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Boston Declaration to fix global health failure of diabetes

Group adopts a unified, action-oriented agenda to address pressing global health issue.


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Volunteers hand out medicine to refugees

According to a consortium of global health professionals behind the recently published “Diabetes in humanitarian crises: the Boston Declaration”, the diabetes epidemic is a massive global health failure.

Type 2 diabetes can be prevented in most cases with lifestyle modification.  Lifesaving treatments exist for both type 1 and type 2 diabetes, although access is a problem.  Type 1 diabetes is fatal without insulin therapy, and when death does occur because of access issues, it must be considered a preventable and senseless tragedy. Today millions of people do not have access to care or treatment, millions don’t even know they live with type 2 diabetes and millions still die earlier than they would with adequate information and care.

More than ever today, there is a need to reverse the lack of care for diabetes and other NCDs in humanitarian settings, say the signatories of the “Boston Declaration”.

To address these gaps, Harvard University convened a meeting in Boston (April 2019) to discuss the immediate needs and barriers to tackling diabetes in humanitarian crises, and to adopt a unified, action-oriented agenda to address this pressing global health issue. This agenda and mission is the “Boston Declaration”.

The human rights violations of people with diabetes that we have witnessed, including the most basic right to life, which is threatened by the barriers to accessing insulin and follow-up, are unacceptable and incompatible with these principles. - Boston Declaration

Sylvia Kehlenbrink, MD, Director of  Global Endocrinologyfor Brigham and Women’s Hospital and Director of the Non-Communicable Diseases in Conflict Program, Harvard Humanitarian Initiative, is Chair of the group.  “Now that the Declaration has been published, I’m in the process of organizing the group and helping structure it moving forward. We have created working streams around each of the four targets in the Boston Declaration: [1] Advocacy, [2] Access to Medicines and Diagnostics, [3] Clinical and Operational Guidance, and [4] Data and Surveillance,” she says, adding, “A number of projects are already underway, such as developing a high-level declaration on the urgent need for universal access to insulin, clinical guidance on the use of insulin, and development of indicators to monitor diabetes care in humanitarian contexts.”

Nearly three out of every four deaths worldwide (2017) were caused by non-communicable diseases (NCDs). People with NCDs like diabetes are especially underserved.  Approximately 68·5 million people are displaced from their homes around the world, mostly to low-income or middle-income countries. More than 100 million conflict-affected non-displaced people and 175 million people affected by natural disasters annually are vulnerable. People living for or at risk for diabetes are particularly vulnerable in crises due to disrupted health services and unpredictable—and often unhealthy—food supplies, which will certainly exacerbate diabetes and lead to complications.

The Boston Declaration states:

“We chose to prioritise efforts on diabetes in humanitarian crises for several reasons.

First, because people with type 1 diabetes who cannot access insulin and continuity of care in a crisis are at acute risk of death. The principles of the Humanitarian Charter and UN Universal Declaration of Human Rights include the right to life with dignity. The human rights violations of people with diabetes that we have witnessed, including the most basic right to life, which is threatened by the barriers to accessing insulin and follow-up, are unacceptable and incompatible with these principles.

Second, the management of diabetes requires an uninterrupted supply of essential medicines, field-based laboratory diagnostics, continuity of care, adoption of healthy lifestyle behaviours, cardiovascular risk reduction, management of comorbidities including depression and hypertension, and secondary prevention of complications.

Thus, diabetes management requires a more complex health-system infrastructure than most other NCDs, but shares many characteristics and risk factors with other NCDs. Hence, the development of an effective diabetes programme could establish a strong platform for provision of high-quality care for other NCDs.”

The group has set four major targets to work towards over the next 3 years as set out by Dr Kehlenbrink above. Annual meetings will be held to monitor progress. The next symposium will be in June 2020 in London. The London School of Hygiene and Tropical Medicine will be hosting. For more information, please see “Boston Declaration” in Lancet Diabetes and Endocrinology.

For the list of signatories, please click here.


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