![\"Richard](\"http:\/\/www.bmj.com\/site\/blog\/icons\/bmjh7648e.jpg\")
The golden phrase for countering non-communicable disease (NCD) is that we need a \u201cwhole of government and whole of society approach.\u201d An important step on that path is obviously for all parties to talk together, and that\u2019s why the International Diabetes Federation for the first time started its biannual conference with a \u201cglobal diabetes forum,\u201d with the title of \u201cHarnessing the private sector expertise.\u201d How did it go?<\/p>\n
I can answer the question directly with data in that a vote at the end with an electronic gizmo showed that 37% were very satisfied and 40% satisfied. I wasn\u2019t one of the 77%, but I wasn\u2019t wholly disappointed. Over the years I\u2019ve learnt that you often have to talk for quite a while before the real talking begins.<\/p>\n
The organisers had spent a lot of time designing our meeting in Dubai. Increasingly a series of Powerpoint presentations is unacceptable as too boring and too one way, so you have to try and find a way to capture the \u201cwisdom of the crowd.\u201d There were perhaps 120 of us divided into something like 12 tables of 10 people, no doubt carefully selected. Each table had a facilitator, a notetaker, and four questions. Overall there were four sets of questions, four \u201cthought leaders\u201d to feedback the tables\u2019 answers to the questions, and an uberfacilitator. In addition, with the gizmos we could not only vote (which we did only twice seriously) but also send texts, which appeared on a huge screen behind the uberfacilitator. Early next year a \u201cDubai Blueprint\u201d based on the conversations will be published.<\/p>\n
Little more could have been done to hear everybody\u2019s views, but meetings, just like parties can be overorganised and lack that spontaneity that makes for a really good party. The route from 10 000 conversations to a blueprint will no doubt be convoluted, but each of us will come away with some thoughts\u2014and these are mine.<\/p>\n
The main thought I took away was that we don\u2019t have a clear vision of success. What exactly do we want to achieve? We clearly aren\u2019t going to rid the world of diabetes, and would success mean more or fewer people with diabetes? We might naturally think \u201cfewer,\u201d but when so many in the world with diabetes are undiagnosed, including in high income countries, success might mean more diabetics. Are we aiming for fewer premature deaths, fewer patients with complications, lower costs, or what? And whatever it is we want to achieve we need targets that are stretching but achievable. They will surely need to be country specific not global.<\/p>\n
We need a clear vision of success in order to enthuse politicians and funders.\u00a0 At the moment diabetes is becoming almost \u201cnormal\u201d\u2014just like obesity. As one woman in my group said, \u201cYou hear about AIDS and you think funerals,\u201d but diabetes is just \u201cone of those things.\u201d But do we want people to be more scared? We may not, but there is lots of talk of the need for \u201coutrage,\u201d the kind of outrage that put AIDS at the top of the global health agenda.<\/p>\n
George Alleyne, the former director of the Pan American Health Organisation, argued in the main conference that we need to frame our case in terms of head, heart, and wallet. We have lots of data to appeal to the head, although some of it based on sand. Our appeals to the wallets of politicians need more solid data, but it\u2019s the call to the heart that is the weakest. Pictures of amputees and people blinded by diabetes don\u2019t seem to work.<\/p>\n
Everybody agreed that having many more patients active in \u201cthe movement\u201d would be beneficial, and a politician from Britain reminded us that politicians listen more to patients than they do to professionals, who are always suspected of vested interest. Very few patient voices were heard at the recent United Nations meeting on NCDs.<\/p>\n
There was lots of enthusiasm as well for \u201ctriple P\u201d partnerships\u2014public, private, people. Nobody seemed to know of one that existed, but they are to be devoutly sought. At the main conference we heard about the need for a new \u201csocial movement\u201d to counter NCDs. I\u2019ve been through that movie before and once devoted a lot of time to studying social movements\u2014particularly the movement to abolish slavery, which has been described as the world\u2019s first social movement. My cautious conclusion was that it\u2019s not easy to create a social movement.<\/p>\n
One of the problems for the International Diabetes Federation or any other organisation concerned with a particular disease is to know how much to devote resources to the one disease and how much to NCDs broadly. I\u2019m an \u201cNCD guy\u201d not a \u201cdiabetes guy,\u201d and I came away feeling that the diabetes people are conflicted\u2014and nobody perhaps feels this more keenly than Ann Keeling, the chief executive of IDF but also the chair and driving force behind the NCD Alliance, which now has 2000 member organisations and is, I think, a magnificent achievement. It is perhaps the start of a social movement.<\/p>\n
What is clear is that it will be a bad day if the disease groups start fighting each other\u2014perhaps for resources\u2014rather than working together. I saw some signs of this when some of the audience in the main conference moaned that diabetes was insufficiently \u201csexy and glamorous.\u201d I couldn\u2019t help thinking that they were perhaps fed up that they themselves were not more sexy and glamorous. Another recurrent message was that we should emphasise the link between diabetes and erectile dysfunction in order to motivate men to take diabetes more seriously. I\u2019m unconvinced that the route to a man\u2019s head or heart is through his penis, but maybe that just illustrates that I\u2019m an out of touch romantic.<\/p>\n
So after hours of somewhat confused conversation we arrived where we started at the conviction that we do indeed need a \u201cwhole of government\u00a0 and a whole of society\u201d approach and that the private sector, despite its conflicts of interest, does belong at the table. The meeting was a step to making it happen, but much more is needed.<\/p>\n