Bharti Hosp, Dept Endocrinol, Karnal, Haryana, IndiaAarhus Univ, Dept Publ Hlth, Aarhus, DenmarkKazakh Acad Nutr, Alma Ata, KazakhstanAcad Prevent Med, Alma Ata, KazakhstanKazakh Natl Med Univ, Alma Ata, KazakhstanDubai Hosp, Dept Endocrinol, Dubai, U Arab EmiratesPondicherry Inst Med Sci, Dept Med, Pondicherry, IndiaMinist Hlth, Directorate Epidemiol, Mexico City, DF, MexicoItalian Coll Gen Practitioners, Florence, ItalyUniv Hlth Network, Toronto, ON, CanadaSiberian State Med Univ, Tomsk, RussiaInst Diabet Endocrinol & Metab Dis, Endocrinol Res Ctr, Moscow, RussiaUniv Fed São Paulo, Dept Med, São Paulo, BrazilPrimary Care Diabet Europe, Barcelona, SpainDubai Hlth Author, Dubai, U Arab EmiratesPeking Union Med Coll, Beijing, Peoples R ChinaUniv Fed São Paulo, Dept Med, São Paulo, BrazilWeb of Scienc

Akanov, Z.

Al Awadi, F.

Cos, X.

Das, A. K.

Du, X.

Espinosa Lopez, C.

Farghaly, M.

Kalra, S.

Lauritzen, T.

Medea, G.

Netto, P.

Oh, P.

Samoilova, Y.

Sharmanov, T.

Shestakova, M.

Diabetic Medicine

English

S. Kalra

T. Lauritzen

T. Sharmanov

Z. Akanov

F. Al Awadi

A. K. Das

C. Espinosa López

G. Medea

P. Oh

Y. Samoilova

M. Shestakova

P. Netto

X. Cos

M. Farghaly

X. Du

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Alma-Ata to Berlin: diabetes prevention and treatment to achieve healthy living

Netto, P. [UNIFESP]

Repositório Institucional UNIFESP

LettersDOI: 10.1111/dme.13374Alma-Ata to Berlin: diabetes prevention andtreatment to achieve healthy livingDiabet. Med. 34, 1169–1170 (2017)The 1978 Declaration of Alma-Ata [1], issued at theInternational Conference on Primary Health Care*, held atAlma-Ata, Kazakhstan (former Soviet Union), is a landmarkin public health. By stating that health is a fundamentalhuman right, the declaration promoted interest and action inthe field of public health, specifically primary health care.While it highlighted maternal child health and infectiousdisease control, it also clearly addressed chronic illness care,the availability of appropriate pharmaceuticals, and the needfor preventive, curative and rehabilitative services. TheThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in anymedium, provided the original work is properly cited.*Organized by T. Sharmanov.Table 1 Excerpts from Alma Ata and Berlin declarationsDeclaration of Alma-Ata Berlin DeclarationI Health is a fundamental human right. With an estimated 14 000 people dying as a result of diabetes and itscomplications every day, time cannot be wasted in closing the gapbetween evidence, policy and practice.Requires the action of many other social andeconomic sectors.All prevention policies should be collaborative across sectors andservices, and linked to every aspect of daily life that might be improvedby promoting healthier lifestyles and physical activity. Departments ororganizations responsible for implementation must be outside thepolitical cycle to prevent the content and its delivery being politicized orimpacted by elections.II Existing gross inequality in the health statusis unacceptable.Ensuring that health systems are addressing the need for equitable, earlyaccess to the personalized education, lifestyle change programmes andtreatments that people with Type 2 diabetes need.Of common concern to all countries. Government policy is required.III Promotion and protection of health is essential tosustained economic and social development, andcontributes to a better quality of life and to world peace.Taking steps to prevent people from developing Type 2 diabetes fromthe outset.IV The people have the right and duty to participateindividually and collectively in the planning andimplementation of their health care.Involvement of patient representation and organizations.V Governments have a responsibility for the healthof their people.Government policy is required.Primary health care is the key to attaining this target Identifying those at high risk of developing Type 2 diabetes anddiagnosing them as early as possible.VI Primary health care is essential health care basedon practical, scientifically sound and sociallyacceptable methods and technology.Collaboration must be fostered between key stakeholders such ascommunity leaders, primary care, secondary care and policymakers toprevent plans from reaching barriers at different levels of the system.At a cost that the community and countrycan afford to maintain.A realistic view of how much funding is needed to deliver impact withprevention initiatives must be taken, acknowledging that significantupfront investment may be required, or that policies may only befounded through levies or reductions elsewhere.VII Primary health care addresses the mainhealth problems in the community,providing promotive, preventive curativeand rehabilitative services.Ensuring that people with diabetes are given the treatment and supportthey need to achieve good control of their blood glucose levels as earlyas possible, to reduce the risk of complications.Includes provision of essential drugs. Early access.VIII All governments should formulate nationalpolicies, strategies and plans of action.Each country must commit to implementing policy to support earlyaction in Type 2 diabetes.It will be necessary to exercise political will,to mobilize the country’s resources and to useavailable external resources rationally.A realistic view of how much funding is needed to deliver impact withprevention initiatives must be taken, acknowledging that significantupfront investment may be required, or that policies may only befounded through levies or reductions elsewhere.IX All countries should cooperate in a spiritof partnership and service.This declaration is, at the same time, a challenge and an inspiration forchange. It will be a global call to action for policymakers to act on thegaps we know exist.X An acceptable level of health can be attainedthrough a fuller and better use of theworld’s resources.It will neither blame nor point the finger, but rather provide inspirationand tangible guidance, making it easier for all stakeholders involved totake the right decisions for people with diabetes.ª 2017 The Authors.Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK 1169DIABETICMedicineDeclaration of Alma-Ata encouraged coordinated effortsbetween various sectors, members of the community or civilsociety and healthcare workers to realize its vision of Healthfor All. The main features of the Declaration of Alma-Ata arelisted in Table 1.Nearly 40 years later, a similar declaration has been madeby experts in the field of diabetes. The Berlin Declarationcalls for early action to stem to the potential healthcatastrophe that Type 2 diabetes is turning out to be [2].The Berlin Declaration is concordant with, and buildsupon, the legacy of Alma-Ata (Table 1). With a philosophysimilar to that of Alma-Ata, the Berlin Declaration notes the‘devastating impact on lives and economies’ of Type 2diabetes [3]; echoing Alma-Ata’s observation that ‘health isessential to economic and social development’ [1].Just as Alma-Ata witnessed the involvement of countriesand non-governmental organizations from across the globe,the Berlin Declaration is based on the input of experts fromall continents, and is endorsed by the leading professionalsocieties of diabetology. Its basic principles are relevant to allnations, regardless of their environment. In this manner, theBerlin Declaration is similar to Alma-Ata, which notes thatprimary health care is influenced by the unique socio-economic conditions of a particular country.The Berlin Declaration has also succeeded in involvingpatient organizations and patient representatives: this is inthe spirit of Alma-Ata, which states that ‘people have theright and duty to participate individually and collectively’ intheir health care.The Berlin Declaration notes that ‘current policies are notdoing enough to take the problem at the root, before diabetesand its related complications set in’. This underlines the needto promote and protect health at the primary level, asenshrined in the Declaration of Alma-Ata. The BerlinDeclaration asks each country to commit to implementingappropriate policy; a reflection of Alma-Ata’s observationthat ‘Governments have a responsibility for the health oftheir people’.The four pillars of the Berlin Declaration are prevention,early detection, early control and early access to the rightinterventions, and they span the entire spectrum of primarycare, as described in the Declaration of Alma-Ata. Theseinclude promotive, preventive, curative and rehabilitativeservices. The fourth pillar (early access) also covers theprovision of essential drugs. The call for national diabetesprevention strategies, covering education, tobacco cessation,nutrition and exercise, reinforces the principles of Alma-Ata.Mention of urban environments, local food environmentsand legislation in the Berlin document echoes Alma-Ata’sreminder to involve other social and economic sectors inprimary health care.The Declaration of Alma-Ata defined health as ‘a state ofcomplete physical, mental and social well-being and notmerely the absence of disease’. Similarly, the Berlin Decla-ration should encourage us to define, and achieve, healthyliving with diabetes or a life without diabetes. A state ofoptimal bio-psychosocial health, achieved by early metaboliccontrol, facilitated by complete access to the right interven-tions, is what we should aim for.Primary care is the key to achieving the goals of bothAlma-Ata and Berlin [4]. The vast number of people livingwith diabetes cannot be managed without the active andcommitted involvement of primary care physicians. The needto involve primary care in diabetes management has beenraised in the past [5], and strategies to utilize availableresources have been discussed [6]. The Berlin Declarationreinforces this movement, and reminds us of the philosophyof Alma-Ata, while working towards a healthier future forpeople with diabetes.S. Kalra1 , T. Lauritzen2, T. Sharmanov3,4, Z. Akanov5,F. Al Awadi6, A. K. Das7, C. Espinosa Lopez8, G. Medea9,P. Oh10, Y. Samoilova11, M. Shestakova12, P. Netto13,X. Cos14, M. Farghaly15 and X. Du161Department of Endocrinology, Bharti Hospital, Karnal,India, 2Department of Public Health, Aarhus University,Aarhus, Denmark, 3Kazakh Academy of Nutrition,Almaty, Kazakhstan, 4Academy of Preventive Medicine,Almaty, Kazakhstan, 5Kazakh National MedicalUniversity, Almaty, Kazakhstan, 6Department ofEndocrinology, Dubai Hospital, Dubai, UAE,7Department of Medicine, Pondicherry Institute ofMedical Sciences, Puducherry, India, 8Directorate ofEpidemiology, Ministry of Health, Mexico City, Mexico,9Italian College of General Practitioners, Florence, Italy,10University Health Network, Toronto, Canada,11Siberian State Medical University, Tomsk, Moscow,Russia, 12Endocrinology Research Centre, DiabetesInstitute, Moscow, Russia, 13Department of Medicine,Universidade Federal de S~ao Paulo, S~ao Paulo, Brazil,14Primary Care Diabetes Europe (PCDE), Spain, 15DubaiHealth Authority, Dubai, UAE and 16Peking UnionMedical College, Beijing, ChinaReferences1 Alma-Ata. Declaration of Alma-Ata: International Conference onPrimary Health Care, Alma-Ata, USSR, 6–12 September, 1978.2 International Diabetes Federation (IDF). IDF Diabetes, 7th edn.Brussels: IDF, 2015. Available at http://www.diabetesatlas.org Lastaccessed 29 January 2017.3 The Berlin Declaration – driving early action in type 2 diabetes.Available at http://www.idf.org/berlin-declaration-driving-early-action-type-2-diabetes Last accessed 24 December 2016.4 Walley J, Lawn JE, Tinker A, De Francisco A, Chopra M, Rudan Iet al. Lancet Alma-Ata Working Group. Primary health care:making Alma-Ata a reality. The Lancet 2008; 372: 1001–1007.5 Bodenheimer T, Wagner EH, Grumbach K. Improving primary carefor patients with chronic illness. JAMA 2002; 288: 1775–1779.6 Kalra S, Julka S, Joshi R, Shah A, Jindal S, Agrawal N et al.Strengthening diabetes management at primary health level. Ind JEndocrin Metab 2015; 19: 443.1170ª 2017 The Authors.Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UKDIABETICMedicine Letters

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Alma-Ata to Berlin: diabetes prevention and treatment to achieve healthy living

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