevention and the number grew to 41% among the projects approved.

The report has started a timely discussion among the members of the board. Being a newly started foundation the most obvious thing to do has been to support projects with visible results within a short time frame.
In one project the foundation has helped with the establishment of more than 20 diabetes clinics in Tanzania, most of them in areas which have been without diabetes treatment.

Today the foundation supports 42 projects covering 60 countries, projects that support awareness of diabetes symptoms, risk factors and complications, the prevention of complications and capacity building in the health systems. All these initiatives are considered secondary prevention, because the action taken is aimed at people who already suffer from diabetes.

Changing the focus to look ahead

The board recognises the importance of targeting people with or without diabetes even before they go to the doctor’s office with high blood pressure, insulin intolerance or even diabetes. Based on the results of the analysis, a fifth focus area named “the coming generation” was created, involving the prevention of diabetes in the generations to come.

An important target group is healthy children with unhealthy habits and young, obese people, who are the coming generation of people with type-2 diabetes.

“The coming generation” includes also children and young people with type 1 whose quality of life the foundation wants to improve. Today the situation for people with type 1 diabetes is very poor. Having limited access to medicine and treatment many suffer from the severe consequences of poorly controlled diabetes, untimely deaths are unfortunately not uncommon.

It is not the intention of the board to cut down on the attention on and the support for secondary prevention, but the numbers presented has opened WDF’s eyes to the need to be more proactive and attract new project applicants from a much broader context. It is easy to imagine collaboration with not only the national Ministry of Health but also Ministry of Education and NGO’s fighting to prevent obesity and cardiovascular diseases.

Going public

The coming generation of people with diabetes is a new target group that needs a different approach. If WDF supported projects want to get the attention of people who are not in regular contact with the health system, they need to make use of a broader range of tools. These include different means of communicating, campaigns in mass media, collaboration with schools and cantinas, advocating politicians to have an impact on consumer taxes.

“It’s a challenge but indeed a positive challenge”, says Sanne Frost Helt, programme manager for the World Diabetes Foundation. “Changing people’s eating and exercise habits is not at all an easy task, but it is within the power of the individual to make some of the most essential changes: Cutting down on oil and fat in your diet costs nothing, and, like exercise, everyone can afford it.”