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DIABETES AUSTRALIA New South Wales Janice McLay Liaison Manager

DIABETES AUSTRALIA New South Wales Janice McLay Liaison Manager. Who is DA-NSW? The charity caring for people with diabetes all of their lives in NSW. Diabetes Australia Who we are. Not for profit organisation Peak consumer body in each state and territory

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DIABETES AUSTRALIA New South Wales Janice McLay Liaison Manager

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  1. DIABETES AUSTRALIA New South Wales Janice McLay Liaison Manager

  2. Who is DA-NSW? The charity caring for people with diabetes all of their lives in NSW

  3. Diabetes Australia Who we are... • Not for profit organisation • Peak consumer body in each stateand territory • Federation of 12 organisations,including health professionals, endocrinologists and educators • Manages the Government’sNational Diabetes Services Scheme

  4. FACT • 7.2% of the Australian population over age 25 have diabetes whilst only 50% are aware of their condition (Ausdiab, 2000)

  5. LEARNING OBJECTIVES • FUN • Update information on inequities for ATSI, socioeconomically disadvantaged, Australian born overseas • Trends Diabetes • Prevalence • Cost to the community • Health Care in Australia • Health promotion

  6. Group Activity - Diabetes • Divide into 4 teams using the Visual charts please present information back to the group- 3min • Team 1- What is Diabetes • Team 2- What is Type 1 and Type 2 Diabetes • Team 3- Risk factors of Type 2 diabetes • Team 4- What can you do to prevent/manage diabetes?

  7. INEQUITIESATSI • Diabetes in ATSI • Diabetes not known in indigenous Australians 1923 • Considered exclusive to Europeans • (1 in 10 Torres Strait islanders) • Are found in relatively large numbers in remote & rural areas( 38% of the central Australian population) • Almost always type 2 • GDM (gestational diabetes mellitus) very prominent

  8. INEQUITIESATSI • Diabetes ATSI • Has been associated with a change from a hunter-gatherer to a “western’ lifestyle • Is now 3.4 times as common as in non-indigenous groups (10-30% incidence) ABS 2006c)

  9. INEQUITIESATSI Diabetes in ATSI is associated with Lifestyle factors • Poor diet • Sedentary lifestyle • Obesity • Alcohol use All these lead to a socioeconomic disadvantage • Genetic factors

  10. INEQUITIESATSI BARRIERS TO GOOD CONTROL

  11. INEQUITIES Hospitalisation rates • Higher than for other Australians for most diagnosis • For care involving dialysis x 17times rate of other Australians • For diabetes endocrinex 4 times rate of other Australians

  12. INEQUITIESATSI Reference: Australia’s Health 2006 TRENDS IN MORTALITY Only mortality from disease of the circulatory system showed a consistently significant decline among Indigenous Australians

  13. INEQUITIES-SOCIOECONOMICALLY DISADVANTAGED 100% DIABETES DEATH RATES 2001-2003 82% 0 LEAST DISADVANTAGED DISADVANTAGED REFERENCE: (AIHW:DIXON %WEBBIE 2005)-AUSTRALIA’S HEALTH 2006.

  14. Contrasting figures-diabetes discriminates Below 3% Byron Ku-ring-gai Pittwater City of Sydney Camden Waverly City Leichhardt Manly Woollahra City Mosman

  15. INEQUITIESAUSTRALIANS BORN OVERSEAS • 1 in 8 Australians were born in a non English speaking country • Diabetes prevalence, hospitalisation and mortality are higher among people born • Southern Europe, Eastern Europe, the Pacific Islands, South-East Asia, China, and the middle Eat and North Africa • - approximately 30% of Australians who have Diabetes were born overseas Reference: Australia's health 2006

  16. INEQUITIESAUSTRALIANS BORN OVERSEAS • Countries displaying higher rates hospitalisation for Diabetes Mellitus are- Greece, Italy , India , Vietnam • Death rates for diabetes higher among people born in Germany, Italy, Croatia ,Greece ,Poland and India

  17. INEQUITIESAUSTRALIANS BORN OVERSEAS • Males born in Middle East and North Africa diabetes prevalence rate 3.6 x of Australian-born males. (reference: AIHW:Holdenson et al 2003) • Females corresponding ratio was 2.4 • Incidence Type 2 among Greek and Italian immigrants > 3x Australian born

  18. INEQUITIESAUSTRALIANS BORN OVERSEAS • Australian descendents of Pacific Islanders in QLD diabetes diagnosed in 8%. Increasing prevalence to 1/5 of persons over45years. • Migrants changes in diet and physical activity have been implicated in their increased risk BARRIERS TO ACCESSING HEALTH CARE SERVICES FOR THEIR DIABETES THAT THEY ENCOUNTER DUE TO LANGUAGE AND CULTURE

  19. 28% diabetes population Polynesians - Blacktown/Campbelltown SE Asians - Auburn/Fairfield Middle East - Bankstown/Fairfield Aboriginal communities - Far West

  20. Definitions for ‘prevalence’ and ‘incidence’ Prevalence – the proportion of people within a population who have a certain disease or condition at a particular time Incidence– number of new cases of a disease or condition arising in a population over a period of time

  21. INCREASING INCIDENCE OF DIABETES-Why? • Increases in Obesity • Physically inactive lifestyle • Ageing population • Risingawareness • Improved detection

  22. Diabetes Facts Australia Thousands Source: AusDiab Source: Aus Diab

  23. INCREASING INCIDENCE OF DIABETES-Why? • 2.5 Million adults obese in 2004-05 • 1 in 5 males 18yrs > and 1 in 6 females (1) • 4.9 million estimated to be overweight(1) • 2004 half of Australians did not undertake leisure-time physical activity at levels recommended for health benefits (1) Reference1. Australia’s Health 2006

  24. INCREASING INCIDENCE OF DIABETES? • Type 1 -2004 – annual incidence of 24.6% per 100,000 population < 15yrs (1 in 4000) • 2004-05 AusDiab estimated every yr 8 person in every 1000 will get Diabetes • 2004-05 NHS -699,600 self reported diabetes. • 13% Type1 • 83% Type 2 + (4% did not know type) Reference: Australia's Health 2006

  25. Atlas shows Prevalence rates 1995 -2006

  26. People have diabetes 530,000 70% increase in 5 years

  27. Diabetes epicentre in Sydney 6%

  28. If trend continues Projected rates 2006 - 2012 1.5m. in NSW 4m.- Australia

  29. HEALTH OUTCOMES OF DIABETES • 20% of people with diabetes reported having 1 or more types of ‘heart, stroke or vascular diseases’ compared with 4% general population. • Kidney replacement therapy due to Diabetes accounted for 30% of all new cases for Kidney registry.

  30. Retinopathy Same scene viewed by a person with diabetic retinopathy Normal vision

  31. HEALTH OUTCOMES OF DIABETES • Diabetes is the most frequent cause of lower limb amputation (not associated with an accident).794 hospital admissions NSW 2004-05 • 30-50% of men with Diabetes suffer from impotence

  32. HEALTH OUTCOMES OF DIABETES • Type 2 accounts for approx 85-90% • 68% of all hospitalisations due to Type 2 • Type1 accounts for approx 23% • Gestational around 7% NSW GOV’T 2006

  33. MORTALITY DIABETES • Diabetes is the 6th highest cause of death in Australia • Diabetes is the underlying or associated cause of death in approx 8% of deaths in Australia. • Diabetes was listed as the only cause in < 2% of deaths, which reflects the fact that people die from the complications of diabetes, not the disease itself.

  34. COST BURDEN FOR TYPE 2 DIABETES • Diagnosed Type 2 diabetes is estimated at $3 billion a year • Average cost per person $5,360 +$5,540 in benefits = $10,900 • Cost per person increases with onset of complications • $4,020 without complications • $9,625 with both micro and macro vascular complications (2.8 times higher) Note: These costs do not include lost productivity from days lost through illness and premature death. Reference:DiabCost

  35. COST BURDEN FOR TYPE 2 DIABETES • Direct health costs were hospitalisation due to • Complications (32 %) • Use of medicines to treat complications (4%) • Each person received an average $5,540 in form of • Government subsidies such as pensions • Sickness benefits Reference: DIABCOST

  36. HEALTH CARE IN AUSTRALIA • Diabetes National Health priority 1996 • Acute and short term focus • Public health -2004-05 1.7% of total recurrent health expenditure • Major chronic diseases account for approx 70% of total health expenditure

  37. HEALTH CARE IN AUSTRALIA What is the Australian government doing for Diabetes? • 2007-08 budget-Prevention • $103.4M over 4yrs to develop Risk assessment ‘tick test’ • $10.6M over 4yrs to develop national nutrition and physical activity survey • $11.7M one off grants over 4yrs for physical activity projects Budget Review 2007-08 Health

  38. HEALTH CARE IN AUSTRALIA What is the Australian government doing for Diabetes? • 2007-08 budget- Chronic disease • $291.3M over 4yrs for Medicare items for longer care sessions • $337.6M over 4yrs for Medicare to help people with chronic conditions made worse by poor oral health-Diabetes is part of this • $57M over 4 yrs on other measures • Ongoing support of NDSS Budget Review 2007-08 Health

  39. HEALTH CARE IN AUSTRALIA What is the Australian government doing for Diabetes? • Comments • Indigenous health $121M well short of the $460M called by the AMA • RDAA say it did not provide sufficient measures to increase the numbers of rural practitioners Budget Review 2007-08 Health

  40. HEALTH CARE IN AUSTRALIA What is the NSW government doing for Diabetes? • $5.2 M program to tackle diabetes in Sydney’s south west • Diabetes Prevention program • Identifying those at high risk • Over 3yrs • 30,000 people, 40-64yrs • Pay gap for diabetes supplies-pens/needles Health NSW government news 2007

  41. Diabetes Australia A Health Promotion Perspective • Target Groups... • Whole community • High risk groups eg. pre-diabetes, indigenous Australians, family members • People with diabetes –Type 1,Type 2,GDM

  42. Diabetes Australia A Health Promotion Perspective • Health Promotion • The process of enabling people to increase control over their health • Health promotion at Diabetes Australia two distinct purposes: • Prevention of diabetes • Management of diabetes

  43. Diabetes Australia A Health Promotion Perspective • A partnership approach... • Diabetes Australia adopts a partnership approach to health promotion • Key partners include: • Community groups • NSW Health & Area Health Services (clinical and health promotion) • Divisions of General Practice & GPs • ADS ,ADEA • Other non-government organisations • Universities & colleges • Other government agencies - DVA / DET

  44. Classification of abdominal obesity by waist circumference Waist circumference (cm) Males Females Normal < 94.0 < 80.0 Overweight 94.0 – 101.9 80.0 – 87.9 Obese ≥ 102.0≥ 88.0

  45. Diabetes Australia A Health Promotion Perspective • Links to health promotion strategies… • Diabetes Australia strategies for promoting health are aligned with national & state health priorities: • Go for 2 and 5NSW - promoting healthy weight, fruit and vegetable consumption • Physical Activity Strategies eg. Active Australia, promotion of National PA guidelines, • Diabetes Australia is represented on NSW physical activity / nutrition networksDAA aligned

  46. Diabetes Australia A Health Promotion Perspective • Activities linking with the 5 key action areas of Ottawa Charter... • Build healthy public policy • Provision of free needles, syringes and blood testing strips via the NDSS • Health care card • Advocacy • Community Sharps Disposal • Lobbying government for funding and services • Working with industry groups

  47. Diabetes Australia A Health Promotion Perspective • Activities linking with the 5 key action areas of Ottawa Charter... • Create supportive environments • Education for employers and advocacy on behalf of people with diabetes • Support for children and adolescents in school environment • Work with partner organisations in prevention & awareness – ADEA/ADS past work AFL / DVA • Workplace awareness and prevention programs

  48. Diabetes Australia A Health Promotion Perspective • Activities linking with the 5 key action areas of Ottawa Charter... • Strengthen community action • Branches and support groups • Community based programs - Tai Chi, DVA, Buzz Day, Great Australian Bite • Capacity building within communities to support initiatives – Councils, Train The Trainer (CALD)

  49. Diabetes Australia A Health Promotion Perspective • Activities linking with the 5 key action areas of Ottawa Charter... • Develop personal skills • Providing information and education about prevention and management of diabetes including: • printed resource material, • websites • customer care line • school visits • community lectures / media • Lifestyle programs - DVA / VITALITY/ Supermarket tours

  50. Diabetes Australia A Health Promotion Perspective • Activities linking with the 5 key action areas of Ottawa Charter... • Reorient health services • Promotion of the value of the contribution of a multidiciplinary team approach to caring for people with diabetes • Provision of support to health professionals eg. Printed resources, customer care line, update and education day for health professionals • Support health services in conducting diabetes awareness & prevention programs

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