In some Pacific Islands as many as one in three adults have type 2 diabetes. Photo: Getty.
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Where's the public outrage at the diabetes epidemic?

Worldwide, diabetes kills almost as many people a year as HIV/Aids, and the number of cases of Type 2 diabetes is set to increase by 50 per cent in the next decade. Why is so little being done to contain the epidemic? 

Over a third of adults in England are at risk of developing Type 2 diabetes, according to a study published in the British Medical Journal earlier this week – and the number of people at risk of suffering from diabetes has trebled in just ten years.

A few more worrying figures: there are currently 3.2 million people in the UK with Type 2 diabetes. A tenth of the NHS budget goes to treating the condition, according to the charity Diabetes UK. Type 2 diabetes can cut short your life expectancy by ten years. If not properly managed, it can lead to a range of complications including heart disease, blindness, kidney damage and nerve damage.

So are we doing enough to fight the disease? The obvious answer is no. We’re not even coming close.

Let’s look at the global problem too. The World Health Organisation (WHO) reports that 1.5 million people die of diabetes a year, making it the eighth most common cause of death worldwide, and almost as deadly as HIV/Aids (which kills 1.7 million a year). Diabetes is often thought of a rich country disease, but it isn’t just that: 80 per cent of diabetes deaths are in low or middle income countries.  In some Pacific Islands over a third of adults are diabetic, and in several Gulf countries over a quarter are. In American Samoa, a staggering 47 per cent of adults are diabetic. 

We’re facing a global health crisis and yet there’s little sense from government that it’s being treated as one.  Last year the all party parliamentary group for diabetes reported on the current state of healthcare provision and concluded, in the words of the chair Adrian Sanders, that "diabetes is one of the greatest challenges we face, yet diabetes healthcare is poor, patchy and expensive, and too many people with the condition are not getting the care or support they desperately need.”

In April, a doctor writing in the Spectator wrote that “medically speaking, I’d rather have HIV than diabetes.” His reasoning: thanks to advances in the treatment of the disease, the life expectancy of someone in the UK who is HIV positive is not all that different from someone that of someone without the condition. Those who are HIV positive and receive the right treatment (usually those in richer countries) are unlikely to suffer complications, and anti-retroviral drugs are now administered in tablet form. In contrast, most people with Type 2 diabetes face daily injections.

And, the good news is that globally, rates of HIV transmission are declining. According to the Global Fund, there were 2.3m new HIV infections registered in 2013 – which is still a lot, and the actual figure for HIV infections could be higher – but is nevertheless down 33 per cent since 2001. In contrast, WHO predicts that in the next decade, global cases of diabetes will increase by 50 per cent

When it comes to the battle to contain the spread of HIV/Aids, it has helped that on an international scale, there are now huge multi-government funded agencies such as the Global Fund. This was set up in 2002 and by 2013 had distributed $16bn to various donors, from governments to NGOs to international development agencies, to combat the disease. UN Aids was set up almost a decade earlier, to co-ordinate the many different UN agencies working to combat the disease and tackle related problems from gender equality, to gay rights and legal protection for sex workers.  The global effort to fight diabetes doesn’t come close.

Plus, long before these international co-ordinated efforts, we have to be grateful for the community activists of the 1980s who forced HIV/Aids on to national agendas, providing the initial impetus for the public awareness campaigns, charity outreach work, and medical research helping to contain the spread and impact of the illness. It’s time to get angry about diabetes in the UK, not only because at least 3.2 million people in the country are at risk of dying young, but because we know from the history of HIV/Aids how big a difference ordinary people getting angry can make. 

Much like HIV, a significant proportion of new diabetes cases can be prevented. You can be unlucky, but there are ways of reducing the likelihood of developing the illness. The rise of Type 2 diabetes has been linked to rising obesity in the UK, so tackling under-nutrition and sedentary lifestyles is key.

And again, much like HIV, tackling diabetes is not just a medical issue – you need to look at the social context. There’s also a strong link between poverty and diabetes in Britain: those in the lowest income bracket are two and a half times more likely to develop diabetes than average. This is because those on lower incomes are more likely to be obese, to smoke, to lack exercise and to suffer from high blood pressure.

There will be no easy way of preventing the rise of diabetes. Just as with HIV/Aids, we have to hope for (and fund) the development of new life-lengthening and life-improving treatments. But it will also involve changing modern diets and lifestyles – and that’s not just a matter of changing behaviour, which is hard enough already, but tackling the deprivation that is so often a cause of bad health.

There’s no miracle cure, but there is one sure-fire way of ensuring that millions of people in the UK and globally die younger than they should, and that’s carrying on exactly as we are now. As things stand, the charity Diabetes UK estimate that by 2025 five million people in the country will have Type 2 diabetes. It doesn't have to be like this. Aren’t you a little bit angry?

Sophie McBain is a freelance writer based in Cairo. She was previously an assistant editor at the New Statesman.

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Find the EU renegotiation demands dull? Me too – but they are important

It's an old trick: smother anything in enough jargon and you can avoid being held accountable for it.

I don’t know about you, but I found the details of Britain’s European Union renegotiation demands quite hard to read. Literally. My eye kept gliding past them, in an endless quest for something more interesting in the paragraph ahead. It was as if the word “subsidiarity” had been smeared in grease. I haven’t felt tedium quite like this since I read The Lord of the Rings and found I slid straight past anything written in italics, reasoning that it was probably another interminable Elvish poem. (“The wind was in his flowing hair/The foam about him shone;/Afar they saw him strong and fair/Go riding like a swan.”)

Anyone who writes about politics encounters this; I call it Subclause Syndrome. Smother anything in enough jargon, whirr enough footnotes into the air, and you have a very effective shield for protecting yourself from accountability – better even than gutting the Freedom of Information laws, although the government seems quite keen on that, too. No wonder so much of our political conversation ends up being about personality: if we can’t hope to master all the technicalities, the next best thing is to trust the person to whom we have delegated that job.

Anyway, after 15 cups of coffee, three ice-bucket challenges and a bottle of poppers I borrowed from a Tory MP, I finally made it through. I didn’t feel much more enlightened, though, because there were notable omissions – no mention, thankfully, of rolling back employment protections – and elsewhere there was a touching faith in the power of adding “language” to official documents.

One thing did stand out, however. For months, we have been told that it is a terrible problem that migrants from Europe are sending child benefit to their families back home. In future, the amount that can be claimed will start at zero and it will reach full whack only after four years of working in Britain. Even better, to reduce the alleged “pull factor” of our generous in-work benefits regime, the child benefit rate will be paid on a ratio calculated according to average wages in the home country.

What a waste of time. At the moment, only £30m in child benefit is sent out of the country each year: quite a large sum if you’re doing a whip round for a retirement gift for a colleague, but basically a rounding error in the Department for Work and Pensions budget.

Only 20,000 workers, and 34,000 children, are involved. And yet, apparently, this makes it worth introducing 28 different rates of child benefit to be administered by the DWP. We are given to understand that Iain Duncan Smith thinks this is barmy – and this is a man optimistic enough about his department’s computer systems to predict in 2013 that 4.46 million people would be claiming Universal Credit by now*.

David Cameron’s renegotiation package was comprised exclusively of what Doctor Who fans call handwavium – a magic substance with no obvious physical attributes, which nonetheless helpfully advances the plot. In this case, the renegotiation covers up the fact that the Prime Minister always wanted to argue to stay in Europe, but needed a handy fig leaf to do so.

Brace yourself for a sentence you might not read again in the New Statesman, but this makes me feel sorry for Chris Grayling. He and other Outers in the cabinet have to wait at least two weeks for Cameron to get the demands signed off; all the while, Cameron can subtly make the case for staying in Europe, while they are bound to keep quiet because of collective responsibility.

When that stricture lifts, the high-ranking Eurosceptics will at last be free to make the case they have been sitting on for years. I have three strong beliefs about what will happen next. First, that everyone confidently predicting a paralysing civil war in the Tory ranks is doing so more in hope than expectation. Some on the left feel that if Labour is going to be divided over Trident, it is only fair that the Tories be split down the middle, too. They forget that power, and patronage, are strong solvents: there has already been much muttering about low-level blackmail from the high command, with MPs warned about the dire influence of disloyalty on their career prospects.

Second, the Europe campaign will feature large doses of both sides solemnly advising the other that they need to make “a positive case”. This will be roundly ignored. The Remain team will run a fear campaign based on job losses, access to the single market and “losing our seat at the table”; Leave will run a fear campaign based on the steady advance of whatever collective noun for migrants sounds just the right side of racist. (Current favourite: “hordes”.)

Third, the number of Britons making a decision based on a complete understanding of the renegotiation, and the future terms of our membership, will be vanishingly small. It is simply impossible to read about subsidiarity for more than an hour without lapsing into a coma.

Yet, funnily enough, this isn’t necessarily a bad thing. Just as the absurd complexity of policy frees us to talk instead about character, so the onset of Subclause Syndrome in the EU debate will allow us to ask ourselves a more profound, defining question: what kind of country do we want Britain to be? Polling suggests that very few of us see ourselves as “European” rather than Scottish, or British, but are we a country that feels open and looks outwards, or one that thinks this is the best it’s going to get, and we need to protect what we have? That’s more vital than any subclause. l

* For those of you keeping score at home, Universal Credit is now allegedly going to be implemented by 2021. Incidentally, George Osborne has recently discovered that it’s a great source of handwavium; tax credit cuts have been postponed because UC will render such huge savings that they aren’t needed.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 11 February 2016 issue of the New Statesman, The legacy of Europe's worst battle