Diabetes Policy Review - Report of the Expert Panel

Panel Summary Response to Terms of Reference

This Policy Review comes only three years after the Canadian Diabetes Strategy was renewed for a further five years. The renewed Strategy's start-up and implementation was impeded by a change of government, creation of a new agency and the resulting delay in funding allocations. This has been a major constraint to evaluating the renewed Strategy fully. Nevertheless, the Panel has attempted, through a comprehensive document review, an international scan of diabetes policies and programs, and a series of consultations with diabetes stakeholders across the country and the cooperative personnel at the Public Health Agency of Canada, to provide an appropriate response to the Terms of Reference.

1. Priorities

Progress in Achieving the Priorities Identified in the Canadian Diabetes Strategy Developed by Stakeholders between 1999 and 2005:

Progress in achieving the priorities identified in the initial and renewed Strategy has been slow. The renewed Strategy does not follow exactly the six strategic areas and four principles identified by all diabetes stakeholders in the initial Strategy from 1999 to 2004. This has been further complicated by the 2006 introduction of a broader Integrated Health Living Strategy, renamed Healthy Living and Chronic Disease initiative, under which the renewed Strategy now operates.

Value and Appropriateness of the Funding Invested in the Canadian Diabetes Strategy since 2005: The Healthy Living and Chronic Disease initiative tends to confuse the process for implementing the priorities of the renewed Strategy. The funding earmarked to the various components of the renewed Strategy appears uneven and, in some cases, insufficient, e.g., for the Community-Based Programming. Another concern is the degree to which the funds allocated have been channelled to administrative purposes as opposed to programming activities.

Priorities Necessary for an Effective Canadian Diabetes Strategy:

• An economic analysis of the economic burden of diabetes in Canada;
• A formal involvement of non-governmental organizations and the provincial/territorial governments;
• Deliverables and Targets - a small set of clear "do-ables"/deliverables with specific targets, which can be easily measured within the first two years, with gradual expansion of the program as the first early targets have been realized, instead of an approach that seems to try to do all things simultaneously;
• Data collection, dissemination and use - data collection (surveillance) is one of the successful components of the existing Canadian Diabetes Strategy; however, collection is one thing, effective dissemination is critical, and appropriate use of the data is vital;
• Research - a cooperative setting of research goals and the initiation of public/private research projects in a close alliance with the Canadian Institutes for Health Research; and
• Information platform - in many jurisdictions, priority is given to the development of a user friendly web-based information platform, such as a directory of services, professional clinics, organizations, research projects and results, etc. (e.g., New Zealand, the United Kingdom, the United States);
• Strong, independent evaluation; and
• Other measures are listed in the Recommendations section of the Report.

Government Instruments that Could Be Used to Achieve the Outcomes Identified in the Canadian Diabetes Strategy:

• More focused body involving the Public Health Agency of Canada, non-governmental organizations, the Canadian Institutes for Health Research and the provincial/territorial governments.
• Changing the Healthy Living and Chronic Disease initiative to a separate multi-departmental action including the Departments of Health and Finance, Sport Canada, as well as ParticipACTION.
• Expanding the existing tax-credit system for off-setting the cost of managing diabetes and the more comprehensive use of the tax-credit system to credit registered child and adult activities that lead to healthier living.

2. Process

Governance of the Program (i.e., What Structures and Processes are in Place to Ensure Transparency and Accountability) and Recommendations for Improvement:

The imposition of the Healthy Living and Chronic Disease initiative on the disease specific strategies has complicated the process and removed any formal procedures for involving non-governmental organizations that were so much a part of the Strategy from 1999 to 2004.

A Model for Managing the Canadian Diabetes Strategy:

An arms-length partnership body is proposed with clear annual and multi-year targets in a number of clearly defined areas.

3. Performance

Progress Made on Achieving Outcomes:

• The process-focused goals identified in the logic model of the renewed Strategy prevented an evaluation of the progress in achieving tangible outcomes.
• An added component of the renewed Strategy, Knowledge Development and Exchange, for example, is now only fully operational, although there were some modest activities in the fiscal year 2006-07.
• The Community-Based Programming component is a complicated, lengthy process which prevents easy assessment. For example, the 48 prevention and capacity building projects of the last two years were of such a short duration, and included such diverse geography and subject matter that a full evaluation of their impact is all but impossible.
• Concerning the Public Information component, the majority of stakeholders were unaware of the existence of the renewed Strategy.
• The Leadership, Coordination and Strategic Policy Development component of the renewed Strategy is weak and ad-hoc.

Recommendations for Improving Program Outcomes:

• A simplified, operational system with some clearly set targets and timelines;
• Emphasis on basic deliverables;
• Knowing the extent and complexity of the disease and its economic burden through highly focused studies (as was done in Finland);
• The facilitation of the coordination of investments in research beyond the biomedical area;
• A separate national multi-sectoral healthy living initiative;
• A comprehensive information platform; and
• A gradual development of creative prevention and other programs delivered through organizations that have a presence on the ground in communities.