A communication gap between federal health entities has fragmented efforts to combat rising diabetes rates.
The Public Health Agency of Canada, Health Canada and the Canadian Institutes of Health Research’s attempts to prevent and control diabetes are uncoordinated and impeded by a lack of inter-departmental co-ordination, the Auditor General states in his spring report.
Auditor General Michael Ferguson recommends the three agencies work together to avoid gaps in research, and to create a national diabetes surveillance strategy in collaboration with Métis, First Nations and Inuit communities across Canada. In a statement released after the audit was tabled, the Minister of Health Leona Aglukkaq said the federal government is in the process of “implementing all the recommendations in the report.”
The AG’s report, tabled in Parliament Tuesday, found that the Public Health Agency of Canada has yet to establish a national approach to diabetes prevention to co-ordinate activities between key federal partners including Health Canada and the Canadian Institutes of Health Research, as well as the provinces, territories, and medical experts. In 2005, the federal government gave the Public Health Agency of Canada $18 million a year to implement a pan-Canadian approach to diabetes under the National Diabetes Strategy.
“The agency was to have established ways to coordinate these activities but has not done so,” the report stated. “As a result, activities are not working together as intended.”
The report also found that Public Health is not living up to commitments made in 2007 to share information gathered about diabetes-related activities with the federal government and the Canadian Institutes of Health Research.
To improve collaboration, Minister Aglukkaq said Public Health is focused on a new approach to chronic disease prevention that is based on partnerships in the public and private sectors.
“We’re encouraging innovation so that our funding has the greatest possible reach and impact for Canadians,” said the Minister in a press release.
The disconnect between the various departments and the government limits the progress of prevention and diabetes-surveillance programs. Health Canada and Public Health, for example, have taken similar, but isolated steps to reduce the prevalence of diabetes among First Nations peoples; Aboriginals are up to three times more likely to be diagnosed with diabetes than the general population. As a result, there is no accurate, national surveillance system that tracks diabetes rates among Canadians, including the prevalence rate of diabetes among Aboriginals living on and off reserves.
Diabetes — a chronic condition that occurs when the body can no longer produce or properly use insulin — is one of the most preventable chronic diseases, affecting at least 6.8 percent of Canadians. According to Public Health, the health care costs for patients with diabetes is three to four times higher the average individuals.
The disease can be prevented and managed through lifestyle changes, including diet and exercise, but the report found Public Health has yet to decide what programs and initiatives to fund. They have no clear guidelines on how to manage and mitigate risk factors, including obesity, or insight into how these activities will contribute to the department’s overall approach to preventing and controlling diabetes.
“The Public Health Agency has not been leading federal efforts to prevent and control diabetes,” Ferguson said in a press release. “Activities remain largely unco-ordinated, and their impact is unknown.”
The number of people diagnosed with diabetes grew by 70% during the ten-year period from 1999 to 2009. The federal government, said Minister Aglukkaq, will combat rising diabetes by addressing the key risk factors of Type 2 diabetes through improved coordination with partners at all levels, including organizations like the YMCA.
“Our approach focuses on risk factors and on partnerships that can help Canadians live healthy lives,” wrote the Minister in a press release.
Although there is a lack of communication between key federal partners, the report also found that Public Health has some significant internal roadblocks. The department is not tracking the cost of diabetes programs. According to the audit, it costs the agency’s office 48 cents to administer one dollar to community-based programs.
The audit examined whether the programs implemented by Health Canada, Canadian Institutes of Health Research and the Public Health Agency of Canada were co-ordinated with partners, and how the departments implemented the Canadian Diabetes Strategy. It covered the period from October 2005 to September 2012.