Health Experts Call For International Action Against Diabetes And TB

Owen Nyaka, CNS Correspondent, Malawi
 The International Union Against Tuberculosis and Lung Disease (The Union) and the World Diabetes Foundation recently released a report at the 45th Union World Conference on Lung Health in Barcelona calling for international action against the looming co-epidemic of diabetes and TB.

The report, ‘The Looming co-epidemic of TB-Diabetes: A call to Action’, synthesizes evidence from the medical and scientific literature, promotes an international policy framework for action, and lays out a new research agenda to fill knowledge gaps. It challenges the conventional approach to health policy making, which has historically addressed infectious diseases and non-communicable or ‘chronic’ diseases independently.

Diabetes triples the risk of a person to develop TB. Diabetes is skyrocketing globally, and is projected to increase from 382 million cases in 2013 to 592 million cases by 2035, with the burden of the disease moving from developed countries to developing and emerging market countries. Unless steps are taken to halt this trend, the consequences will be an increasing number of people developing TB as a result of diabetes; thus potentially reversing the progress made against TB over the last few decades. An estimated 1.5 million people died of TB in 2013, according to World Health Organization (WHO).

“Ice hockey legend Wayne Gretzky was successful due to his playing strategy. His objectives was not to skate to where the puck was on the ice, but always to skate to where the puck was heading. We need to use the same approach to TB-diabetes,” said Dr. Anil Kapur, member of the Board of Directors of the World Diabetes Foundation.

“In places where this issue has been studied-- from India to China to East Africa and the United States—we are seeing significantly higher rates of diabetes among TB patients than what appears in the general population. If we do not act now to head this off, we are going to experience a co-epidemic of TB-diabetes that will impact millions and sap public health systems of precious resources. The key is to prevent this from happening,” he said.

“We saw something similar happen with TB and HIV/AIDS to what is happening now with TB and diabetes,” said Dr. Anthony Harries, Senior Advisor to The Union. “For years we had medical evidence that HIV/AIDS destroyed people’s immune systems, allowing TB to quadruple in many countries in Africa. And even though we had a policy framework for responding, it took many years to mobilize a robust response. Millions of people were impacted by TB-HIV co-infection before it became the norm to screen people living with HIV for TB and vice versa. We want to raise an alarm that we do not watch history repeat itself with TB-diabetes.”

Six of the ten countries projected to have the greatest numbers of people living with diabetes by the year 2035-- China, India, Brazil, Indonesia, Pakistan and the Russian Federation-- are also classified as high TB burden countries by the WHO.

This year’s annual World Conference on Lung Health issues theme, ‘Community-Driven Solutions for the Next Generation’ was chosen to reflect the need to find solutions to the lung health challenges we face by involving all stakeholders from health care professionals and policymakers to the people and communities they serve. This approach recognises the essential role of affected persons and advocates, whose input must be integrated into the conception, design and implementation of interventions along with that of other experts, such as clinicians and researchers, government officials and donors.

TB is an airborne, infectious disease caused by bacteria while diabetes is a chronic illness that weakens the immune system, making people with diabetes more susceptible to developing TB. The report, ‘The looming Co-epidemic of TB-diabetes: A Call to Action’, is the first to present the epidemiological evidence and a framework for responding, with recommendations for healthcare systems to begin offering bi-directional screening, where people with TB are screened for diabetes and people with diabetes are screened for TB, then offered appropriate treatment services.

Dr. Gan Quan, Director at The Union told this reporter that Malawi government should realize the dangers of the tobacco industry’s interference even though it did not sign and enact the Framework Convention on Tobacco Control (FCTC). He said that countries like Malawi who are not a signatory to FCTC should realise that tobacco use is one of the main contributors to Non-Communicable Diseases (NCDs). Hence controlling  tobacco usage is an effective measure to curb the NCDs epidemic.

“One piece of advice I would offer is that measures should be put into place to restrict the advertising, promotion, and sponsorship of the tobacco companies. As a tobacco-growing nation, people generally might be more sympathetic to the tobacco industry and are more likely to take tobacco advertising, promotion, and sponsorship for granted,” said Dr. Quan. He advised the tobacco companies to distance themselves from public health policy making, especially in relating to tobacco control. “The necessity is clearly outlined in Article 5.3 of the FCTC and its guidelines,” he said.

Commenting on banning public smoking, Dr. Quan said that owners of public premises would never be willing to maintain a smoke free environment in their businesses unless forced to do so because telling smokers to stop smoking or to go outside to smoke can potentially insult some customers. Yet the owners of public premises do have the responsibility to keep their venues safe and healthy for all who have access to them.

 “Therefore, it becomes necessary to require owners/managers of public premises to maintain a smoke free environment to protect the health of non-smokers through legal measures. On the other hand, the government also has the responsibility to ensure that its citizens (non-smokers in this case) live in a healthy environment through enforcement actions of the smoke free law,” said Dr. Quan.

Efforts to get reactions from tobacco companies proved futile but on the need to ratify the FCTC, Journalists Association Against AIDS Malawi, programme Manager, Dingaan Mithi said Malawi should quickly accede to the Framework Convention on Tobacco control to show that it puts public health on the top of the agenda rather than only looking at trade and profiteering.

“It is important for Malawi to take necessary steps to curb passive smoking which has devastating consequences on people’s health. We should also remember that tobacco continues to kill a lot of people in the country, hence we cannot ignore the tobacco disease burden any longer,” he said. Mithi added that Malawi should join the rest of the world to sign the FCTC and put in place the legislation to ban public smoking just like what Zambia and South Africa have done. 

Owen Nyaka, Citizen News Service - CNS
29 October 2014