Health: Diabetes

Baroness Hussein-Ece Excerpts

Thursday 4th November 2010 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I thank the noble Lord, Lord Harrison, for securing this debate on a very important health issue, and I also pay tribute to him for the eloquent way in which he has shared his extensive experience and knowledge.

We all know of someone affected by diabetes. Those alarmingly high numbers of people who are more likely to develop type 2 diabetes are over three times more likely to go on to develop serious complications of diabetes which include stroke, kidney damage and heart disease. People living in deprived areas who are socially disadvantaged are two and a half times more likely to develop diabetes. They are more likely to have problems with late diagnosis and have poor lifestyles and poor care, which often compound the difficulties in managing their condition. That, of course, includes poor foot care.

The overwhelming evidence demonstrates that reducing health inequalities in deprived areas and for people from disadvantaged backgrounds, including those with mental illness, would almost certainly lead to more prevention and better management of diabetes. I want to talk about how this condition disproportionately affects people from black and minority ethnic communities, which was mentioned earlier.

Diabetes is increasingly recognised as a public health problem of potentially enormous proportions. This poses significant clinical and economic challenges for the NHS. According to UK studies, the prevalence of diabetes is significantly higher in some minority ethnic groups, which are six times more likely to develop diabetes. Figures suggest that up to 20 per cent of people from south Asian backgrounds and 17 per cent of people who are black African-Caribbean are living with type 2 diabetes, compared with some 3 per cent of the general population. I know from my own background that people from the Turkish community are also at greater risk of developing diabetes. Both my parents developed type 2 diabetes in later years and I confess that that has given me greater first-hand experience in caring for someone with diabetes and the importance, which I never realised before, of good foot care and healthcare generally.

Whereas within the general population type 2 diabetes usually occurs over the age of 40, people from black and minority ethnic communities can get it from the age of around 25. Getting treatment early can reduce the risk of developing complications such as stroke, blindness, heart disease and amputations. There are a number of factors why it impacts disproportionately on black and minority ethnic communities, which include genetic differences in how the body processes fat, but poor knowledge of services, poor housing and social deprivation are huge factors. I was pleased to read how in some parts of the UK with significant numbers of ethnic minority communities, the health services are responding and proactively working with organisations such as Diabetes UK to address some of these unmet needs.

For example, in the past few months NHS Haringey, in partnership with Diabetes UK, has developed the community champions training courses. People from minority ethnic communities, health trainers and religious and community leaders attend sessions about what type 2 diabetes is, who is at risk, signs and symptoms, myths and misconceptions—of which there are many—complications and the NHS services that are available. After qualifying, the community champions then spread the word about diabetes in their local communities by organising stands, talks and healthy-living days. To date, more than 30 community leaders, nutritionists and NHS health trainers in Haringey have qualified as diabetes community champions and they are keen to raise awareness at community events^. Several more training projects are planned in other parts of London. When I was working in the NHS in north London in the 1990s, projects on simple foot care such as nail clipping for older people were done at daycare and health centres. They were simple and cost-effective, and helped many vulnerable people with their foot care.

We know that prevention is often better than cure. That is why we need a more consistent public health strategy across areas with the greatest need and risk. Early diagnosis of those at greatest risk and better management would prevent the acute conditions that far too many people go on to develop, which result in greater risk to the individual and their families, the need for more intensive health services and hospital admission.

The problems are often not just about diagnosis, but about continuing care and managing the condition after diagnosis. Unfortunately, people from deprived backgrounds, including people from ethnic minorities, are less likely to have annual or regular health checks for blood pressure and cholesterol, for example, and, worryingly, many primary care trusts have not had strategies in place to deal with this.

I would like to see more consistent work to raise the profile of diabetes care within minority ethnic groups; strengthen leadership at national and local levels, particularly with GPs; improve practices and change general attitudes through the delivery and uptake of effective and appropriate training; and support a wider community development approach by going out into communities to listen to and involve people in the pathways of their diabetes care. The level and type of services should not necessarily rely on where you live or how involved your GP may be. There should be consistency and equal access to support and services regardless of your background or where you live.