Diabetes Policy Review - Report of the Expert Panel

Executive Summary - Top 10 Themes

This Expert Panel has been asked by the Minister of Health to review the Public Health Agency of Canada's Diabetes Initiative in the context of its historic development and considering appropriate accountability and effectiveness principles. This we have attempted to do.

This Report details:

• the history of the development of the federal government's diabetes policy;
• stakeholder response to the Expert Panel's Terms of Reference, interwoven with some ideas coming from a national literature review;
• an international review of diabetes policy and practices in a number of countries;
• the Panel's specific responses to the Terms of Reference; and
• specific recommendations to act as guide posts for the revised Strategy.

We believe significant changes are necessary to the existing structure and programs of the Canadian Diabetes Strategy.

To underscore our almost obsession with clarity, we describe this summary as our Top 10 Themes, their more fulsome expression and additional points to be found sprinkled throughout the Report but with specific expression in the Recommendations section.

1. Knowledge of the Strategy - Very few stakeholders were aware of the renewed Canadian Diabetes Strategy. The umbrella Healthy Living and Chronic Disease initiative was virtually unknown.

   Needless to say, the Public Information component of the renewed Strategy needs extensive change and improvement.

2. All Types of Diabetes - The present Strategy tends to focus on type 2 diabetes. Any credible national public policy strategy must flow from the premise that diabetes in all its forms is to be addressed. It is only after this primary recognition that one can realistically confront the policy and program choices necessary to develop a coherent strategy, both from a programming and research perspective.
3. Partnership - In countries who have achieved success in addressing diabetes (e.g., Finland and Denmark), partnerships are prevalent. Canada lacks real partnerships. A new entity involving partnerships is being proposed to oversee the revised Strategy, including setting goals for diabetes research. Additionally, the Panel envisages substantial partnerships among the public and private sectors and non-governmental organizations to advance research and deliver specific programs of the Strategy.
4. Healthy Living Promotion - The umbrella Healthy Living and Chronic Disease initiative should be separate from the renewed Canadian Diabetes Strategy and should involve multi-departmental cooperation, enlightened use of the tax system and partnerships with entities such as ParticipACTION which the federal government is already supporting.
5. Targets / Results - Specific measurable targets leading to tangible results should be a hallmark of a renewed highly focused Strategy. Good public policy means priorities and choices - one cannot be all things to all people. Independent evaluation is crucial.
6. Information - Information concerning all aspects of diabetes to those with diabetes, researchers and health professionals as well as to the general public through one portal (e.g., the United States, the United Kingdom) should be a sound and necessary investment.
7. Economic Burden of Diabetes - There is a lack of study on the economic burden of diabetes, as in the United States and Finland.
8. Electronic Health Records - A lack of organized medical records across the country challenges the delivery of diabetes-related programs and services.
9. Childhood Obesity / Prevention of Type 2 Diabetes - The recent Report by the Advisor on Healthy Children & Youth (known as the Leitch Report) indicated that Canada ranks 27th out of 29 OECD countries in childhood obesity and 21st in child well-being, including mental health.¹ Obesity is a significant modifiable risk factor for type 2 diabetes.
10. Prevention - Two key areas identified were the prevention of the onset of type 2 diabetes and the complications of all types of diabetes. Screening and self-management are highlighted as areas of immediate focus.

Clear goals, specific measurable targets, robust studies, necessary research, effective prevention and partnerships with an eye on results rather than process should reap progress and positive results in five years.