Alma‐Ata to Berlin: diabetes prevention and treatment to achieve healthy living

The 1978 Declaration of Alma-Ata 1, issued at the International Conference on Primary Health Care1, held at Alma-Ata, Kazakhstan (former Soviet Union), is a landmark in public health. By stating that health is a fundamental human right, the declaration promoted interest and action in the field of public health, specifically primary health care. While it highlighted maternal child health and infectious disease control, it also clearly addressed chronic illness care, the availability of appropriate pharmaceuticals, and the need for preventive, curative and rehabilitative services. The Declaration of Alma-Ata encouraged coordinated efforts between various sectors, members of the community or civil society and healthcare workers to realize its vision of Health for All. The main features of the Declaration of Alma-Ata are listed in Table 1. Nearly 40 years later, a similar declaration has been made by experts in the field of diabetes. The Berlin Declaration calls for early action to stem to the potential health catastrophe that Type 2 diabetes is turning out to be 2. The Berlin Declaration is concordant with, and builds upon, the legacy of Alma-Ata (Table 1). With a philosophy similar to that of Alma-Ata, the Berlin Declaration notes the ‘devastating impact on lives and economies’ of Type 2 diabetes 3; echoing Alma-Ata's observation that ‘health is essential to economic and social development’ 1. Just as Alma-Ata witnessed the involvement of countries and non-governmental organizations from across the globe, the Berlin Declaration is based on the input of experts from all continents, and is endorsed by the leading professional societies of diabetology. Its basic principles are relevant to all nations, regardless of their environment. In this manner, the Berlin Declaration is similar to Alma-Ata, which notes that primary health care is influenced by the unique socio-economic conditions of a particular country. The Berlin Declaration has also succeeded in involving patient organizations and patient representatives: this is in the spirit of Alma-Ata, which states that ‘people have the right and duty to participate individually and collectively’ in their health care. The Berlin Declaration notes that ‘current policies are not doing enough to take the problem at the root, before diabetes and its related complications set in’. This underlines the need to promote and protect health at the primary level, as enshrined in the Declaration of Alma-Ata. The Berlin Declaration asks each country to commit to implementing appropriate policy; a reflection of Alma-Ata's observation that ‘Governments have a responsibility for the health of their people’. The four pillars of the Berlin Declaration are prevention, early detection, early control and early access to the right interventions, and they span the entire spectrum of primary care, as described in the Declaration of Alma-Ata. These include promotive, preventive, curative and rehabilitative services. The fourth pillar (early access) also covers the provision of essential drugs. The call for national diabetes prevention strategies, covering education, tobacco cessation, nutrition and exercise, reinforces the principles of Alma-Ata. Mention of urban environments, local food environments and legislation in the Berlin document echoes Alma-Ata's reminder to involve other social and economic sectors in primary health care. The Declaration of Alma-Ata defined health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease’. Similarly, the Berlin Declaration should encourage us to define, and achieve, healthy living with diabetes or a life without diabetes. A state of optimal bio-psychosocial health, achieved by early metabolic control, facilitated by complete access to the right interventions, is what we should aim for. Primary care is the key to achieving the goals of both Alma-Ata and Berlin 4. The vast number of people living with diabetes cannot be managed without the active and committed involvement of primary care physicians. The need to involve primary care in diabetes management has been raised in the past 5, and strategies to utilize available resources have been discussed 6. The Berlin Declaration reinforces this movement, and reminds us of the philosophy of Alma-Ata, while working towards a healthier future for people with diabetes.

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