Type 1 Diabetes (T1D) is a complex chronic disease that requires consistent access to insulin, syringes, and blood glucose monitors. This can be a challenge anywhere, and one that is particularly acute across many low- and middle-income countries (LMICs), where health systems often lack the resources for comprehensive diabetes care. T1D can be a death sentence for those who cannot afford insulin, while others may not receive proper care until they develop life-threatening complications, such as diabetic ketoacidosis (DKA). Children are at particular risk.
Helmsley recognizes that barriers to care are deeply entrenched. Our goal is to create a sustainable, global movement that improves policies, supply chains, and health systems for the most vulnerable T1D populations in LMICs, where – as elsewhere – type 2 diabetes is far more common.
Internationally, new cases are skyrocketing. From 2009 to 2019, the number of people worldwide diagnosed with diabetes, type 1 and type 2, increased 62 percent, to 463 million, according to Diabetes Research and Clinical Practice. By 2045, the number is projected to be 629 million.
This surge is felt most acutely in LMICs, which often lack the clinics, diagnostic tools, medical specialists, educators, distribution networks, and government support to give people with T1D an opportunity for success. In some countries, T1D carries a stigma – mothers are blamed for their child’s condition and are spurned by their community, while the children themselves become pariahs. Meanwhile, the increase in type 2 cases will lead to greater need for wide distribution and availability of insulin.
Our Global Access program focuses on three main areas:
First, health systems need to be stronger so that they can care for anyone with a chronic illness, including T1D. According to the World Health Organization (WHO), at least half of the world’s population still lacks access to essential health services for non-communicable diseases (NCDs), so we work with partners addressing this need. This includes expanding PEN-Plus (the Package of Essential NCD Interventions-Plus), an integrated delivery model that provides high-quality care for T1D and other severe chronic NCDs in low-resource countries. We anticipate that more than 20 countries will be part of a network committed to expanded treatment for T1D and other severe chronic diseases, and four of these countries will implement PEN-Plus nationwide.
We are also galvanizing a global movement, through partnerships with groups like the NCD Alliance, to advocate for the needs of the growing number of people living with chronic conditions in LMICs.
Second, we want to improve access to insulin, which is unaffordable for most people living in LMICs. We work on two timelines – addressing the medium-term need of changing multinational pricing and supply chain practices, while also ensuring that children who need insulin today can get it. We have supported Health Action International, a nonprofit, to develop partnerships with the WHO and to support civil society organizations in Peru, Mali, and Tanzania to advocate for better insulin pricing and diabetes policies globally. We also support efforts to distribute insulin and supplies across poor communities in more than 40 countries.
Third, we recognize that health care is but one part of what is needed to be healthy. Food security is essential. In impoverished communities, our approach to supporting the T1D community is holistic, supporting efforts for sustainable livelihoods and economic development.
A new Lancet Commission report shows for the first time that non-communicable diseases and injuries (NCDI) cause more death and disability at every age among the world’s poorest billion than in wealthy countries. These conditions account for over a third of the burden of disease among the poorest, including almost 800,000 deaths annually among those aged under 40.
Formed by 23 global health experts, the Lancet NCDI Poverty Commission focuses on reversing the neglect of the world’s most marginalised people living with NCDIs. Many are young and developed NCDIs primarily due to factors beyond their control, such as lack of access to health care. To try to manage their NCDIs, between 19 million and 50 million of the poorest billion spend a catastrophic amount of money each year in direct out-of-pocket costs on health care.
“The pandemic has exposed the myth that extreme poverty was disappearing,” said Commission Co-Chair Gene Bukhman of Harvard Medical School, Partners In Health, and Brigham and Women’s Hospital. “We need a cross-border movement with a common sense of humanity to serve people living with NCDs in poor countries, whose economic and health status makes them doubly vulnerable to COVID-19.”
Among the poorest billion, non-communicable diseases and injuries kill more people under age 40 than HIV, TB, and maternal deaths combined. Among the poorest billion, people with a diverse set of severe NCDs – such as type 1 diabetes, rheumatic and congenital heart disease, and pediatric cancers – live 20 fewer healthy years than in high-income countries. Yet less than US$100 million – or just 0.3% of development assistance for health – is allocated to NCDIs among countries comprising the poorest billion.
“No disease should practically be a death sentence in one country but treatable, preventable or curable in another,” said Commission Co-Chair Ana Mocumbi of Universidade Eduardo Mondlane and Instituto Nacional de Saúde in Mozambique. “Universal health coverage is unobtainable unless the global health community broadens the geographies and conditions covered by action on non-communicable diseases.”
The Commission provides the clearest-ever picture of how quality care and other cost-effective, proven solutions can save millions of lives each year if scaled to reach everyone in need. Progressive implementation of affordable, cost-effective, and equitable NCDI interventions between 2020 and 2030 could save the lives of more than 4.6 million of the world’s poorest, including 1.3 million who would otherwise die before the age of 40 years.
“Even before the pandemic started, low-income countries did not have the resources to deliver a truly comprehensive set of public health services”, said Commissioner Chelsea Clinton of the Clinton Foundation. “A meaningful recovery from COVID-19 requires richer nations to invest in equitable and effective interventions to enable the poorest billion to overcome non-communicable diseases.”
The release of the Commission’s report also marks the launch of the NCDI Poverty Network to mobilize greater funding and political commitment for the health of the poorest billion. and was informed by more than 250 academics and policy makers who convened associated national commissions in 16 countries.
“Ensuring the best quality of life for individuals requires making investments that go beyond any one disease to strengthen the foundations of health systems,” said Gina Agiostratidou of The Leona M. and Harry B. Helmsley Charitable Trust, which provided major support for the Commission. “To address the interconnections of health and wealth, we must work together.”
To request an embargoed copy of the report or interview with one of the Commissioners, contact: Melanie Archer, Manager, Global Health Strategies, +41 (0) 76 428 72 60, email@example.com
Notes for Editors:
The Commission was convened by The Lancet and co-chaired by Gene Bukhman and Ana Mocumbi. The Commission includes 23 global health experts and was informed by more than 250 academics and policy makers who convened associated National Commission leaders across 16 countries. Major support for the Commission came from the Leona M. and Harry B. Helmsley Charitable Trust. The Commission is hosted in the Program in Global NCDs and Social Change at Harvard Medical School with support from NCD Synergies of Partners In Health.
NCDIs include conditions such rheumatic heart disease, type 1 diabetes, sickle cell disease, pediatric and cervical cancers, epilepsy, depression, appendicitis, and trauma in its various manifestations.
The Commission’s report will go live at 23:30 UK time on 14 September 2020 on The Lancet website. The Commission is being launched during an online event on 15 September, register here: https://bit.ly/2YFr3pw