1. Slide No 1 A partnership for a healthy future Oxford Vision 2020: Stig Pramming Cambridge April 2004

2. Slide No 2 Global projection: Growth of diabetes mellitus 250 200 150 100 50 0 20002010 Number (millions) Year 300 2025 Type 2 diabetes ~ 90% 140 280 “Diabetes will double in 25 years” Financial Times 6 Nov 2000

3. Slide No 3 Epidemiology: Burden of diabetes is increasing Increased childhood and adult obesity Decreasing levels of physical activity Increasing urbanisation Increased longevity Earlier diagnosis A new patient is diagnosed with type 2 diabetes every 5 minutes Epidemic (WHO, 1997)

4. Slide No 4 An aging, increasingly overweight and unfit population Cultural adversity Uneven and inadequate distribution of services Complex health service Unpredictable demands on NHS with limited resources Fragmentation of services Lack of cohesive policy and planning Deficits in our knowledge – prevention / care / cure Deficiencies in ability to collect data – monitor process, outcomes and cost Diabetes: A multitude of challenges (1/2)

5. Slide No 5 Strategy and implementation – main principles Reduce ineffectiveness through co-ordination/integration Awareness of DM - Consumer, provider and public Quality and effectiveness – prevention and care? Access – health care services Imperatives for change Identify and disseminate information Define and implement ‘best practice’ Diabetes: A multitude of challenges (2/2)

6. Slide No 6 Obesity Physical Activity Hypertension Dyslipidaemia Macro- vascular Diseases Diet Depression DIABETES Smoking The universe in which we operate

7. Slide No 7 XXL Welfare Pyramid TM 50% of global mortality 3=4

8. Slide No 8 Chronic conditions: Myth 1 “We must deal with AIDS/TB/Malaria first” No! You must deal with both and develop the health system accordingly. There is co-morbidity and some of the infectious diseases become chronic, eg, AIDS

9. Slide No 9 “Economic growth will automatically improve all health conditions” No! Economic growth may exacerbate chronic conditions. Chronic conditions: Myth 2

10. Slide No 10 “Chronic conditions are individual failure and your own responsibility “ No! Governments, industry and others play an important role. Chronic conditions: Myth 3

11. Slide No 11 “Chronic conditions are issues for the rich and old in the developed world, and a natural consequence of their lifestyle” No! Low socio-economic status leads to cumulative exposure and decreased access to quality medical care. One high risk group are 30-40 yrs old in developing nations. Chronic conditions: Myth 4

12. Slide No 12 “ Treatment of chronic conditions will only benefit people with the specific diseases” No! Chronic conditions control benefits societies economically and, thus, us all. Chronic conditions: Myth 5

13. Slide No 13 “The health care system can deal with chronic conditions” No! Healthcare systems deal with acute diseases, not chronic. It was never designed but developed gradually and has no structure for prevention, which requires a multi-sector effort. Chronic conditions: Myth 6

14. Slide No 14 Who is responsible for policy response for chronic conditions? Heads of state: Not in focus Health ministries: Inadequate capacity and budget WHO: Has tried for 48 years - 5% of budget vs. 60% of mortality Academic health centres: Not a priority Research institutions: Not funded in proportion to magnitude International donors: Only for AIDS modest support against tobacco World Bank, regional banks: Recognised but no increase in funding Private-public partnerships: All on infectious diseases Global NGOs: No support Media: Little and conflicting interest Research journals: Not proportionally Pharmaceutical industry: Major contribution

15. Slide No 15 Diabetes prevention programme NCD Unit for prevention /control National survey for hypertension No surveillance system nationally NCD policy Budget line for NCD Integrated primary care prevention NCD info in annual report Focus on chronic diseases? (167 countries) Alwan 2001

16. Slide No 16 " Oxford Vision 2020 has brought together a diverse group of influential people and organisations who have all acknowledged the need for urgent action to address the growing problem of chronic disease. The commitment shown from the participants suggests that action will follow” Derek Yach Representative of the Director General Noncommunicable Diseases World Health Organization

17. Slide No 17

18. Slide No 18 Participants included Corporate Bowker Media & Communications House of Monday Morning Institute for Alternative Futures International Business Leaders Forum Johnson & Johnson JP Morgan LIMIU Limited Memory Pharmaceuticals Merck Sharp & Dohme (MSD) Nestlé S.A. New Health Group Novo Nordisk PepsiCo Pharma Futures Strategy XXI Group LTD. Government/Public health Centre for Disease Control & Prevention – USA Chinese Centre for Disease Control & Prevention Department of Health – UK Health Canada House of Commons Medical Research Council, South Africa National Treasury, Republic of South Africa UK Treasury

19. Slide No 19 Participants included Universities City University - London Earth Institute, Columbia University Geneva University Hospitals OCDEM Stanford University School of Medicine Umeå International School of Public Health University of Brasilia University of California at San Francisco University of Geneva University of New South Wales University of Oxford/Radcliffe Infirmary University Potchefstroom University of Queensland, School of Population Health University of Sydney University of Toronto Vanderbilt Diabetes Centre Organisations European Centre on Health of Societies in Transition Healthy Eating & Active Living HE+AL Partnership International Council of Nurses International Federation of Pharmaceutical Manufacturers Assoc. International Obesity TaskForce OECD SustainAbility The World Bank World Health Organization World Heart Federation World Medical Association European Association for the Study of Diabetes

20. Slide No 20 oxfordvision2020.org