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Addressing the Need to Control the Increasing Burden of Diabetes and other Non-communicable Diseases in the Australia and the Asia Pacific Region

Addressing the Need to Control the Increasing Burden of Diabetes and other Non-communicable Diseases in Australia and the Asia Pacific Region


Australia is among the Southeast Asia countries where 60% of deaths have been reported to be due to chronic non-communicable diseases (NCDs). The problem is reported to arise from the changing environmental factors that have encouraged inadequate physical activity, unhealthy diet and tobacco use (Dans et al., 2011). The trend indicates that the measures put in place are not adequate to control the diseases. This paper will discuss the key tensions in public health that have led to the unfortunate trend and the strategies that needs to be put in place to reduce the growing burden of NCDs, with particular reference to diabetes in Australia as compared to New Zealand.

Diabetes Trends in Australia and Asia Pacific Countries

The Global Burden of Disease (GBD) data shows that among the NCDs that cause years of life lost (YLLs) in Australia, diabetes has increased in rank from position 12 to position 10 between 1990 and 2013, changing with an increase of 11%. The trend is similar to that of New Zealand where the ranking has increased from position 14 in 1990 to position 11 in 2013, representing an increase of 60%. The dietary risks for diabetes are relatively similar between the two countries. The high body mass index is a slightly more important risk factor for diabetes in Australia than in New Zealand.

High systolic blood pressure is more strongly associated with cardiovascular diseases than diabetes in both countries, but the relative association to cardiovascular diseases is greater in New Zealand, indicating that the risk for diabetes in Australia is higher. In contrast, high fasting blood glucose is a slightly more important risk factor for diabetes in New Zealand than Australia. Low glomerular filtration rate and low physical activity are also slightly more important in New Zealand (Institute for Health Metrics and Evaluation [IHME], 2015a; IHME, 2015b).

The World Health Organization (WHO) (2015) declares that it aims to enhance the development of the measures to prevent diabetes. WHO provides scientific diabetes prevention guidelines, standards and norms for the diagnosis and care of diabetes, builds awareness and celebrates the Diabetes Day on 14th November, and surveys diabetes and its risk factors. WHO further asserts that these measures are supported by its global strategy on health, physical activity and diet, which reduce obesity and overweight as well.

To criticize the efforts of WHO, Friel, Labonte and Sanders (2013) dismisses the capacity of WHO’s frameworks to reach the non-communicable disease (NCD) core. The frameworks include the one set by WHO of reducing the chances of dying from NCDs by 25% by 2025. To actualize the goal, WHO developed 25 indicators and 9 global voluntary targets for monitoring the progress. The main problem with the framework is that it focuses on individualised causes, a trend that could encourage interventions to focus only on behavioural risk factors and yet evidence supporting the importance of societal factors has challenged the approach.

Omran, as quoted by McKeown (2009), formulated two propositions, which together propose that declining fertility typically follows declining mortality and the relationship leads to an altered age distribution in the population, which shifts in the long-term disease and mortality patterns. Man-made [sic] and degenerative diseases gradually replace the infection pandemics experienced in the previous generations.

To control diabetes effectively, policymakers must address the systemic inadequacies that contribute to high Body Mass Indices, physical inactivity, unhealthy diets with high saturated fat and sugar contents and with little fruits and vegetables, and tobacco use (WHO, 2015). The Framework Convention for Tobacco Control aims to contain tobacco use. Controlling the non-communicable diseases, just like for infectious diseases, is dependent on international co-operation. International co-operation would reduce cross-border challenges for instance promotion of unhealthy products through the advanced technologies, smuggling them across borders and taking advantage of trade liberalization to expand their production (WHO, 2014a).

WHO’s Framework Convention on Tobacco Control formulated the Protocol to eliminate illicit trade of Tobacco Products in 2012. A meeting held in Colombo to create awareness of the program found that the challenges of controlling unhealthy products that predispose people to diabetes among other NCDs are systematic and they include resistance from the powerful illicit actors, influence from high-level politicians, little stakeholder participation, and procedure and problem complexity (WHO, 2014b). There is a need for strong governmental actions targeting the high-risk groups. WHO should consult and collaborate with the member states while supporting and encouraging global and national actions. Controlling diabetes is a complex process and would require a few committed countries to pressure and support it (Beaglehole & Bonita, 2009).

Ethical Tensions in Diabetes Control

There exist cost-effective interventions for controlling NCDs. Venkatapuram, McKee and Stuckler (2012) identified four ethical tensions responsible for the ineffectiveness of WHO’s Global Monitoring Framework, which was developed to counter the increasing burden of NCDs. The conflict between human rights involves the people who should be protected from misinformation on activity and food, inadequate access to medicines and indirect bodily harm while on the other hand the manufacturers also need to be protected from the infringement of the freedom of expression in their advertisements and disrespect to their patent rights. The retention of patents by the manufacturers slows the arrival of competitors and, therefore, encourages monopoly, which could lead to overpricing of medical products, such as the drugs for diabetes (Lanjouw, 2005).

Patents are protected by the trilateral cooperation of WHO, the World Trade Organization (WTO) and the World Intellectual Property Organization (WIPO). The cooperation aims to support efforts to protect trade and intellectual property in order to enhance the development of factual and empirical information (Lanjouw, 2005). Protection of intellectual property would enhance market entry of the new products as well as encourage further innovation (WIPO, 2012). Australia agreed to adhere to the international standards. Australia works to promote the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement of the WTO (Australian Government Department of Foreign Affairs and Trade, 2014). The WTO supports the TRIPS agreement and argues that its role in the protection of intellectual property is part of the wider action at the national and international levels to address public health problems (WTO, 2001).

The second tension as narrated by Venkatapuram, McKee and Stuckler (2012) involves social determinants where political leaders fail to determine efficiently the areas to focus on in the “causal chain. The third tension is the need for the rich countries to allocate their resources to their obligations to provide aid to the poor countries and to meet the needs of their own citizens. The burden of NCDs poses a threat to the available domestic resources, which results in a glaring global inequality. The countries are inclined to self-interest, such as addressing HIV infections to foster national security, rather than donating for the global public good.

There is also concern for deciding whether to focus on the most responsive populations, the most inclusive actions or the most affected populations. A high-level meeting from WHO declared that priorities would be given to four NCDs including diabetes, chronic lung diseases, cardiovascular disease and cancer, along with their common risk factors including physical inactivity, harmful alcohol use, poor diet and tobacco use (Venkatapuram, McKee and Stuckler, 2012). NCDs are responsible for 60% of all deaths in Southeast Asia. The conditions are associated with poverty and they pose a major threat to the country through avoidable mortality and morbidity. Low-income populations have been exposed to modifiable risk factors due to inadequate policies on public health, marketing of unhealthy foods and unplanned urbanization (Dans et. al., 2011).

Appropriate Strategies

To formulate relevant policies, WHO must address the transformative effect of globalization. There is a need to promote global health diplomacy based on the relationship between health policy and foreign policy where international institutions, governments and nongovernmental organizations work together to manage health risks. Countries should overcome their national interests and align their health and foreign policies based on the ethical, epidemiological and diplomatic realities as influenced by globalization.

The World Health Assembly recognised the importance of the relationship. WHO, WTO and WIPO should formulate policies to protect and promote health in appropriate and ethical ways. Experts, advocates and health ministries can provide their ethical and epidemiologic principles on global politics into the debate and clear the tension between international health and national interests (Drager & Fidler, 2007).

There is a need to address the weak representation of health in trade governance. Global health governance lacks coherence due to lack of clear leadership. WHO should take the lead role and involve the WTO. WTO can link with health to help in policy formulation and implementation, and the provision of funding. The collaboration should first focus on the areas of neglect or interest such as the rising burden of diabetes in the Asia Pacific region. WHO would be strengthened to influence national interests through negotiations to create collaborative links between national governments including the low-income and middle-income countries, pro-health coalitions and stakeholders (Lee, Sridhar & Patel, 2009).

Governments, which have the primary responsibility of healthcare, need to appreciate the importance of global health diplomacy and develop new skills to promote coherence between health policy and foreign policy to promote development, improve the environment, foster trade and security, and gain soft power. Global health diplomacy is helpful through groups such as the G8 and the Organization of Islamic Cooperation. It is important for the global health diplomacy to take into consideration globalization and its impact on the relationship between the rich and poor countries. The the 2011 High-level Meeting of the UN focused on the issues. Health diplomats need to be competent to effectively prepare for and hold negotiations (Kickbusch & Kökény, 2013).

Global health governance should be directed at clear and achievable goals. The goals should focus on identifying the risk factors, causes and protective factors, intervening early and advancing prevention, expanding access to healthcare and improving treatments, raising awareness, building the capacity of human resource and transforming policies and health systems (Collins et al., 2011). The governance should also improve the surveillance of the diseases and their risk factors, monitoring of policies, creating appropriate referral systems and creating a healthy environment that gives people the right health choices (Dans et. al., 2011).

The High-level Meeting of the UN General Assembly (2011) should have put more input in addressing. With the strengthening of WHO by WTO, the organization should be able to control NCDs including diabetes through the World Health Report of 2010. WHO should ensure that governments allocate enough resources to the control of NCDs. Diversified and new sources of funding should be identified. Long-term aid should be achieved by exhorting external donors in accordance to their commitments (WHO, 2011). Effective control and management of diabetes would require new tools to build upon the existing mechanisms through program establishment and evaluation. The use of electronic medical records, behavioural and national surveillance would effectively respond to the local burden of diabetes in Australia in relation to its political will, available infrastructure and capacity, the needs of its constituents and the state of the existing efforts (Fuster & Kelly, 2010).


This paper has demonstrated that diabetes has imposed an increasing burden in Australia and other Asia Pacific countries. WHO has not taken robust steps to address the environmental factors that encourage the increase and has focused on behaviour change instead. The key tensions that have contributed to this trend include conflicts between human rights and corporate rights, pin-pointing on the most appropriate areas in the ‘causal chain’ to invest, conflict between the self-interest and global public good among the governments and prioritization of the diseases. WHO should collaborate with WTO and WIPO to strengthen its influence. WHO should promote coherence between health, foreign, trade, security and other relevant ministries in formulating policies that are mutually beneficial. WHO would also facilitate the cooperation of the international community, non-governmental organizations, similar minded bodies and other stakeholders in designing mechanisms to address the burden of NCDs. Addressing NCDs must give special attention to addressing diabetes because it has shown an increase in rank among the diseases that contribute to the highest YLLs.


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