This year 2021, under the Covid-19 pandemic, we are celebrating 100 years of the discovery of insulin and 95 years of the Protective Association of Diabetics of Portugal (APDP).
The introduction of one of the first “miracle cures” and the emergence of the associative movement of citizens with illness prompted us to initiate these reflections for World Health Day on health and citizenship:
Innovations to save – Over the past 100 years, scientific research and technological development, along with economic growth and new social models, have resulted in better quality of life and an increase in average life expectancy.
The discovery of insulin represented one of the greatest innovations in medicine and introduced the concept of chronic illness – a fatal disease has become a condition of life where citizens are encouraged to take care of themselves. In addition to drugs, the technology developed has allowed people to have more control over their disease management.
Education to Training – Innovation only worked because it was recognized early on that diabetes management must focus on people. To achieve this goal, a new role has been defined for health professionals – that of educators. Professionals must be able to use resources that are appropriate to people’s knowledge in order to be effectively trained for their new roles.
Increasing health literacy as a relevant health policy goal does not exhaust the responsibility of health systems to develop and recognize the fundamental role of education in better health outcomes.
Today, this educational process is also understood to include peer involvement and the participation of patient associations, a connection closer to people’s needs and community resources (this is how APDP was born).
Adequate for improvement – Chronic diseases represent the largest consumption of health resources today and are recognized as one of the greatest threats to the sustainability of health systems as well as to economic and social development. We have to discuss alternatives. We need better disease prevention measures in order to have more resources to better treat the sick. Healthcare organization and processes must be tied to funding models that value the best outcomes and efficiency. The evaluation of the results must be a constant in this process that we want to improve.
There is a need to understand the complexities of diabetes and address it in an integrated way, the importance of acting on its social determinants and reforming the health system itself, and transforming it into a resilient and better-resourced system to care for living people with chronic diseases, including diabetes.
On this World Health Day, when the World Health Organization emphasizes the importance of health workers and nurses, it is important that official and government agencies take on the implementation of measures based on existing experience and knowledge, including that of patient associations. This period of pandemic that we are experiencing was and is an excellent example of the importance of both morbidity and mortality from chronic diseases in general and diabetes in particular.
APDP suggests that the Portuguese government consider three challenges to make a difference in the fight against diabetes:
1. Reduce the risk
It is necessary to end the view that diabetes is a lifestyle-induced disease without considering its complexity, the influence of genetics, obesogenic environments, and the impact of social inequalities. A “health in all policies” approach helps shape communities that are more conducive to health than disease, including through better housing, employment, transport and other social policies. Schools at all levels of education need to incorporate health education practices into their curriculum. In addition to health units, prevention and early diagnosis strategies should also involve organizations at the community level.
2. Integrate care
It is important to strengthen the closeness, to ensure their mobility, to guarantee every citizen a doctor and to establish a strong connection with the communities and the social sector. New models of care should be implemented through the creation of integrated and multidisciplinary units like the work developed by APDP, whose goals focus on people-relevant health outcomes and promote autonomy and personalized care and focus on assessment needs.
3. Ensure access to health care
It is important to ensure the surveillance, monitoring, and quality of care for people with diabetes. An emphasis on therapeutic education and peer support should be incorporated into health services as it is shown to be effective in providing psychological support and improving outcomes for health and wellbeing. Access to innovation must be based on assessment models that include people with diabetes and outcomes that are relevant to them. The integration of new technologies and the digitalization of health must be accompanied by strategies to improve health literacy and by mechanisms that ensure that no one is left behind.
This is a time of change that challenges us and makes us aware of the urgent need for concrete and effective action. The answer to these challenges will be more effective the better we can involve people with diabetes at all levels of the decision-making process. There is a need to change the communication paradigm between people with diabetes and the healthcare system, leveraging whatever knowledge they can introduce.
The authors write according to the new orthographic agreement