“When people have nothing left to eat, they will eat the rich,” said Jean-Jacques Rousseau. He didn’t have diabetes in mind. European cuisine has come a long way since the French Revolution. Sure, there is more food on our tables than there used to be, but Europeans are eating too much and dying early.
The food landscape in Europe is undergoing major changes, with a rapid increase in the availability of shelf-stable, calorie-dense foods, while financial and demographic constraints limit access to healthier alternatives and a sharp increase in high body mass index (HMI) cases.
Consumption of ultra-processed foods, fats, sugars and animal products has increased significantly, paralleled by a steady decline in physical activity levels, largely linked to changing work and transport patterns.
This trend is particularly evident among low- and middle-income groups, where the transition from traditional to industrialized diets has been rapid and significant. This rapid change has led to a sharp rise in nutrition-related non-communicable diseases, including type 2 diabetes.
Common risk factors
A European Commission official acknowledged to Euraactive that “diabetes remains an epidemic in the EU,” but stressed that “we have made great progress, however, in a comprehensive approach to non-communicable diseases, targeting common risk factors for diseases such as diabetes and cardiovascular disease.”
“Under the ‘Healthy Together’ initiative, we have made available an unprecedented amount of funding to support joint work on diabetes and other non-communicable diseases,” the official added.
While this is true, the European Commission does not have the power to directly implement health policy – health remains a national matter – all Brussels can do is facilitate and encourage, providing mechanisms for coordination and benchmarking, while using EU funds to support broader health initiatives.
With the ever-increasing impact of diabetes on Europe’s economies, the vision of a European Health Union is not just a path to better health outcomes, but a path to stronger, more productive economies, where disease is less debilitating and debilitating.
Early Intervention Strategies
Immediate action in the form of early intervention strategies such as patient education, regular medical checkups, and pharmacological approaches are potential short-term solutions.
These strategies, coupled with lifestyle changes, can provide clinicians, public health experts, and policy makers with effective tools to combat this burgeoning health crisis.
Studies from Finland, China and the United States suggest that early intervention can prevent, or at least delay, the onset of type 2 diabetes. But the challenge lies in implementation: Few countries have the health systems to take a proactive approach or the infrastructure to prioritize early intervention.
Developing and implementing strategies that will have a lasting impact at population level remains a persistent challenge. European and global communities must address these issues to curb growing diet-related health concerns.
The rising costs of diabetes
Diabetes is a leading cause of blindness, kidney failure, heart attacks, strokes and limb amputations and is on the rise, especially in low- and middle-income countries. Between 2000 and 2019, diabetes mortality increased by 3%, with an estimated 2 million deaths in 2019 alone.
This places a huge burden on healthcare systems, with the International Diabetes Federation (IDF) estimating that 537 million people worldwide will have diabetes in 2021, resulting in global healthcare costs of $966 billion and projected to reach more than $1,054 billion by 2045.
The main drivers of costs are hospital inpatient and outpatient care, but indirect costs account for 34.7% of the total burden, primarily due to lost productivity due to labour force withdrawal and premature death.
The increasing prevalence of type 2 diabetes is primarily driven by the increasing prevalence of obesity and physical inactivity. In 2019, only 40% of countries had operational policies in place to address overweight and obesity. Smokers are 30-40% more likely to develop type 2 diabetes than non-smokers, indicating the need for a comprehensive economic and health approach.
National diabetes burden
A major diabetes study published in The Lancet identified regional and national diabetes disease burdens as part of a systematic analysis that included projections of prevalence up to 2050.
A report produced by the GBD 2021 Diabetes Collaborators noted that high BMI contributes to more than 60% of disability-adjusted life years (DALYs) from type 2 diabetes in Central and Eastern Europe.
In 11 global regions, including Central and Eastern Europe, high BMI accounts for more than 60% of DALYs. In contrast, in South Asia, high BMI accounts for less than 40% of type 2 diabetes DALYs.
Between 2021 and 2050, the global total age-standardized diabetes prevalence is expected to increase by 59.7%, resulting in 1.31 billion people living with diabetes in 2050, a change of 3.31% per year.
Of this increase, 49.6% is due to obesity trends, and the remaining 50.4% is due to demographic changes.
Surveillance, prevention and intervention
The WHO Regional Office for Europe stressed to Euractive that the World Health Organization (WHO) is committed to promoting and supporting the adoption of effective measures to monitor, prevent and manage diabetes and its complications, particularly in low- and middle-income countries.
In April 2021, the WHO launched the Global Diabetes Compact, a global initiative aimed at achieving lasting improvements in diabetes prevention and treatment, arguing that data and technology can play a key role in managing the rising incidence and costs of diabetes.
“Accurate population-level information on diabetes is limited,” a European Commission official told Euraactive. [However,] The Commission is working to improve access to such information through the CHIEF project (led by the JRC) and the JACARDI project (a collaborative activity led by the Italian Instituto Superiore di Sanità).”
“Through CHIEF, the European Commission is developing the concept of a sustainable indicator collection framework for diabetes and is leading this effort together with the European Network of Diabetes Registries (EU-BIROD).”
Data on diabetes from most national surveillance and surveillance systems are scarce and inadequate: only 56% of countries worldwide have conducted diabetes prevalence surveys within the past five years.
To promote harmonization and comparability of disease burden studies across Europe, the European Burden of Disease Network (EBoDN) was established in collaboration with WHO and IHME.
Transparent data is needed
Although 50% of countries worldwide, mostly high-income countries, report having diabetes registries in place, these are mainly hospital-based and have limited coverage, resulting in insufficient information on diabetes outcomes.
In this context, the WHO Secretariat, with the support of academic societies, has developed a draft approach for setting diabetes coverage targets, which recommends setting five global diabetes coverage targets to be achieved by 2030. Achieving these targets will contribute to the achievement of SDG target 3.4.
Model projections based on these data demonstrate that achieving target levels of diagnosis, treatment, and management of the three targets (blood glucose, blood pressure, and statin use) at least 60% would result in a median increase in disability-adjusted life years (DALYs) of 38 per 1,000 people over 10 years, translating into significant public health benefits as well as economic gains.
Effective public policy-making to increase access to affordable medicines and health products requires the use of evidence derived from rigorous analysis of reliable and transparent data on prices and availability.
Europe does not have this data, so the diversion of funds from public and private sector budgets to address diabetes and its associated disease profile cannot compensate for the leakage of economic reserves. It is time for Europe to curb its sugar overdose and become fiscally sound and economically strong. We need a French fry revolution.
[By Brian Maguire | Euractiv’s Advocacy Lab ]
