TRANSCRIPT
More than 1.3 million Australians are currently living with diabetes - that's 1 in 20 of us. And it's on the rise. Between 2000 and 2021, the number of people living with diabetes almost tripled.
In May, the government launched a parliamentary inquiry into diabetes, to better understand this growing problem.
The committee is currently considering more than 400 submissions made by a range of organisations and healthcare providers, as well as individuals living with the condition. The diversity of groups represented in the submission process reflects the breadth and depth of the issue.
It also reveals how some communities are disproportionately affected.
"Diabetes Australia and the National Diabetes Services Scheme are making more and more resources in different languages for immigrant populations to Australia, which is fantastic. There's a real need to see more educational resources and tailored, culturally safe programs for Aboriginal and Torres Strait Islander people, particularly for those in rural and remote languages for whom English is not their first language."
That's Dr Matthew Hare, an endocrinologist based in Darwin and board member for the Australian Diabetes in Pregnancy Society - one of the groups that made a submission.
"Looking after diabetes during pregnancy is really important because it does have short-term associations with pregnancy complications such as larger babies, trouble with the delivery, need for caesarean section, and pre-eclampsia. But diabetes during pregnancy also has long-term implications for the health of both the mother and the child. We know that when babies are exposed to high blood-sugar levels during a pregnancy they have increased risk of developing obesity and diabetes during their own life. So gestational diabetes or pre-existing diabetes during a pregnancy has intergenerational consequences."
Dr Hare says about 1 in 5 pregnancies are now affected by diabetes.
For Aboriginal and Torres Strait Islander women, the risks are even higher. That's partly because, while many women develop diabetes during pregnancy, Indigenous women are far more likely than other groups to already have type 2 diabetes.
Indigenous Australians were almost 3 times more likely to be living with diabetes than their non-Indigenous counterparts. It's one of the many gaps in healthcare outcomes that Health Minister Mark Butler says his government wants to close. He spoke in September about increasing access to an oral medication for diabetic kidney disease - and the need to do more.
"It's clear that, in spite of the best of intentions, very substantial investment, that the current approach isn't working. We need a new approach to work with community, to listen to community, by which I mean First Nations communities about better ways to intervene, to change behaviours, and to close that gap."
It's an issue that deeply concerns the National Rural Health Alliance, which also made a submission to the inquiry. CEO Susi Tegen says geographical isolation can compound issues for Indigenous people with diabetes.
"The funding for Aboriginal and Torres Strait people also needs to increase, and it needs to be supported with Aboriginal communities. It has to be co-planned, on the ground, and we need more Aboriginal and Torres Strait Islander healthcare students and trainees, and that way we can provide culturally- and language-appropriate healthcare for those people that are on the ground. And that goes for multicultural communities as well."
Ms Tegen says people often forget how many rural and remote industries rely on international workers. People from some migrant backgrounds are more likely to develop type 2 diabetes, as are older age groups. Ms Tegen is concerned older migrants, even those living with family, can be isolated and not even realise they have developed the condition.
"It's not unusual for people not to know. How do you know something when you haven't had it in the past? And they may not understand the language or the systems in Australia, understand the medical and health system - it's very difficult. They may not be telling their children that they have any problems. And they may not be telling their children that they have any problems. Most people are quite stoic, and particularly in the country, in rural Australia. But if people come from another country and then they move to rural areas. They might be thinking, 'we're really lucky in Australia', and they don't actually know what's available."
The National Rural Health Alliance wants more funding to go towards awareness, detection and prevention programs.
Ms Tegen also says building - and maintaining - a multdisciplinary workforce is crucial. That means end-to-end training programs in rural and remote locations, to combat the drain when people move away to study.
"Because we know that when you have a person from a rural area that's gone to primary school and secondary school and then goes on either into health or medical training in rural communities, they're more likely to stay."
Large distances also add to the cost of transporting medications - and to the financial and emotional burden for rural Australians accessing specialist care.
"People have to go away from their work, their children have to be looked after, they then have to pay for accommodation in the city, they have to travel. I couldn't imagine a city person being happy to travel someone else. We flip the model and say 'OK Bondi Junction people, or Toorak people': you have to travel to somewhere that's three hours away, and then stay there the night because your appointment's early in the morning or the last one at the end of the day."
Dr Hare says the Australian Diabetes in Pregnancy Society is also passionate about increasing access to high-quality care. He'd like to see more money go towards technology and resources. But, he says, it's more fundamentally about reducing health inequity at a population level.
"Targeting women who are at particularly high risk with individualised targeted programs is fantastic, but really we need to be changing the environment as well. That's the food environment - addressing inequity in access to food. We know that women with food insecurity are more likely to develop diabetes. And we also know that we live in an environment that increasingly encourages a sedentary lifestyle and easy access to high-caloric intake. So we'd strongly support calls from others as well, for fiscal policies like a tax on sugar-sweetened beverages as well."
Submissions to the Inquiry into Diabetes are now closed, with the delivery date for the final report yet to be announced.
