Executive summary

Diabetes is a serious public health issue, a condition that can and often does lead to heart attack and stroke, blindness, kidney disease, nerve damage and amputation. It is estimated to account for as many as 25,000 deaths per year in Canada. The condition is even more prevalent in Atlantic Canada than in the country as a whole, and appears to be increasing more rapidly here. This is not surprising, given that the region also ranks poorly in levels of obesity and physical inactivity, the two modifiable risk factors for Type 2 diabetes, the focus of this report. In our region, four of every ten adults are overweight and six of every ten do not get enough physical activity, figures that are substantially higher than in the rest of Canada. When combined with a more rapidly aging population, increasing rates of obesity and diabetes will pose a serious challenge not only to the individuals and families affected, but also to the entire health care system. It is a critical situation that requires immediate and concerted action.

At the population level, Type 2 diabetes can be prevented by reducing levels of physical inactivity and obesity. A population health approach to diabetes prevention is aimed at reducing the exposure of the entire population to the underlying causes of inactivity and obesity. Because most of these causes are outside the health sector, bringing about change in these areas requires that strategies be developed and implemented in close collaboration with other sectors. The recreation and food/food service industry sectors are both central to the environmental changes that need to take place for success in preventing diabetes. A population-wide reduction in diabetes will require a long-term commitment in many sectors and a succession of diverse strategies carried out over many years. Successful strategies for promoting population health include: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services.

An environmental scan was carried out in the region in order to gain a better understanding of the existing infrastructure for the primary prevention of Type 2 diabetes. This study found that until now, preventing diabetes has not been a high priority in the region, although many organizations carry out prevention activities. Several organizations in each province are using a population health approach to reduce inactivity or obesity at either the regional or provincial level. Work in this area appears to be somewhat more advanced in the area of physical activity and the recreation sector. Most of the population-wide, multisectoral initiatives are in the early stages of development and have not yet acquired funding or developed strategies. A few are coming to the end of their funding.

For most other initiatives, however, working to increase the knowledge and skills of individuals is still the primary approach to bringing about behavioural change. Overall, few initiatives are multisectoral and even fewer involve both the recreation and health sectors working together. There are very few partnerships with the food industry. According to respondents, the greatest obstacle to primary prevention is insufficient resources, both human and financial.

Results of this environmental scan indicate that the population health approach to preventing diabetes is a new way of thinking for many people in the region. To translate this new way of thinking into new ways of acting, it will be necessary to increase the level of commitment and capacity within the organizations that are doing the work. A successful diabetes prevention strategy will thus require concentrated efforts to increase the capacity of organizations and individuals to work in collaboration with other sectors and to create environments and conditions that encourage healthy choices. These efforts must include training, resource material, access to information about what works, and adequate financial and human resources to reorient, coordinate and implement primary prevention programs.

The results also suggest that diabetes prevention will require two separate but related strategies, one for each of the two modifiable risk factors. In every province intersectoral partnerships to reduce inactivity have been created in response to a national policy framework, and work is well underway. Although these partnerships are an important first step to preventing diabetes, they will need to take strong, sustained and well-designed measures in order to bring about measurable changes in behaviour. To do so they will need both political and financial support.

Province-wide intersectoral partnerships for improving nutrition are not as well developed. In some provinces, heart health projects have developed strong partnerships and implemented strategies within a single health region. This expertise and the infrastructure that has developed over the past decade are important resources for provincial strategies to address nutrition or obesity. However, achieving a measurable, population-wide impact on obesity will require a policy framework that provides political and financial support to build capacity and coordinate the work of many organizations.

The Canadian Diabetes Strategy provides an excellent opportunity to improve population health for the new century. Given adequate support, there already exists within the region all of the resources required to prevent Type 2 diabetes. Major steps taken now will require additional funding, but to do nothing will in the end cost far more. A concerted effort to prevent inactivity and obesity now will bring results that extend far beyond diabetes to the prevention of other non-communicable diseases. In so doing, it will improve quality of life and reduce health care costs for decades to come.

 

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