Diabetes: A silent threat…to Zimbabwe’s economic development
TO the 14th of November, Zimbabwe joins the rest of the world in commemorating World Diabetes Day. As the nation commemorates this important day on the global health calendar it is important that we reflect not only on the physical and psychological impact that diabetes has on individuals and populations but also reflect on the economic consequences of this disease and its potential negative impact on the nations vision of an upper middle-income economy by 2030.
The World Health Organisation estimates that the total number of people with diabetes globally rose from 171 million in the year 2000 to 415 million in 2015 and will surpass 600 million by 2030. This catastrophic exponential increase in number of cases will also occur in Zimbabwe with potential devastating impact on socio economic development in general. By 2030 the global economy will require approximately USD2.5 trillion to combat diabetes. Billions of dollars will be required in Zimbabwe to provide access to adequate treatment and care for diabetes and its consequences. Millions more will be lost from the economy from lost productivity as a direct consequence of diabetes. Policy makers therefore, need to take urgent action to prepare our health and social security systems to mitigate the effects of diabetes.
Diabetes is a complex metabolic disorder involving many body organs and systems and can devastate the lives of affected individuals. People with diabetes are up to four times more likely to develop cardiovascular diseases, and up to 40 times more likely to require lower limb amputation, than people without diabetes. Furthermore, diabetes is among the leading causes of visual impairment, blindness and kidney failure in adults. Diabetes is the fourth leading cause of death by diseases worldwide. More than one million people died from diabetes in 2005 and almost 80 percent of these deaths occurred in low and middle income countries like Zimbabwe. Due to the premature disability, morbidity and mortality associated with diabetes, it is one of the most costly diseases to manage. This burden is even more of a problem in developing countries where diabetes and associated cardiovascular diseases develop at earlier ages and with greater severity. The majority of people with diabetes in developing countries are below 64 years of age, whereas in developed countries most are in older age groups. This early onset of diabetes in the more economically productive years of life leads to a devastating extra burden of cost in developing countries. This not only puts extra pressure on individuals, but also affects families, society, and the healthcare system of the country.
So what needs to be done? Prevention is the best option to tackle this costly epidemic. Preventive interventions should be available at all levels, with integrated, comprehensive, multi-faceted and multi-sectoral approaches. In this regard, activities should be aimed at preventing diabetes from occurring in susceptible individuals and populations through prevention and modification of environmental and behavioural risk factors and determinants. Because diabetes emerges rapidly in young people, special interventions should be planned and implemented at schools and colleges to target children and adolescents in developing countries. Activities such as early screening for diabetes (aiming at early detection), and prompt and effective management of the disease, should be designed with the purpose of preventing and delaying the onset of complications. Efforts should also be made to delay onset of the premature disabilities and the deaths associated with secondary complications of diabetes. Furthermore, improved standards of care and management of diabetes in the healthcare systems of developing countries would particularly help to ensure that all persons with diabetes have easier access to high-quality management of their disease at an affordable cost. Resources for combating diabetes need to be proactively mobilised. Considerations by policy makers to introduce sin tax such as sugar tax to mobilise resources to combat diabetes, may need to be taken into consideration. Incentivising employers and organisations that promote wellness through tax rebates on money spent on employee wellness initiatives can also be considered. Regional countries and healthcare providers could collaborate and share data on diabetes burden and negotiate with global pharmaceutical companies for lower prices in exchange for bulk procurement of diabetes medicines.
Healthcare funders such as Premier Service Medical Aid Society (PSMAS) have started taking a lead role in managing the cost impact of diabetes. Healthcare funders have the privileged position of understanding the cost impact of diseases and diabetes has emerged as the leading cost driver amongst non-communicable diseases. PSMAS has shifted its focus towards preventive health offerings from the initial focus of provision of curative services by promoting healthy lifestyles for our members through a wellness program dubbed Premier Lifestyle. Concurrently, improving case management of existing diabetes patients will help minimize complications, thereby contributing to management of the cost burden in the long term.
It is therefore apparent that a significant concerted effort amongst national stakeholders i.e. Government through the Ministry of Health & Child Care and Treasury, health funders, diabetes associations and the medical fraternity, will be required to fight diabetes and its potential economic consequences if Zimbabwe is to attain its socio economic objectives by 2030. In line with the 2019 theme “Diabetes: Protect your family,” let us all come together and fight to protect our families from the financial losses incurred from diabetes. By Munyaradzi Mujuru
● Dr Munyaradzi Mujuru is the Health Risk & Utilisation Manager in the Managed Care Division of PSMAS. He writes in his personal capacity.