More than 32 million adults and 170,000 children live with a form of diabetes in the EU. Although 14 types of diabetes have been identified so far, the most common are Type 1 and Type 2. Most cases of Type 2 Diabetes are preventable. Yet, Type 1 and other forms are not. While all patients require available, accessible, and affordable long-term healthcare to survive and thrive, many inequities exist across Europe. To address this, EPHA joined the International Diabetes Federation Europe in the call for a ‘Diabetes Resolution’, which was adopted by the European Parliament on 23 November without amendments.
Inequities in diabetes healthcare exist across Europe at multiple levels. There are inequities in the primary prevention of Type 2 Diabetes by socioeconomic status, ethnicity, and other upstream determinants of health. For the management of all diabetes types, there is variation in diabetes education, care quality, and healthcare accessibility. Financially, access to health insurance and lack of pricing transparency by the pharmaceutical industry can obstruct access via unaffordability at both patient and health system levels.
While numerous public health initiatives bolster EU action on diabetes prevention, such as the ‘Healthier Together – EU Non-Communicable Disease Initiative’, so-called ‘lifestyle drift’ in health policy leads to the omission of addressing upstream determinants of Type 2 Diabetes and inequities in the long-term management of all types of diabetes. For example, Type 1 Diabetes advocate Jean Langford reported that in Limerick, Ireland, “there is no foot check clinic, but there is an amputation clinic”; highlighting the stark inequities in care felt by people already diagnosed with the condition.
The Diabetes Resolution
The Diabetes Resolution has 7 main factors across the prevention pathway, from tackling effective primary prevention to improving healthcare system resilience and reducing health inequities across all areas of diabetes care. Specifically, the Resolution calls for Member States to develop, implement and monitor national diabetes plans and strategies, to ensure equitable access to treatments, primary and secondary care, and diabetes education. It also calls for stronger EU leadership and collaboration with Member states to achieve these targets.
While this initiative takes a single-disease approach, there are many opportunities for the Resolution to be leveraged elsewhere. The Resolution highlights the role of food affordability and front-of-pack labelling in establishing healthy environments for all, calling for healthy, sustainable food to also be the most affordable. EPHA strongly supports this message as we work towards improving health literacy.
Furthermore, the European Parliament voted in favour of the Diabetes Resolution without amendments regarding medicine pricing. This involved overcoming efforts to minimise calls to improve transparency and public funding traceability for pharmaceutical investments, to periodically evaluate the incentive system, and to ‘highlight the factors limiting affordability and patient access to medicinal products’. This sends a clear message against exorbitant pharmaceutical pricing and presents early steps to promote fairer market competition, a key target of the Access to Medicine’s Alliance.
In conclusion, the Diabetes Resolution highlights inequities in condition management for all types of diabetes, and the need to shore up healthcare system resilience to support the wide health effects of diabetes; all of which are essential to produce meaningful change in diabetes prevention and management across the EU. EPHA, together with IDF Europe, welcomes the vote for the new Diabetes Resolution, which offers the opportunity to bring about healthier and more equitable societies for people living with diabetes as well as all EU citizens living with NCDs and other conditions.