ARCHIVED - Diabetes Policy Review - Report of the Expert Panel
I. Structural Recommendations
- The Panel recommends the creation of 'Partners for Diabetes' which should be given responsibility for the federal Diabetes Strategy. This body, composed of appointments from non-governmental organizations, the Public Health Agency of Canada, provincial/territorial governments and the Canadian Institutes for Health Research, would set the goals and objectives of the Diabetes Strategy.52
- Notwithstanding the fact that there are existing operational models, some of which the Panel has explored, formal discussion should be undertaken between the 'Partners for Diabetes' and relevant federal government departments and agencies to devise appropriate operational mechanisms for this new body.
B. For ease of administration, the Panel recommends the following procedures:
- An interim arrangement be established for the final two years of the existing Strategy whereby the 'Partners for Diabetes' would assist in re-profiling existing funding allocations to the Panel's recommended priorities.
- During this interim period, extensive discussion between the 'Partners for Diabetes' and relevant government departments and agencies would be undertake to ensure that at the expiry of the existing Strategy, the recommendations contained in this Report are implemented to support future federal investments in diabetes.
- This new arrangement would provide block funding to the 'Partners for Diabetes' to pursue its goals and priorities. The necessary measures will be established to ensure accountability and transparency through a formal governance structure with appropriate procedures consistent with federal government policies.
C. The Panel recommends that the Healthy Living and Chronic Disease initiative be separate from the renewed Canadian Diabetes Strategy, and become a co-ordinated, integrated, multi-sectoral strategy involving all relevant partners (e.g., the Departments of Health, the Environment and Finance, the Canada Revenue Agency, Sport Canada, ParticipACTION). Serious consideration should be given to ParticipACTION acting as the lead in the implementation of the Healthy Living and Chronic Disease initiative. The Panel acknowledges that this is a significant departure from the present policy and recognizes that extensive discussion with all the partners would be necessary in order to effect this change.
- Some of the elements of this new Healthy Living and Chronic Disease initiative could include:
- tax systems:
- doubling the maximum amount of the existing Children's Fitness Tax Credit from $500 to $1,000;
- enhancing the existing Children's Fitness Tax Credit to include support measures for low-income families, e.g., refundable tax credits; and
- introducing similar tax credit for any registered physical activity and sports programs for adult Canadians.
- national goals and measurements:
- developing realistic, measurable targets for addressing obesity; and
- reporting to Canadians annually on progress toward the achievement of the present physical activity and healthy eating targets.
- enhancement and expansion of the existing programs being supported by ParticipACTION.
- consider for implementation - other successful healthy living initiatives that have been undertaken.
- monitoring and evaluation:
- the Canadian Institutes for Health Research should lead the evaluation of the initiative.
D. The National Diabetes Surveillance System should remain within the Public Health Agency of Canada's mandate. However, the current funding from the renewed Strategy for Surveillance remains with the new entity and should be re-profiled to maintain the integrity of the annual $18M commitment to diabetes. Additional priorities of the National Diabetes Surveillance System should include:
- the creation of a national cohort study to track the health outcomes of Canadians; and
- the incorporation and expansion of Statistics Canada's physical measures surveys.
II. Functional Components
The renewed Strategy and future federal investments in diabetes become the focus of 'Partners for Diabetes'.
A. Mandate: Recognizing types 1, 2 and gestational diabetes:
- to target and assist individual Canadians known to be at high risk of type 2 diabetes and Canadians living with all types of diabetes;
- to coordinate and facilitate efforts/investments in research relating to cures for the disease as well as research for improving current management and support services for people diagnosed with diabetes; and
- to monitor and communicate the results to the target population and the Canadian public annually.
- Decrease, by 50%, the number of the undiagnosed Canadians by March 31, 2012.
- Decrease, by 50%, emergency department visits by Canadians with diabetes by March 31, 2012.
- 25% of Canadians diagnosed with diabetes will have self-management training by March 31, 2012.
- Establish, in the first year, the benchmark for public funding for diabetes research in Canada. Increase annually by 5% the amount of public investment in diabetes research by March 31, 2012.
- Produce annually a report on progress being made towards goals and fulfilment of mandate beginning April 1, 2010.
C. 'Partners for Diabetes' - the initial appointments should include the Canadian Diabetes Association, Juvenile Diabetes Research Foundation, Diabète Québec, the Canadian Institutes for Health Research, the Public Health Agency of Canada, and provincial/territorial governments.
- As noted in the Panel's response to the Governance section of the Terms of Reference, the nature of this body is to be determined through discussion between the new body and relevant government departments/agencies.
III. First Priorities
The Panel believes that 'Partners for Diabetes' should undertake the following priorities immediately.
- 'Partners for Diabetes' should review the priorities of the renewed Strategy and re-allocate the funding according to their newly identified priorities.
- Undertake immediately, a national economic analysis of the burden of diabetes. The analysis should include historic and projected economic impacts;
- Disseminate and effectively communicate the information from the National Diabetes Surveillance System.
- The Canadian Institutes for Health Research will be an integral part of 'Partners for Diabetes' and engaged in creating the platform for facilitating and coordinating investments in research and in establishing the benchmarks for achieving the goals identified above. An additional responsibility would be to initiate discussion with the private sector to determine if partnerships could be developed for diabetes research and the nature and extent of such partnerships.
- Diabetes Information Platform (DIP): Establish a web-based information platform, using where appropriate examples from the United States or other countries. This includes building on work already done from renewed Strategy investments.
- Establish an independent evaluation and monitoring mechanism. 'Partners for Diabetes' should report, through the federal Minister of Health, to the public annually on progress towards the goals.
- Focus efforts and investments on addressing obesity among children and youth as a priority for the prevention of type 2 diabetes.
IV. Ongoing Priorities
The Panel believes that 'Partners for Diabetes' should also consider the following priorities as they develop the longer-term diabetes strategy.
- The Panel has found through its deliberations on the renewed Strategy that there has been an over-emphasis on process as opposed to content. Therefore, the Panel would like to stress the importance of focusing efforts on achieving results and outcomes that impact diabetes in Canada as opposed to process measures.
- Foster early discussions with the private sector to encourage openness to leverage and collaborate on opportunities between the partners and the private sector. This could involve universities, think-tanks or organizations like the Conference Board of Canada and Research Canada.
- Leverage and collaborate on innovative diabetes-related endeavours (e.g., PRIISMETM) to enhance the outcomes of the initiative. Support and collaborate on innovative initiatives, like electronic health records systems under Infoway, to improve health outcomes for people with diabetes.
- Create contractual arrangements that build on existing expertise and projects in communities to avoid duplication and maximize outcomes that deliver on the priorities of the initiative. These contractual arrangements should be concluded with governments and non-governmental organizations like Diabète Québec, Juvenile Diabetes Research Foundation and the Canadian Diabetes Association who already have a presence in many communities and with other organizations where a specific expertise and delivery skill exists. An example of these arrangements would be training Canadians with diabetes in self-management techniques.
- Increase the emphasis on providing diabetes information to the Canadian public as well as to target audiences.
- Focus on reducing the inequities in the prevalence of diabetes across Canada (e.g., geographic, ethnic, socioeconomic).
- Identify gaps in human resource capacity at the community level at an early stage to deliver on the priorities of the Strategy and develop a strategy to address the gaps in a timely manner.
- Foster education throughout prevention initiatives and provide leadership in screening measures to individuals at high risk.
V. Future Developments
The Panel feels compelled to comment on its process of deliberation and consultation, as well as the development of the new initiative now being proposed. One of the difficulties centred around the fact that many of the components of the renewed Canadian Diabetes Strategy were in the development stage. Hence, being able to deliver specifically on some of the Terms of Reference was a challenge. Adding to this challenge was that many of our consultations exposed a lack of knowledge about the Strategy itself, and where knowledge did exist it was limited and insufficient to lead to a substantive evaluation of outcomes.
Nevertheless, the Panel has attempted in the earlier part of this report to respond to the direction of the Terms of Reference that was provided. The Panel deliberated over the approach it should take to these recommendations and agreed that, rather than taking a specific prescriptive approach to the new initiative, it would provide flexibility to the new partnership ("Partners for Diabetes") in the expectation that debate and discussion of the new partnership would lead to more innovative and timely components.
Yet the Panel, as witnessed above, felt obligated to provide themes and approaches that seemed common to many of our consultations and deliberations. Additionally, it is the expectation of the Panel that this approach will lead to an incremental development of the new initiative, while examining previous components of the original as well as renewed Canadian Diabetes Strategy, some of which may be used, others of which may be amended, and others discarded. Furthermore, it is the Panel's opinion that beginning with key deliverables, leading to additional steps, which will see a fulsome initiative over time (two to five years), assuming a new five-year renewal beyond 2010, with robust funding, is a superior and more realistic functional approach.
The Panel is mindful (as reflected in some of the directions and principles enunciated above), that in the development of the initiative, great care must be given to ensure that those entities that already exist in the health care field (e.g., the Health Council of Canada, the Canadian Institute for Health Information, Infoway) are consulted and coordination established in order to use their expertise to enhance the initiative.
The Panel wishes to thank Natsuko Kodama from JLS Management Consulting Inc. and Lindsay Olmstead, seconded from the Public Health Agency of Canada, who have provided invaluable writing, research and administrative support. The Panel also acknowledges the cooperation and assistance provided by the staff of the Public Health Agency of Canada and Health Canada in our efforts. The Panel thanks all those who provided their time, expertise and advice during our stakeholder consultations.
The Panel has enjoyed the challenge given by the Minister of Health. Finally, we would like to stress the necessity of cooperation of the highest order in public health areas of: information, research, technology, management and prevention.
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