Chronic diseases have long-term, corrosive impacts on our societies and yet, they are often underestimated and underfunded. For too long, we have neglected the psychological, physical, and economic toll chronic conditions have on our collective well-being and future prosperity.
“Chronic diseases have long-term, corrosive impacts on our societies and yet, they are often underestimated and underfunded.”
But we do so at our own peril.
The COVID-19 pandemic demonstrated the enormous pressures our healthcare systems are under throughout the country. Having a robust and resilient healthcare system is critical to building a functioning and flourishing future. As they say, “Health is wealth.”
However, we still consistently deprive our systems of the investments required to realize this future.
The State of Diabetes Management in Canada
This short-sightedness is painfully apparent in how Canada is tackling (or not tackling) one of its most pervasive chronic conditions—diabetes. A chronic, metabolic disease characterized by elevated levels of blood sugar, diabetes can lead to serious damage to the heart, blood vessels, eyes, kidneys, and nerves over time.
About half a billion people worldwide live with diabetes, and its prevalence has been steadily increasing over the past few decades. In fact, a new study published by The Lancet estimates that the number of adults living with diabetes worldwide will more than double by 2050.
“The International Diabetes Federation ranks Canada among the worst OECD countries for diabetes prevalence.”
In Canada, the number of people with diabetes has doubled since 2020, and the International Diabetes Federation ranks Canada among the worst OECD countries for diabetes prevalence.
Currently, more than 4 million people in Canada (10% of the population) live with a diagnosis of diabetes. Even more troubling—that number soars to almost 12 million people when you factor in people who have prediabetes or are at high risk of developing diabetes. This represents approximately one in three Canadians.
The Cost of Diabetes
The costs of treating and managing this growing epidemic in Canada are staggering. If the trend continues, the healthcare costs associated with diabetes will top $20 billion annually by 2030. A recent report issued by TELUS Health revealed that diabetes has replaced inflammatory diseases, such as rheumatoid arthritis, as the top drug category for claims in Canada.
“The healthcare costs associated with diabetes will top $20 billion annually by 2030.”
This financial strain comes at a time when Canada is already experiencing incredible stresses on its provincial and territorial healthcare systems, including human resource shortages, long waitlists, and overcrowded emergency rooms.
The complications that arise from diabetes significantly impact these systems, accounting for 30% of strokes, 50% of kidney failures requiring dialysis, and 70% of all non-traumatic leg and foot amputations.
And it is not only the healthcare systems that bear the economic load of diabetes. Between medications, daily supplies, devices, dietary needs, time off work, and other related bills, the financial burden can be devastating to an individual or family’s income. Depending on where you live in Canada and your income, people living with diabetes may need to pay up to $10,000 to $18,000 per year out of their own pocket for medications, devices, and supplies.
“Drug costs are defined as “catastrophic” in Canada when they are more than 3% of a family’s annual income. Over 50% of people living with type 1 diabetes experience costs above 3% of their family income.”
To put this personal financial burden in perspective, drug costs are defined as “catastrophic” in Canada when they are more than 3% of a family’s annual income. Over 50% of people living with type 1 diabetes experience costs above 3% of their family income, as do almost half of people living with type 2 diabetes.
Throughout Canada, families affected by diabetes are being forced to choose between paying their rent and grocery bills or following the (often expensive) treatment plan recommended by their doctor. The inevitable result is poorer health outcomes for people.
The Social Dimension of Diabetes
A particularly troubling element of this epidemic of diabetes is that it is increasingly marked by health inequity. Type 2 diabetes disproportionately impacts people of African, Arab, Asian, Hispanic, Indigenous, and South Asian descent as well as those who are of a lower socioeconomic status.
The diabetes epidemic is unquestionably limiting the power and potential of millions of people living in our country, often those already living in our most underserved or marginalized communities.
I’ve listened to the stories of people who live with diabetes from coast to coast to coast. I’ve heard from mothers who have been forced to leave the labour force so they can be on-call daily to ensure their child’s diabetes is managed at school. I’ve heard from parents who can’t afford a blood glucose monitor, so instead walk up multiple times a night to ensure their preteen doesn’t have a seizure due to low blood sugar, leaving them exhausted every day at work. I’ve heard from employees who were forced to quit their job because of a debilitating heart attack or kidney failure.
“The diabetes epidemic is unquestionably limiting the power and potential of millions of people living in our country, often those already living in our most underserved or marginalized communities.”
Whether you know it or not, diabetes has transformed the life of someone you know: a neighbour who can’t run anymore because of nerve damage in her feet; an uncle who is wheelchair-bound due to amputations; a senior who loses his driver’s license and independence because of the complications of his condition; a teenager who feels anxious, isolated, and unsure where to turn.
Canada can no longer afford to ignore the stark reality: the impact of diabetes on people, families, employers, healthcare, and the economy is devastating and will continue to escalate at an alarming rate without coordinated action.
How Canada Can Tackle Diabetes
The good news is that last October, the Honourable Jean-Yves Duclos, federal Minister of Health, tabled the Framework for Diabetes in Canada, a comprehensive strategy that aims to address the complex condition and rising prevalence of diabetes in Canada. The Framework was developed in consultation with my own organization, Diabetes Canada, as well as people impacted by diabetes, health groups, and all levels of government. It has the potential to prevent millions of diabetes diagnoses as well as ensure that all those living with diabetes have improved and equitable access to vital care.
This Framework can serve as a roadmap for change. However, since the tabling, the Federal Government has not yet committed to funding the Framework with real dollars. That is why Diabetes Canada and other advocacy groups, are continuing to urge governments at the federal, provincial, and territorial levels to invest in this pivotal moment.
“Canada must take collaborative action to implement the recommendations of the Framework for Diabetes at the federal, provincial, and territorial levels, backed by sustainable and significant funding.”
Without concrete investments, the Framework will remain just that—a Framework.
To bring it to life, Canada must take collaborative action to implement the recommendations of the Framework for Diabetes at the federal, provincial, and territorial levels, backed by sustainable and significant funding.
In the last six months, we have seen some positive action taken at the provincial level—with some provinces announcing their own diabetes strategies and frameworks, using the Framework as a policy roadmap. Ontario just recently passed a motion to develop a Framework on chronic diseases, with a focus on diabetes. Manitoba, British Columbia, and Alberta have all confirmed their commitments to creating provincial diabetes strategies. If implemented properly, with the right funds, the Framework can serve as a template for other chronic conditions—which could have transformative impacts on our healthcare system by facilitating economies of scale and seamless knowledge-sharing systems.
Ambitiously addressing chronic conditions in Canada would unlock untold possibilities and potential for future generations. But we must act now and not let the promise of this Framework go unfulfilled.
Canada has an unprecedented opportunity to implement innovative policies and exercise global leadership with bold action on diabetes, paralleling what Finland, Sweden, Denmark, India, and other progressive countries have done.
In fact, most countries in the European Union have implemented similar strategies, and those strategies are paying dividends. Finland, for example, implemented a national approach in 2000 that provided an overarching framework, but left specific design to local partners. This model’s success led to a range of new models and practices being developed from the bottom-up, taking account of local needs, resources, and initiatives. It is recognized as an international success in reducing the burden of diabetes on the Finnish people. Similar successes are stemming from national strategies in place in Sweden, Denmark, India and Portugal, among many other countries.
“We urge all levels of government to fund the Framework to unlock a better future for millions of people in Canada.”
In 1921, the discovery of insulin by Banting, Best, Collip, and Macleod elevated Canada to the world stage as a leader in science and innovation. With their discovery, they forever transformed our collective future. And yet, if the Toronto group (as they are affectionately called) were to be transported to Canada in 2023, I believe they would be dismayed at the epidemic levels diabetes has reached. After their groundbreaking discovery, the future must have seemed so bright and full of possibility. One hundred years later, it is time for us to recapture that hope for the future by acting today.
We urge all levels of government to fund the Framework to unlock a better future for millions of people in Canada.