A top-down approach to diabetes

The Lancet, Volume 377, Issue 9779, Page 1720, 21 May 2011

On May 10, the UK's National Institute for Health and Clinical Excellence published its new guidance on the prevention of type 2 diabetes in adults. The guidance focuses on population-level and community-level interventions in high-risk groups and the general population. The groups at high risk include certain ethnic communities (south Asian, black, and Chinese) and lower socioeconomic groups (people in unskilled jobs), in addition to individuals who are obese or overweight and those who are not physically active. Of the ethnic communities in the UK at greater risk, people of south Asian origin are up to six times more likely to have the disease than white individuals. Also, people from lower socioeconomic groups are three and a half times more likely to develop ill health from the disease than groups with higher incomes.

The guidance makes 11 recommendations, mostly on how commissioners and providers of public health services can best convey messages to promote behaviours that reduce diabetes and associated harms. The key, although unsurprising, recommendations are the promotion of healthy diets and physical activity. Promoting healthy eating is to include working with food manufacturers and caterers to reduce the calorie, saturated fat, and salt content of foods, and working with retailers on price structure, labelling, and promotion to encourage healthier diets. Promoting physical activity is to centre on planning regulations and transport policy. Measures relating to ethnic and socioeconomic groups include the provision of information in appropriate languages and through so-called community champions, and ensuring that all measures are affordable to individuals.

Ultimately, the successful implementation of this guidance will need the cooperation of many parties, but the involvement of commercial partners must not be used to shift responsibility away from providers of public health. And success will also rely on engaging the communities that have been neglected so far. Although the recommendations might seem straightforward, they are long overdue and, if implemented, will powerfully affect public health beyond just diabetes.