Thoughts, Words, Action: The Alma-Ata Declaration to Diabetes Care Transformation

Thoughts, Words, Action: The Alma-Ata Declaration to Diabetes Care Transformation Diabetes Ther (2018) 9:873–876 https://doi.org/10.1007/s13300-018-0440-2 EDITORIAL Thoughts, Words, Action: The Alma-Ata Declaration to Diabetes Care Transformation . . Sanjay Kalra Zhanay A. Akanov Alex Y. Pleshkova Received: April 3, 2018 / Published online: May 9, 2018 The Author(s) 2018 document is relevant for the management of ABSTRACT the diabetes pandemic. The International Conference on Primary Health Care, held at Alma-Ata, present-day Keywords: Diabetes care delivery; Health Kazakhstan, in September 1978, was a landmark economics; Health policy; Primary care; in global health care. The Declaration of Alma- Psychosocial management; Type 1 diabetes; Ata that was adopted at that conference suc- Type 2 diabetes cessfully refocused attention and energy on primary health care. In a similar manner, the United Nations resolution of 2006 highlighted Primary health care has always been considered the dangers of the diabetes pandemic. The the Cinderella of health systems. However, it underlying philosophy of the Declaration of reached the high table of global health policy at Alma-Ata is assessed in this editorial, to deter- the International Conference on Primary mine whether it remains relevant for modern Health Care held at Alma-Ata, present-day and future diabetes care. We highlight the Kazakhstan, in September 1978. This was a concordance between the Declaration of Alma- seminal event in health politics and led to the Ata and the principles of present-day diabetes drafting of a sempiternal document, the Decla- care, and come to the conclusion that the 1978 ration of Alma-Ata [1]. Although health policy had long advocated the need for strengthening Enhanced digital features To view enhanced digital features for this article go to https://doi.org/10.6084/ primary health care, the Alma-Ata Declaration m9.figshare.6216428. successfully refocused attention and energy on this mode of health care delivery. S. Kalra (&) Similarly, prior to the highlighting of the Department of Endocrinology, Bharti Hospital, dangers of the diabetes pandemic in the United Karnal, India Nations resolution of 2006, diabetes and other e-mail: brideknl@gmail.com non-communicable diseases had long been Z. A. Akanov neglected by public health planners and policy- Head of Center of Diabetes, Head of Clinic of makers. The United Nations resolution of 2006 Internal Diseases, Asfendyarov Kazakh National Medical University, Almaty, Kazakhstan helped the world understand the Cassandra-like significance of the diabetes pandemic [2]. A. Y. Pleshkova Over the past 40 years, primary health care Clinic of Internal Diseases, Asfendyarov Kazakh provision has moved from thoughts and words to National Medical University, Almaty, Kazakhstan 874 Diabetes Ther (2018) 9:873–876 action and reality. In parallel, diabetes care has widespread use of technology to improve diabetes grown from its humble, ineffective beginnings prevention and care [8]. into a well-developed science [3]. A relook at the Primary care is important as it is the first philosophy underlying the Alma-Ata Declaration point of contact between individuals and the may help us assess the present state of diabetol- health care system. While it is accepted as the ogy and plan effectively for the future. ‘‘first element’’, it is also part of a ‘‘continuing The Alma-Ata Declaration re-emphasizes the health care process’’. Thus, the Alma-Ata con- definition of health as a state of complete cept of primary care is absorbed into the chronic physical, mental and social well-being, and not care model that characterizes diabetes [9]. merely as the absence of disease or infirmity. The Alma-Ata Declaration provides an over- This concept is followed in diabetes care, using arching definition and description of the com- the frameworks of bio-psychosocial health [4]. ponents of primary health care. Promotive, The responsibility for action to achieve global preventive, curative and rehabilitative services health is placed upon multiple stakeholders, are included in the ambit of primary care. including those in the social, economic and Although the document does not specify any health sectors. This too is concordant with the chronic disease, it explicitly states that ‘‘pre- philosophy underlying modern diabetes care, vailing health problems’’ should be addressed which calls for team work and shared decision- by education, prevention and control. Modern making in managing the syndrome [5]. diabetology relies on therapeutic patient edu- The Alma-Ata Declaration acknowledges the cation and self-management education to inequalities that exist in health care systems ensure healthy living with diabetes [10]. Thus, and notes the need to improve health as a the approach used represents a conversion of means of achieving and improving socioeco- the words penned at Alma-Ata into action. nomic development, quality of life and ‘‘world In 1978, a call was made to formulate peace’’. This thought process is reflected in an national policies, strategies and plans of action enhanced focus on patient-reported outcomes to utilize primary health care. This policy has as a target of optimal diabetes care. Current borne fruit in most countries across the world. International Diabetes Federation (IDF) guide- The call for ‘‘Early Action’’, made as part of the lines also recognize the inequality in health care Berlin Declaration, reiterates the need for systems and propose basic, comprehensive and proactive national policies on diabetes [11]. The standard strategies to manage diabetes [6]. multinational character of recent initiatives in The Alma-Ata Declaration reaffirms that diabetes prevention and management reiterate health care is the ‘‘right and duty’’ of ‘‘people’’. the request in the Alma-Ata Declaration to all This is a paraphrasing and a forerunner of the countries to ‘‘cooperate in a spirit of partnership modern concept of patient-centered or person- and service’’. centered care [7]. Although government bears Theissueofinternational cooperationinthe the main responsibility of providing health organization of primary healthcareisanimpor- care, for the management of diabetes a multi- tant component of health systems of all coun- sectorial effort is needed to achieve optimal tries. All citizens are special recipients of socially socio-economic productivity. It is clear that the oriented medical care, and any practical innova- diabetes pandemic cannot be managed without tion in this area helps raise the quality of care to a the involvement of all concerned stakeholders, higher level. In general, the patient-centered care including the individual and the community. model is another name for the principles and In this context, the Alma-Ata Declaration pre- philosophy of the Alma-Ata Declaration. The dates twenty-first century diabetes care by four application of these principles in diabetes care indicates the humanity of the global health sys- decades. It defines primary health care as ‘‘essen- tial’’ health care which is built on practical, scien- tem. This is especially important in the context of tifically sound, socially acceptable methodology. the growing diabetes pandemic. This is syncretic with the concept of diabetes being The 1978 Alma-Ata Conference hoped for a family and societal condition, as well as the ‘‘Health for All’’ by 2000. Sadly, however, Diabetes Ther (2018) 9:873–876 875 billions of our fellow human beings still do not Open Access. This article is distributed have access to optimal health care. Similarly, under the terms of the Creative Commons millions of men and women with diabetes Attribution-NonCommercial 4.0 International continue to be undiagnosed or untreated, or License (http://creativecommons.org/licenses/ their disease remains uncontrolled [12]. This is by-nc/4.0/), which permits any noncommer- reason enough for us to remember the Alma-Ata cial use, distribution, and reproduction in any Conference and the document which emerged medium, provided you give appropriate credit from it and re-dedicate ourselves to its philos- to the original author(s) and the source, provide ophy and ideals. a link to the Creative Commons license, and In his work ‘‘The Book of Words’’ the famous indicate if changes were made. Kazakh philosopher Abay Kunanbayev encour- ages literacy and education as a means of pro- gress [13]. This is true in diabetes care as well, REFERENCES where both health care providers and persons living with diabetes must upgrade their knowl- edge and skills in order to manage diabetes in 1. World Health Organization. Alma Ata declaration. Geneva: World Health Organization; 1978. an optimal manner. They also have to work in collaboration with other medical and non- 2. Silink M. United Nations resolution on diabetes. medical stakeholders, all of whom form a Pract Diabetes. 2006;23(7):279. complex ‘‘diab-ecosystem’’ which influences 3. Cornell S. Continual evolution of type 2 diabetes: diabetes outcomes. an update on pathophysiology and emerging Strengthening this diab-ecosystem at the treatment options. Ther Clin Risk Manag. primary level is the most efficient strategy to 2015;11:621–32. limit the impact of diabetes. Thus, the Alma-Ata 4. Kalra S, Baruah MP, Sahay R. Salutogenesis in type 2 Declaration assumes even greater relevance as diabetes care: a biopsychosocial perspective. Indian we tackle the diabetes epidemic of the twenty- J Endocrinol Metab. 2018;22(1):169–72. first century. 5. Kalra S, Unnikrishnan AG, Baruah MP. Interaction, information, involvement (The 3I strategy): rebuilding trust in the medical profession. Indian J ACKNOWLEDGEMENTS Endocrinol Metab. 2017;21(2):268–70. 6. International Diabetes Federation. Clinical Guide- lines Task Force. Global guideline recommenda- Funding. No funding or sponsorship was tions for type 2 diabetes: for standard, received for this study or publication of this comprehensive, and minimal care. Diabet Med. article. 2006;23(6):579–93. 7. Kalra S, Megallaa MH, Jawad F. Perspectives on Authorship. All named authors meet the patient-centered care in diabetology. J Mid Life International Committee of Medical Journal Health. 2012;3(2):93–6. Editors (ICMJE) criteria for authorship for this 8. Kalra S, Balachandran K. Technosocial competence article, take responsibility for the integrity of in diabetology. Indian J Endocrinol Metab. the work as a whole, and have given their 2017;21(4):489–91. approval for this version to be published. 9. Kalra S, Baruah MP, Kalra B. Diabetes care: evolu- Disclosures. Sanjay Kalra, Zhanay Akanov tion of philosophy. Indian J Endocrinol Metab. 2017;21(4):495–7. and Alex Y. Pleshkova have nothing to disclose. 10. Assal JP, Mu¨hlhauser I, Pernet A, Gfeller R, Jo¨rgens Compliance with Ethics Guidelines. This V, Berger M. Patient education as the basis for dia- article does not contain any studies with betes care in clinical practice and research. Dia- human participants or animals performed by betologia. 1985;28(8):602–13. any of the authors. 876 Diabetes Ther (2018) 9:873–876 11. Kalra S, Lauritzen T, Sharmanov T, Akanov Z, Al diabetes for 2015 and 2040. Diabetes Res Clin Pract. Awadi F, Das AK, et al. Alma-Ata to Berlin: diabetes 2017;1(128):40–50. prevention and treatment to achieve healthy living. Diabet Med. 2017;34(8):1169–70. 13. Kunanbayev A. The book of words. http://www. leneshmidt-translations.com/book_of_words_abai_ 12. Ogurtsova K, da Rocha Fernandes JD, Huang Y, kunanbaev_english/index.htm. Accessed 6 Mar Linnenkamp U, Guariguata L, Cho NH, et al. IDF 2018. diabetes atlas: global estimates for the prevalence of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Diabetes Therapy Springer Journals

Thoughts, Words, Action: The Alma-Ata Declaration to Diabetes Care Transformation

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Medicine & Public Health; Internal Medicine; Diabetes; Cardiology; Endocrinology
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Abstract

Diabetes Ther (2018) 9:873–876 https://doi.org/10.1007/s13300-018-0440-2 EDITORIAL Thoughts, Words, Action: The Alma-Ata Declaration to Diabetes Care Transformation . . Sanjay Kalra Zhanay A. Akanov Alex Y. Pleshkova Received: April 3, 2018 / Published online: May 9, 2018 The Author(s) 2018 document is relevant for the management of ABSTRACT the diabetes pandemic. The International Conference on Primary Health Care, held at Alma-Ata, present-day Keywords: Diabetes care delivery; Health Kazakhstan, in September 1978, was a landmark economics; Health policy; Primary care; in global health care. The Declaration of Alma- Psychosocial management; Type 1 diabetes; Ata that was adopted at that conference suc- Type 2 diabetes cessfully refocused attention and energy on primary health care. In a similar manner, the United Nations resolution of 2006 highlighted Primary health care has always been considered the dangers of the diabetes pandemic. The the Cinderella of health systems. However, it underlying philosophy of the Declaration of reached the high table of global health policy at Alma-Ata is assessed in this editorial, to deter- the International Conference on Primary mine whether it remains relevant for modern Health Care held at Alma-Ata, present-day and future diabetes care. We highlight the Kazakhstan, in September 1978. This was a concordance between the Declaration of Alma- seminal event in health politics and led to the Ata and the principles of present-day diabetes drafting of a sempiternal document, the Decla- care, and come to the conclusion that the 1978 ration of Alma-Ata [1]. Although health policy had long advocated the need for strengthening Enhanced digital features To view enhanced digital features for this article go to https://doi.org/10.6084/ primary health care, the Alma-Ata Declaration m9.figshare.6216428. successfully refocused attention and energy on this mode of health care delivery. S. Kalra (&) Similarly, prior to the highlighting of the Department of Endocrinology, Bharti Hospital, dangers of the diabetes pandemic in the United Karnal, India Nations resolution of 2006, diabetes and other e-mail: brideknl@gmail.com non-communicable diseases had long been Z. A. Akanov neglected by public health planners and policy- Head of Center of Diabetes, Head of Clinic of makers. The United Nations resolution of 2006 Internal Diseases, Asfendyarov Kazakh National Medical University, Almaty, Kazakhstan helped the world understand the Cassandra-like significance of the diabetes pandemic [2]. A. Y. Pleshkova Over the past 40 years, primary health care Clinic of Internal Diseases, Asfendyarov Kazakh provision has moved from thoughts and words to National Medical University, Almaty, Kazakhstan 874 Diabetes Ther (2018) 9:873–876 action and reality. In parallel, diabetes care has widespread use of technology to improve diabetes grown from its humble, ineffective beginnings prevention and care [8]. into a well-developed science [3]. A relook at the Primary care is important as it is the first philosophy underlying the Alma-Ata Declaration point of contact between individuals and the may help us assess the present state of diabetol- health care system. While it is accepted as the ogy and plan effectively for the future. ‘‘first element’’, it is also part of a ‘‘continuing The Alma-Ata Declaration re-emphasizes the health care process’’. Thus, the Alma-Ata con- definition of health as a state of complete cept of primary care is absorbed into the chronic physical, mental and social well-being, and not care model that characterizes diabetes [9]. merely as the absence of disease or infirmity. The Alma-Ata Declaration provides an over- This concept is followed in diabetes care, using arching definition and description of the com- the frameworks of bio-psychosocial health [4]. ponents of primary health care. Promotive, The responsibility for action to achieve global preventive, curative and rehabilitative services health is placed upon multiple stakeholders, are included in the ambit of primary care. including those in the social, economic and Although the document does not specify any health sectors. This too is concordant with the chronic disease, it explicitly states that ‘‘pre- philosophy underlying modern diabetes care, vailing health problems’’ should be addressed which calls for team work and shared decision- by education, prevention and control. Modern making in managing the syndrome [5]. diabetology relies on therapeutic patient edu- The Alma-Ata Declaration acknowledges the cation and self-management education to inequalities that exist in health care systems ensure healthy living with diabetes [10]. Thus, and notes the need to improve health as a the approach used represents a conversion of means of achieving and improving socioeco- the words penned at Alma-Ata into action. nomic development, quality of life and ‘‘world In 1978, a call was made to formulate peace’’. This thought process is reflected in an national policies, strategies and plans of action enhanced focus on patient-reported outcomes to utilize primary health care. This policy has as a target of optimal diabetes care. Current borne fruit in most countries across the world. International Diabetes Federation (IDF) guide- The call for ‘‘Early Action’’, made as part of the lines also recognize the inequality in health care Berlin Declaration, reiterates the need for systems and propose basic, comprehensive and proactive national policies on diabetes [11]. The standard strategies to manage diabetes [6]. multinational character of recent initiatives in The Alma-Ata Declaration reaffirms that diabetes prevention and management reiterate health care is the ‘‘right and duty’’ of ‘‘people’’. the request in the Alma-Ata Declaration to all This is a paraphrasing and a forerunner of the countries to ‘‘cooperate in a spirit of partnership modern concept of patient-centered or person- and service’’. centered care [7]. Although government bears Theissueofinternational cooperationinthe the main responsibility of providing health organization of primary healthcareisanimpor- care, for the management of diabetes a multi- tant component of health systems of all coun- sectorial effort is needed to achieve optimal tries. All citizens are special recipients of socially socio-economic productivity. It is clear that the oriented medical care, and any practical innova- diabetes pandemic cannot be managed without tion in this area helps raise the quality of care to a the involvement of all concerned stakeholders, higher level. In general, the patient-centered care including the individual and the community. model is another name for the principles and In this context, the Alma-Ata Declaration pre- philosophy of the Alma-Ata Declaration. The dates twenty-first century diabetes care by four application of these principles in diabetes care indicates the humanity of the global health sys- decades. It defines primary health care as ‘‘essen- tial’’ health care which is built on practical, scien- tem. This is especially important in the context of tifically sound, socially acceptable methodology. the growing diabetes pandemic. This is syncretic with the concept of diabetes being The 1978 Alma-Ata Conference hoped for a family and societal condition, as well as the ‘‘Health for All’’ by 2000. Sadly, however, Diabetes Ther (2018) 9:873–876 875 billions of our fellow human beings still do not Open Access. This article is distributed have access to optimal health care. Similarly, under the terms of the Creative Commons millions of men and women with diabetes Attribution-NonCommercial 4.0 International continue to be undiagnosed or untreated, or License (http://creativecommons.org/licenses/ their disease remains uncontrolled [12]. This is by-nc/4.0/), which permits any noncommer- reason enough for us to remember the Alma-Ata cial use, distribution, and reproduction in any Conference and the document which emerged medium, provided you give appropriate credit from it and re-dedicate ourselves to its philos- to the original author(s) and the source, provide ophy and ideals. a link to the Creative Commons license, and In his work ‘‘The Book of Words’’ the famous indicate if changes were made. Kazakh philosopher Abay Kunanbayev encour- ages literacy and education as a means of pro- gress [13]. This is true in diabetes care as well, REFERENCES where both health care providers and persons living with diabetes must upgrade their knowl- edge and skills in order to manage diabetes in 1. World Health Organization. Alma Ata declaration. Geneva: World Health Organization; 1978. an optimal manner. They also have to work in collaboration with other medical and non- 2. Silink M. United Nations resolution on diabetes. medical stakeholders, all of whom form a Pract Diabetes. 2006;23(7):279. complex ‘‘diab-ecosystem’’ which influences 3. Cornell S. Continual evolution of type 2 diabetes: diabetes outcomes. an update on pathophysiology and emerging Strengthening this diab-ecosystem at the treatment options. Ther Clin Risk Manag. primary level is the most efficient strategy to 2015;11:621–32. limit the impact of diabetes. Thus, the Alma-Ata 4. Kalra S, Baruah MP, Sahay R. Salutogenesis in type 2 Declaration assumes even greater relevance as diabetes care: a biopsychosocial perspective. Indian we tackle the diabetes epidemic of the twenty- J Endocrinol Metab. 2018;22(1):169–72. first century. 5. Kalra S, Unnikrishnan AG, Baruah MP. Interaction, information, involvement (The 3I strategy): rebuilding trust in the medical profession. Indian J ACKNOWLEDGEMENTS Endocrinol Metab. 2017;21(2):268–70. 6. International Diabetes Federation. Clinical Guide- lines Task Force. Global guideline recommenda- Funding. No funding or sponsorship was tions for type 2 diabetes: for standard, received for this study or publication of this comprehensive, and minimal care. Diabet Med. article. 2006;23(6):579–93. 7. Kalra S, Megallaa MH, Jawad F. Perspectives on Authorship. All named authors meet the patient-centered care in diabetology. J Mid Life International Committee of Medical Journal Health. 2012;3(2):93–6. Editors (ICMJE) criteria for authorship for this 8. Kalra S, Balachandran K. Technosocial competence article, take responsibility for the integrity of in diabetology. Indian J Endocrinol Metab. the work as a whole, and have given their 2017;21(4):489–91. approval for this version to be published. 9. Kalra S, Baruah MP, Kalra B. Diabetes care: evolu- Disclosures. Sanjay Kalra, Zhanay Akanov tion of philosophy. Indian J Endocrinol Metab. 2017;21(4):495–7. and Alex Y. Pleshkova have nothing to disclose. 10. Assal JP, Mu¨hlhauser I, Pernet A, Gfeller R, Jo¨rgens Compliance with Ethics Guidelines. This V, Berger M. Patient education as the basis for dia- article does not contain any studies with betes care in clinical practice and research. Dia- human participants or animals performed by betologia. 1985;28(8):602–13. any of the authors. 876 Diabetes Ther (2018) 9:873–876 11. Kalra S, Lauritzen T, Sharmanov T, Akanov Z, Al diabetes for 2015 and 2040. Diabetes Res Clin Pract. Awadi F, Das AK, et al. Alma-Ata to Berlin: diabetes 2017;1(128):40–50. prevention and treatment to achieve healthy living. Diabet Med. 2017;34(8):1169–70. 13. Kunanbayev A. The book of words. http://www. leneshmidt-translations.com/book_of_words_abai_ 12. Ogurtsova K, da Rocha Fernandes JD, Huang Y, kunanbaev_english/index.htm. Accessed 6 Mar Linnenkamp U, Guariguata L, Cho NH, et al. IDF 2018. diabetes atlas: global estimates for the prevalence of

Journal

Diabetes TherapySpringer Journals

Published: May 9, 2018

References

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