LET’S BEAT DIABETES LOOKING BACK, MOVING ?· LET’S BEAT DIABETES LOOKING BACK, MOVING FORWARD ...…

  • View
    212

  • Download
    0

Embed Size (px)

Transcript

  • LETS BEAT DIABETES

    LOOKING BACK, MOVING FORWARD A Review of Progress since 2005 and Recommendations for the Future November 2009 Chad Paraone Tracey Barron Brandon Orr-Walker Siniva Sinclair

  • Cancer, diabetes, heart diseases are no longer the diseases of the wealthy.

    Today, they hamper the people and the economies of the poorest populations, even more than infectious diseases.

    This represents a public health emergency in slow motion (Ban Ki-moon, UN Secretary-General, 2009)

    We have to be more active in prevention It will not be easy

    but it is a battle that we will all have to fight.

    The choice is simple. Either we spend all our time mopping the floor,

    or we get up and turn off the tap. (Professor Jean Claude Mbanya, President, International Diabetes Federation, 2009)

    Kua tawhiti ke to haerenga mai, kia kore e haere tonu; he tino nui rawa ou mahi, kia kore e mahi nui tonu.

    We have come too far not to go further. We have done too much not to do more

    (Sir James Henare, Ngati Hine, 1989)

  • CONTENTS

    EXECUTIVE SUMMARY ........................................................................................... 1

    1. WHAT WE SET OUT TO DO.............................................................................. 7 1.1 A Letter from 2020.............................................................................................................................. 7 1.2 The Original Challenge ....................................................................................................................... 9 1.3 Response.............................................................................................................................................. 9 1.4 Brief Plan Outline.............................................................................................................................. 10

    2. MAKING IT HAPPEN ....................................................................................... 12 2.1 Key achievements and commentary .................................................................................................. 12

    3. PROGRESS MARKERS................................................................................... 19 3.1 LBD Key Performance Indicator Framework ................................................................................... 19 3.2 Key results by KPI and commentary ................................................................................................. 20 3.3 LBD Intermediate term indicators nutrition and physical activity.................................................. 29 3.4 Summary Progress Markers............................................................................................................ 31

    4. LOOKING BACK - STRENGTHS AND CHALLENGES .................................. 33 4.1 Strengths ............................................................................................................................................ 33 4.2 Challenges ......................................................................................................................................... 34

    5. CURRENT ENVIRONMENT ............................................................................. 35 5.1 Obesity, diabetes and cardiovascular disease size and cost ............................................................ 35 5.2 Other key environmental factors ....................................................................................................... 43

    6. MOVING FORWARD: THE NEXT FIVE YEARS............................................. 47 6.1 Recommendation to continue ............................................................................................................ 47 6.2 Supporting rationale .......................................................................................................................... 47 6.3 Key aspects of the 2010-2015 Plan ................................................................................................... 50 6.4 The next six months........................................................................................................................... 55

    7. APPENDICES................................................................................................... 59 APPENDIX 1: LBD network and connections ............................................................................................... 60 APPENDIX 2: Marae running initiatives in Counties Manukau .................................................................... 61 APPENDIX 3: List of LBD evaluation reports from the School of Population Health .................................. 62 APPENDIX 4: Summary of Achievements by action area............................................................................. 65 APPENDIX 5: LBD Implementation Score ................................................................................................... 86 APPENDIX 6: Strengths and Challenges To Date ......................................................................................... 88

    8. REFERENCES.................................................................................................. 94

  • LBD: Looking Back, Moving Forward Page 1

    EXECUTIVE SUMMARY In 2004, Counties Manukau was experiencing a growing epidemic of type 2 diabetes. At the time it was estimated more than 12,000 people had been diagnosed as having diabetes, with nearly twice this number having undiagnosed diabetes. The numbers were projected to double in 20 years, inflicting major costs on the health sector and wider community. In response, a wide group of community partners, lead by Counties Manukau District Health Board (CMDHB) developed and launched Lets Beat Diabetes, a five year district-wide strategy aimed at long-term, sustainable change to: prevent or delay the onset of diabetes, slow down disease progression, and improve quality of life for people with diabetes. Encompassing ten action areas, the Lets Beat Diabetes (LBD) strategy proposed a wide-ranging set of concurrent initiatives across many fronts with multiple partners representing many different sectors and interests. It was guided by the basic concept that a whole society, whole life course and whole whanau/family approach was needed, and that sustained effort was needed over a 15-20 year period to achieve material change. In February 2005, the CMDHB Board approved a base funding envelope of $10 million to support implementation of the five year plan. MAKING IT HAPPEN Action got underway in July 2005. Given the scale and complexity of the strategy, programme organisation was vital to the success of LBD. Despite the many challenges, there has been good progress in this area over the last four and a half years, including:

    Development of a good foundation and networks for collective action with community partnerships, relationships and common interest connections;

    Large scale mobilisation of community partners and coordinated activity, with over 500 organisations having implemented or supported aligned initiatives in the district;

    Attracting more than $10 million in additional funding to assist with these efforts (over and above the CMDHB five year funding commitment);

    Increased conversation and dialogue in the community around obesity and diabetes, nutrition and physical activity;

    Hard-earned experience and accumulated understanding of network management and cross-sector collaboration on a large scale, complex project of this nature; and

    Rich new knowledge and insight from evaluation learnings and major LBD population surveys in Counties Manukau.

    RESULTS LBD objectives for the first five years were focussed on Knowledge, Attitudes and Participation levels. Change in population level nutrition and activity behaviour patterns was not expected at this stage.

  • LBD: Looking Back, Moving Forward Page 2

    In terms of participation, LBD was successful in attracting substantial investment and resources, and using this to galvanise large scale action in Counties Manukau, from government agencies to grassroots community groups. In terms of improving awareness, knowledge and attitudes, a comparison of results from two large population surveys spaced 2.5 years apart indicates LBD made good gains in some areas, offset by disappointing results in others. Timing differences in the two surveys (the first in summer, second in winter), plus the impact of the recession biting in 2009 (thus higher unemployment and tighter household budgets) may have impacted the results. Positive results picked up by the 2009 survey include pockets of improvement around the benefits of healthy eating, impact of overweight on health, concerns about getting diabetes, and a more supportive environmental support. Specific increases include: Connections made between a healthy diet and prevention of diabetes (big increase) Pacific people associating drinking water with healthy weight South Asians associating not cooking in fat with healthy weight Interest among Pacific people in eating more healthily Concern among Maori about health problems from being overweight Concern overall that someone in the family has/may get diabetes Reported support for eating healthy and being more active from:

    o from doctors and medical centre staff o whanau and close friends

    Reported support at work for being active Examples of areas where the results were disappointing, in terms of no movement or deterioration at a population level, include: No movement in: Associating the control or reduction of fat intake with achieving a healthy weight A