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VOICE-OVER: Today at the

National Press Club, the

President of Diabetes

Australia, Dr Gary Deed. The

latest estimates are that up to

1.8 million Australians have

diabetes, and is Australia's fastest growing chronic

disease. It can only get

worse. Dr Deed will outline

the strategy for improving the

lives of diabetes sufferers in lives of diabetes sufferers in today's National Press Club

address. Ladies and gentlemen, welcome

to the National Press Club, and today's National Australia Bank

address. It's our great

pleasure today to welcome Dr

Gary Deed, the national

president of Diabetes

Australia, and for many years,

an advocate on behalf of those people who live as

people who live as he does,

with diabetes. And that's a

lot of people. It's estimated

by the latest calculation that

somewhere between 1.3 and 1.8

million Australians live with

diabetes, and about 900,000 of

them are registered with the Federal Government's national

diabetes support scheme, which

means that there are many hundreds of thousands who hundreds of thousands who are

not. Either because they're

not aware of their condition,

or of the existence of that

support scheme, which is worth

some $700 million a

year? $150. Dr Deed is a GP

based in Brisbane, but this is his

his particular interest outside

his professional work and he'll

tell you more about those

statistics I mentioned so

Gary Deed. briefly. So please welcome,

APPLAUSE

Let me begin by recognising

the traditional owners of this

land on which we stand here

today, the Ngunnawal people, their

their elders past and present.

National Press Club chairperson

Ken Randall, members of the

board, distinguished guests and

media. I dedicate this speech

today to people working

tirelessly to assist people and

their families living with

diabetes and also those at

risk. In particular, the

chair of the Honourable Judi Moylan, the

chair of the diabetes

parliamentary support group,

and a colleague Professor

Martin Silink, the President of the International Diabetes

Federation. I particularly

want to thank Mr Matt O'Brien,

the recently retired CEO of

Diabetes Australia for his

tireless work and vision. This

is a talk for those who have

strategic vision and passion to

turn diabetes around. It's turn diabetes around. It's

been 40 years since a man stood

on the surface of the moon and

by doing so, captured our imagination with the

possibilities of a very bright

future. I can remember, but

can you remember that magic

time? A time of hope and

positivity. I stand here today

in a much different world, but

I have the same enthusiasm I have the same enthusiasm for

our futures. Surely if we can

put a man on the moon, we can

also achieve a goal of turning

diabetes around here in

Australia. We can reach this

goal by adopting the spirit and

vision that were there 40 years

ago when we put a man on the

collaboration across government moon, the broad level of

and industry through the and industry through the

application and integration of

knowledge. A sustained

commitment to a program that

set an audacious goal that

ultimately was realised. I

ask, have we got unity around

this common goal of turning

diabetes around? If not, we

face a future where our

children may not enjoy the same level

level of health as our current

generation. This year, during

National Diabetes Week, we'd

like Australians to reflect on

a very simple but important

question, are you at risk? I'm

sure you would all agree that

in these very turbulent times,

this is a question that is

likely to be on the minds of

many Australians in a variety

of different contexts. What we

are asking Australians to do is

directed at their risk of

developing diabetes, but specifically Type 2 Diabetes.

By visiting our new website

areyouatrisk.com.au, every

Australian that spends the time

can answer some simple

questions which will lead to a

better understanding of their individual risk of

individual risk of developing

Type 2 Diabetes. We'd also

give opportunities to address

their risks. Again, the

website is areyouatrisk.com.au.

I recommend you look at it. So

what is diabetes? In very

simple terms, diabetes is a

chronic condition where your

body can't properly use glucose

such as fats as well as other energy sources

such as fats and proteins. The

very structural and energy

aspects of our body's

metabolism. This sounds benign

enough, but can have very

serious effects on our blood

vessels, nerves and many

tissues. People with diabetes

have twice the risks of

developing of developing

cardiovascular diseases such as

stroke and heart attack. And

is all diabetes the same? Of

course, the answer is no.

There are three main types of

diabetes - Type 1, Type 2, and

gestational diabetes. It's

important to understand the

differences between each. Type

1 Diabetes generally occurs in

childhood and early adults and

is marked by the lack of

insulin, so people with Type 1

Diabetes need to take insulin

either by injection or through

insulin pumps, actually in

order to survive. Around 10%

of the cases of diabetes are

Type 1. We know this is caused

by an autoimmune process and

still there is no cure. Type 2

Diabetes is by far the most

common form of diabetes, making

up to 85% of cases. It's

called the epidemic of the 21st

century. It is different to

Type 1 Diabetes, as it's marked

by a reduced or ineffective

insulin response. For some

cases of Type 2 Diabetes, the

management may include changes

to diet, increased exercise and

weight loss. Many people with

Type 2 Diabetes require a range

of oral medications and eventually

eventually even insulin. Gestational diabetes is the third type of diabetes that

makes up around 5% of cases.

It is a temporary form of

diabetes in pregnant women that

usually disappears when the

baby is born. Women who have

had gestational diabetes are at

increased lifetime risk of

developing Type 2 Diabetes.

And recent studies have shown

that their babies may also have

a greater chance of developing

Type 2 Diabetes. How big is

this issue? Diabetes is an

important issue for every

Australian at an individual,

community, national and also

international level. We are

part of a global community

where there are 246 million

people living with diabetes,

this number is expected to grow

to 380 million within the next

20 years. At this number, 380 million, there'll be enough

people with diabetes on our

planet to join hands to form a

human chain reaching all the

way to the moon. We have a

challenge never to get to the

moon via this method. We live

in a country where there are

275 new cases of diabetes

developing each and every day,

which means at the end of each

and every year, we can fill the

Melbourne cricket ground with

people with newly-developed diabetes.

diabetes. The Australian

Diabetes, Obesity and Lifestyle

Study commonly known as AusDiab

estimated that for every person

diagnosed with diabetes, there

is a person undiagnosed. More recent estimates put the figure

of undiagnosed between 300,000

and 800,000. Thus, we estimate

around 1.5 million people are

living with diabetes in

Australia at this time.

Whatever the figure may be, the previouslience of diagnosed

diabetes continues to rise in

all groups, all types. -- the

previous lance. The Government

has recognised diabetes as a

national health priority and

spends around $6 billion every

year on diabetes, but we still

see the numbers of cases

rising. As I said before, a

person with diabetes is at

greater risk of developing

complications like heart

attacks and stroke, eye and

kidney diseases, neuropathy,

limb amputation, depression and sexual dysfunction. It is the

leading cause of blindness in

Australian adults, and 90% of

these are preventable. A third

of people starting treatment

for end stage kidney disease do

so because of diabetes.

Diabetes and its complications

were responsible for around

5.5% of the burden of disease

in Australia in 2003 alone.

92% of that was due to Type 2

Diabetes. The burden of

diabetes is often

underestimated, as the cause of

death is often recorded under

the name of the complication,

not the disease diabetes

itself. If we look at the

contribution of diabetes to

stroke and heart disease, it

accounted for over 8% of the

total burden of disease in

Australia in 2003. All this

underscores the importance of

promoting a strong message to

the Australian people, getting us all to answer the question,

are you at risk? To turn

diabetes around, what are the

central elements in a strategy

to address this? We need a

clear vision, both nationally

and internationally to address

the issue. In responding to this challenge, Diabetes Australia formulated a

strategic plan with the

following - increased

awareness, a focus on

prevention, driving initiatives

to assist early detection of

diabetes, supporting the

implementation of

evidence-based best practice

initiatives for diabetes, and

promoting the need for research

into all aspects of diabetes,

particularly a search for the

cure. This is our 5-point plan

- awareness, prevention,

detection, management and

ultimately, a cure. Its

strength is in its simplicity,

but this should in no way hide

the challenges in successfully

delivering on that strategy.

The question of are you at

risk, touches on five of those

main areas of strategy. In

addressing this risk question,

one must turn to the causes of diabetes which are thought to

be a combination of genetics,

lifestyle, environment, including socioeconomic

environment. Within this set

of potential causes, there are

two groups of risk factors

which can be either modified or

those that can't. Starting

with those risk factors that

can't be modified, those

primarily under the control of

our genes, there are population

groups which have a much higher

predisposition to developing

diabetes than others. For example, Indigenous Australians

are three times as likely as

non-Indigenous Australians to

have diabetes, and have much

greater hospitalisation and

death rates than other

Australians. In a more general

sense, ethnicity is also a risk

factor for developing diabetes.

This is a key issue for

Australia, as we are a

multicultural nation with up to

28% of our population now born

overseas. More overseas-born

people than Australian-born

people develop diabetes.

Looking at some specific

population groups, we see rates

of diabetes are higher in

people born in the South

Pacific islands, southern Asia,

southern Europe, the Middle

East and North Africa. Age is a non-modifiable risk factor

for all of us. Australia's

population is ageing and

reflects the rates of other

western industrialised nations.

Our ageing population is

placing increasing pressure on

the health system in terms of

cost and service provision.

People with diabetes use a

range of health services to

manage their illness. Their

blood glucose monitoring,

checking their blood pressure,

blood lip I had levels, helping to reduce symptoms and the risk

of complications, but also to

enhance their quality of life.

Having complications greatly

increases the use of health

services. Older people with

diabetes use more health

resources compared to the rest

of the population. As our

population ages, we need to be

mindful of ways of keeping

ourselves healthy, preventing

or at least delaying for as

long as possible, the onset of

diabetes. Thus the question,

are you at risk, needs to

target these identified

communities and groups at

higher risk. The modifiable

risk factors for diabetes, this

comes back to those risk

factors such as physical

inactivity, smoking, poor diet,

with the end result being

overweight or obese.

Modifiable risk factors are

central in preventing Type 2

Diabetes. They can also help

reduce complications from this

disease. However, the previous

lens of these key risk factors

- being overweight and obese -

are increasing here in

Australia. Recent figures put

the number of obese Australians

at 3.7 million. Addressing

overweight and obesity is

critical in any national

strategy to prevent diabetes.

We know that diabetes also

follows a social gradient. Diabetes previous lens and

death rates for the most

disadvantaged 20% of our

population are nearly twice as

high as those for the better

off 20%. We know that this

disadvantaged 20% do not

exercise enough, eat more

energy-dense food, eat

low-nutrient food, smoke more

than those in the better-off

20% of the population. Public

policy, organisational

practices need to change to

support ways to change

individual health behaviours,

and address Type 2 Diabetes and

those at risk of this disease.

However, individual behaviour

change messages alone will not

do this, particularly amongst

this disadvantaged 20%. Many

of whom can't access healthy

food, do not have access to

environments that support being

physically active. Addressing

these causal factors for

diabetes will require a

collaborative, sustained and comprehensive national

response. The Australian Government has already

identified diabetes as a

national health priority, and

there are a number of

initiatives focusing public

attention on this chronic

disease. The national diabetes

strategy, which aims to improve

prevention, early detection and

management of diabetes is one.

Within this document, there is

a clear outline of strategies,

including the National Services Improvement Framework. It was developed four years ago, but

is yet to be implemented. In

building on these initiatives, Diabetes Australia took the

lead, with the support of the bipartisan parliamentary

diabetes support group, with

more than 50 politicians from

both the Senate and the House

of Representatives. We co-hosted two national

conferences, the Futures Forum

in 2007, and the Canberra

Summit in 2008. They were

aimed at bringing together the

leaders from across the

diabetes community to assess

Australia's progress to date

and to workshop the elements of

this collaborative, sustained

and comprehensive national

response. The Futures Forum in

2007 brought together an esteemed collection of Australian politicians,

policymakers, service

providers, and internationally

acclaimed researchers in

diabetes. We worked on the

theme of assessing Australia's

progress. From awareness, to

finding a cure for diabetes,

looking at where we are, where

we need to be and what

solutions may be possible. The

forum set down some key

principles to help drive future

planning. These principles

planning. These principles

include equitable access to

information, such that

education and health services

should be ensured for all

groups in the population. That

we need to improve our efforts

to apply what we already know

about diabetes, while we

continue to generate new

knowledge. Also society-wide

strategies were needed to

improve the physical

encourage environment which will

encourage healthier lifestyles.

The Canberra Summit in 2008

followed and continued with the

theme, emphasising the need for

action based on partnerships

between key stakeholders in

order to build capacity to be

more effective through

collective knowledge. Also, to

apply evidence-based best

practice and strategically

target interventions. A few of the more significant outcomes

from the Canberra Summit

focussed on the need for

Diabetes Australia to move

upstream towards awareness,

prevention and early detection,

and that evidence does support

prevention and preventative

interventions. The summit

strongly supported the need to encourage the implementation

and the use of existing

comprehensive guidelines. The evidence-based guideline for

case detection and diagnosis of

Type 2 Diabetes, and the evidence-based guideline for

the primary prevention of Type

2 Diabetes. This latter

guideline recommends the use of

the Australian Type 2 Diabetes

risk assessment tool, or

Aus-Drisk tool for

identification of people at

risk. This tool forms a basis

of our areyouatrisk.com.au Web

page mentioned earlier. The guideline further recommends

lifestyle modification programs

be offered to all individuals

at high risk of developing Type

2 Diabetes, and that farm

logical interventions could

also be considered in some

cases. It also recommended

that community-based cases. It also recommended

intervention should be used in

specific settings and target

groups such as workplaces,

schools and the disadvantaged

populations. Further again, it

emphasised the impact of the

built environment and how the

built environment influences

reduced opportunities for

physical activity, healthy food

choices and these factors

should be considered in urban

design and planning. Future

prevention of chronic diseases

such as diabetes rests with the

structures that ensure health

becomes a responsibility for

all of Government, all areas of

Government, through all of

Government policy approaches.

For instance, integrating

planning and urban development,

transport and housing to develop healthy local

communities promoting physical

activity for all residents.

Recent Government commissions

of inquiry, including the

Hospital and Health Care Reform

Commission, the national

preventative health task force,

and the primary health care

strategy and some of their

draft reports, will undoubtedly

reference these important

issues. Since the Canberra

Summit, Diabetes Australia has

looked to push the envelope of

innovation in terms of

partnership, to help address

the risks and those at risk of

diabetes through individual and population-based information,

collection and knowledge s. --

and technologies. The first

example of partnership is based

around the innovative

believe that technology will application of technology. I

play an increasing and vital

part in the early detection and

be critical in the development management of diabetes and will

of self-management strategies.

One promising technology

includes a system of

communication that allows a

person with diabetes while

monitoring their blood glucose

levels to transmit this information through their

mobile phone to their health

professional or carer. This

technology can help send reminders about taking

medication, when to do the

blood glucose testing for

instance. It may assist the

person who is at risk with

medication compliance, or who

may need education or

information updates. Another

example is the Australian

Diabetes Map developed at

Diabetes Australia. It's an

example where technology links

policymakers, program

developers, service deliverers

and researchers. The current

version of the map provides information based on the

numbers of people registered on the national diabetes services

scheme. This is a scheme that

has been operating for over 20

years and which Diabetes

Australia manages on behalf of

the Commonwealth Government.

The map gives strategic

information about diabetes p,

revalence and type by Federal,

State, Territory or electorate

and postcode. It can be

overlaid by socioeconomic and

other data to point out hot

spots, useful for the types of

users just mentioned. The map

provides the opportunities to

identify gaps in information,

assists in designing new health

delivery platforms, assists in designing new health

prioritisation of interventions

and to assess their

effectiveness. But also to

guide the financial support to further improve health

outcomes. The map can also be

used to monitor targeted

interventions such as progress

to specific quantative goals

such as the annual reduction by

10% in the number of patients

with an at-risk blood glucose

level. The diabetes map also

has the potential to link into

proposed systems under the Australian Government's

E-Health program and has been

accepted for presentation by

Diabetes Australia to the

leaders of the international

diabetes community at the

prestigious International

Diabetes Federation Congress in

Montreal in October of this

year. The next partnership is

our strongest example of the

value that can be accrued by thinking outside the square,

and involves the national

partnership with a leading

Government agency, the

Australian Sports Commission.

This is to address a specific

risk population. Diabetes

Australia was approached by the

Sports Commission to partner

them through their Active After

School Communities Program by

establishing a campaign of

turning to sport for good

health. I would like to thank

them for their leadership and

generosity in providing an

opportunity for Diabetes

Australia to reach 150,000

schoolchildren, their families

and their school communities

with our important message

around being aware of diabetes,

the risk factors associated

with the development of Type 2

Diabetes, and the importance of developing healthy lifestyle

habits early on in life.

Congratulations again to the

Australian Sports Commission. I look forward to hearing of

the successes of this program

as it is delivered over the

coming months. Another

partnership that is strongly

developing is in the area of

Indigenous people with

diabetes. We recently

commissioned the Urbis report

into Indigenous health in

diabetes. It clearly

identifies areas of specific

need. Diabetes Australia, with NACCHO, our Queensland

organisation, have developed a

model program for addressing

at-risk population s. The

model is delivered through the Aboriginal Medical Services,

and should help empower these

community-based health centres

to bring better health outcomes

in an area that is sorely

needed. We are awaiting

Government and ministry

approval for the project to go

ahead. Enough with talk, let's

move ahead with this project.

Too many Indigenous people are

at risk for too long not to

take up this challenge. I

would like to stress that

partnerships and collaboration

will be crucial in order to

address diabetes, particularly

in these populations most

disadvantaged and most at risk, like our Indigenous communities

and in settings where people

work, live and play. The challenges for Diabetes Australia and other

stakeholders in diabetes are

not small ones. However,

people of vision , politicians,

policymakers, program developers, service providers

and researchers have the

knowledge and skills and

commitment to make a change.

We must overcome the obstacles and barriers to preventing

diabetes, detecting it,

managing it and finding a cure.

Particularly, there is a clear

need for more resources and

effort to be put into

prevention. Not just immediate

prevention of risk factors for

Type 2 Diabetes as I mentioned,

nutrition, physical inactivity

and smoking. Important as

these individual risk

behaviours are, the underlying social determine insignificants

of diabetes are as important --

determinants of diabetes are as

important, if not more so, as

they underlie the risk factor s

that create diabetes and many

of the other chronic diseases

that currently burden Australians. They have been

underresearched and

underweighted for way too long,

but the evidence shows that

they hold the key to addressing

the questions of inequity in

the spread and focus of chronic

diseases like diabetes,

particularly in the least

well-off 20% of our population.

I call on all stakeholders in

the diabetes community to

advocate and pragmatically

implement the Sydney

Resolution, agreed upon by a

multinational group of

strategic thinkers brought

together by the Oxford Health

Alliance, released here in

Australia in 2008 by my close

colleague, Associate Professor,

Ruth Colaguiri. This call to

action echoes our Futures Forum

and Canberra Summit. Namely,

health places are needed designing unpolluted

smoke-free, safe local areas

that promote social interaction

and activity. Like here today.

Healthy food, making healthy

food affordable and available

to all. Healthy business,

engaging business to realise

that good health equals good

business. Healthy public

policy, formulating

comprehensive innovative and

integrative whole of Government

policy that promotes good

health. Ultimately, healthy

society, addressing in equity

and social disadvantage. This

Sydney Resolution is inspiring

in its scope, achievable in its

implementation. It represents

a simple strategy to help

people living with diabetes now

and those at risk in the

future. Our children. Today,

I wish to announce that I'm

stepping down as national

president of Diabetes Australia

after three years in this role,

and 14 years voft in this

organisation. During my time

as president, I sought to build

a strong national voice for

diabetes, emulating the clear

messages of a strategic vision

and collaboration. With many

of the people sitting here with

me today. I'm stepping aside

in order to provide Diabetes

Australia with the freedom to

choose its next steps in

responding to the challenge of

turning diabetes around. My

personal view is that the

transition needs to be made

from a strong national voice to

a strong single national

entity. Clearly, the signposts

are there. People with

diabetes, our partners require

Diabetes Australia to have

visionary leadership to take up

this challenge. Through

working together, people with

vision will find the solution

to reducing this risk of

diabetes. Just like those with

vision 40 years ago realised

the seemingly impossible task

of putting a man on the moon. Thank you. APPLAUSE

Thank you very much, Dr Deed.

As usual, we have a period of

questions. They start today

with Mark Metherall. From the

'Sun-Herald'. Look, for years

Diabetes Australia and various

other diabetes campaigners have

made this point about there

being only about half the

population of diabetes having

been diagnosed with this. Is

it not extraordinary that at a

time when we're seeing huge increases in the ordering of

pathology tests that this

situation still remains. Why

is it that doctors and their

patients fail to have their

blood glucose levels checked?

And the second part of the

question if I may, can you give

us any sort of estimate of the

savings in terms of reduced

suffering and cost if indeed

more people were diagnosed

earlier with diabetes? The

first part of your question is

a very important question, why

are people undiagnosed with

diabetes in such a place like Australia? That really reflects

some of the issues I brought

out in my talk around the

social determinants of health

that determine how you access

health. It really reflects

that, in fact, and the figures

show, those socially

disadvantaged 20% sometimes

don't have clear focussed

access to health systems that

allow them to have the

diagnosis of diabetes, let

alone good health care. So I

wouldn't suggest that it is a

failure of the individual. I

wouldn't suggest it's a failure

of individual doctors. It's a

failure of our health system to

address the social inequity

that allows people clear and

informed access to proper

health care. The second part

of your question was around

what would be the health

savings. I have to deafer that

I'm not a health economic guru.

We all know that -- defer. We all know that well-managed

diabetes, the detection of

diabetes early, the better

management of complications

leads to better health

outcomes. 1% reductions in a

person's overall control of

their blood glucose level

significantly reduces their

risk of death and complications

and disability. So early

diagnosis, better management is

knowledge we currently have.

So if you apply the health

economics to that, it really

says that we can't not look for

these people. We have to do

something about them. On a

whole of nation, and an

individual level. Dr, I thought

the implication of Mark's first

question was why shouldn't it

be a standard test for any GP

with a patient? Testing for

diabetes is an appropriately

applied test in an at-risk

population. My talk today is

really saying to you, and what

I've sort of mentioned today is

that we need to identify

at-risk populations. I

mentioned that 20% of the

population which may not have

good access to health care, but

there are other people there if

you do your are you at risk or

your Aus-Drisk tool, those are

the people we are calling to

have their blood tests. I

don't call for population-wide

screening for diabetes. It

should be targeted. The

evidence is targeted

intervention and then testing

is the most appropriate

route. The next question is

from Simon Gross. In the last

financial year just finished

the NH and NRC put out about

$51 million plus for diabetes

research, which is about a 500%

increase over eight years. Are

you content with the share of

this kind of research funding

that diabetes is getting, and

can you identify any particular

areas where you see a need or

would see value in raising the

funding levels? Absolutely, and

I acknowledge that funds are

going into diabetes research.

But we need way more. If you

break it down into a particular

type of diabetes such as Type 1

Diabetes, if you live with that

disease, if you're a parent or

a child living with that

disease, funding for research

to find a cure should be

never-ending, there's never

enough money and I really call

on Australians to stand up and

look at an illness that has

devastating effects on not only

the individual but their

family, and call for more

funding. In the area of Type 2 Diabetes and gestational

diabetes, I mentioned for

instance those risk factors

that put people at risk need

better research and better

understanding. Those social

determinants - why are people

who are disadvantaged more at

risk? What can we do about it?

It's often more than social

marketing. It's not just

selling a message to them, it's

actually building an

environment that promotes good

health. For instance,

yesterday in Queensland I was

at a launch with the Transport

Workers' Union encouraging

truck drivers to be more

active. That for instance is

something that should be

replicated, and research into

does interventions make a

difference in that population

risk group? We need more

research into social

determinants of health,

behavioural change, let alone

the biomedical model that's

currently well-funded. We need

to shift the funding into what

we call translational research,

people on the ground living

with diabetes and also those at

risk. Dr Deed, let me ask the

next question. I was surprised

to hear you say early in your

address... well, you posed the

rhetorical question, have we

got unity around this goal of

turning diabetes around? Don't

we? And given your remarks

about stepping down yourself,

is that one of the reasons? A

controversial question. I

believe that people with vision

have unity around this message

of turning diabetes around. I

mean, why else would you be

here? I believe that our

responses to this issue need to

be unified and very solid

behind vision and strategy.

Our purpose of Diabetes

Australia is actually to not

have diabetes, to reduce

everyone's risk of diabetes,

and I just call that the fact

unified approaches in a very

difficult time, we're talking

about economic reality, not

trying to waste resource s.

Single, strategic, visionary

approaches are more efficient

and lead to better outcomes

than everyone working at the

edges rather than with a single

goal behind them. So I believe

that, as I said my personal

belief is that, Diabetes

Australia would do way better

if it was a single strong

national organisation with one

single national goal to turn

diabetes around. Perhaps you

could tell us why that isn't

the case? We are a wonderful

federation of like-minded organisations throughout

Australia, and in that, there's

a great depth of skill, a great

depth of passion. It's a

historic fact that we came

together as a federation coming

from a State-based and health

professional base. Diabetes

has been here, but it is now

developing into a disease and

those at risk that go beyond

State organisational

boundaries. It's a national

issue, let alone an

international issue. So our

history applies ourselves to

our organisation, but I believe

Diabetes Australia needs to

stand up with a vision to make

it a much stronger, because

diabetes does not end at the

border between Queensland and

NSW, between Victoria and

NSW. Sounds a bit like the

problem of the country. Absolutely. The next

question is from Laurie Wilson.

I think I'm quoting accurately

when you said that diabetes is

the leading cause of blindness

and that in 90% of those cases,

I presume you mean those caused

by diabetes, they are

preventable. I'm wondering,

can you expand a bit on that?

Is it just a case of when you

say they're preventable, of simply early detection and

treatment, or is it more

complex than that? A very

important question, especially

for any person with diabetes,

because the history of diabetes

shows that after many years

issues with complications

affecting the eyes can arise.

It's been very clear, the

evidence shows that even if you

have diabetes you can prevent

those complications arising by

better management, and better

management includes controlling

your blood glucose level.

There are measures I as a

doctor use to help guide people

I see, one of which is called

haemoglobin A 1 C. A 1 C to

patients. The evidence shows

if you can assist a patient to

achieve a target of a A 1 C to

7%, the risk of complication to the eyes diminish dramatically.

Even if you reduce it by 1%,

the complications may reduce the complications may reduce by

more than 20%. It's very

simple. This is the point of

what I talked about before, we

often have this current

knowledge, but it's the

application of the current knowledge that needs to be encouraged. A question from

Peter Phillips. Dr Deed, Peter

Phillips, one of the directors

of the National Press Club. Some of the fundamentals of

your address are very

confronting, $6 billion worth

of expenditure and yet the

continued increase in the

incidence of diabetes. I

wonder in the circumstances as

we face the round eternal of

the cashbook and the journal, I

wonder in the circumstances

whether it isn't time for

Diabetes Australia and for the

health and medical services

sector more broadly to be more

aggressive and more prescriptive, particularly in

their dealings with Government about steps beyond those which

are being taken now, more

aggressive in prescriptive

through the education sector.

More aggressive and pre

scriptive in relation to sacred

cows such as the advertising

industry and what can what

can't be advertised in relation

to diet and other fundamental

considerations. Is that a part

of a legacy that you might

leave for your successor, a

clarion call for greater

aggression and greater

prescriptiveness? A very

important point. What you've

illustrated is there's a lot of

work to be done and you've

illustrated some very clear

opportunities available to organisations like Diabetes

Australia to make a difference.

I mentioned the Sports

Commission. I'd like those

messages to be a positive

message. The positive message

I'm wanting to leave is that

you can do something about

diabetes. You can do something

about preventing diabetes. If

you don't feel you're able to,

there are resources and

opportunities available to you

. If those opportunities are

not available, Diabetes

Australia's vision should be to get those resources available

to you to help you make a

healthy choice, and those are

the opportunities, yes. And

that is something that needs

aggressive pushing. Diabetes

Australia is ideally Sitchated

to have vision and strategy

around the goal of turning

opportunity, we have diabetes around. We have the

partnerships available to us.

We should now move forward and

take those opportunities, to

help especially those people at

risk. I talked about

Indigenous people. Why, for

instance, is the fact that

communities just outside of for

instance Cairns, Aboriginal

communities, pay more for food

than people in the Cairns

community? Why can't we do

something about that? 20

kilometres away. That inequity

is there, it's real, but who

has the vision to actually make

a difference? That's what I'm

calling on. Let's go back to

Mark. We're soon to see the

outcome of a Health Reform

Commission's final report. How

much does the current sort of

divided nature of the divided

health system between Federal,

State and Territory systems

impact adverse ly on the care

of people with diabetes, and

would you like to see a single

funding system for health? Very

important commissioned report.

I am certainly not privy to the

outcomes of that report, so

what I'm talking about today is

my own vision and my own

belief. I work in a health

system that is fragmented, but

maizingly it does work well and

many of my patients have good

care. But if we're talking

about people with diabetes who

require multiple inputs to

their health, multiple service providers, the best practice

model would be to make sure

that those providers are

talking together with one

system, and also the funding

streams are made more

efficient. If the hospital

health care reform commission

suggests that there may be

better approaches to funding of

hospital systems, under a

Federal model I'd be quite

happy to look at that model.

What I'm really... I care

about, though, is the Type 2

Diabetes, that predominant type

of diabetes in Australia is managed largely in general

practice and hopefully, if it's

better managed in general

practice there'll be less

likelihood to need tertiary

care systems. So if we're

looking at the hospital health

care reform commission and the

primary care health strategy,

those strategies should address

both general practice, diabetes

educators, dieticians,

pharmacists, Diabetes Australia

to work together on a

community-based general

practice-centred approach to

helping diabetes. Simon Grose.

So far, your talk's been marked

by a kind of resigned

desperation. I'd like to give

you an opportunity to talk

about some hope. I'm sure

you're aware of the clinical

trial being undertaken at the

moment implementing work done

by Lyn Harrison at the Walter

and Eliza Hall Institute. He's

working on Type 1 Diabetes,

he's found very strong evidence

that if you give kids who are

at risk of Type 1 Diabetes

insulin via a nasal spray for a

period of time, you can change

the immune system's response so

it doesn't attack the

pancreatic cells. This

research is funded by US money.

It started in 2006, I think

it's going to go for about five

years. If it proves as

effective as it's hoped, it may

be possible to just give kids

who are at risk of Type 1

Diabetes this nasal spray for a

few years and they could live

normal lives. What kind of,

how do you assess this

prospects of this research and

what kind of difference do you

think it would make in, say,

5-10 years' time if it was an

effective treatment to the

management and the attitude to

managing diabetes? I think this research is something to be

internationally recognised.

Australians have been way at the forefront of internationally recognised

research not only in diabetes,

but in vaccination production

et cetera, and this is looking

at very similar research and

similar biomedical models.

What a wonderful place it would

be if I could say to you "Well,

I can prevent you developing

Type 1 Diabetes" , let alone at

the same time if you do develop

it, I could manage it better.

So I mean, we need to support

this research. It is significant internationally and nationally, and it gives a

hope. That's for Type 1

Diabetes. For Type 2 Diabetes

out there, though, the vast

majority of diabetes requires

as I said, better focussed

research and better funding

researched around Type 2

Diabetes, and so yeah, I think

there's hope. I mean, I don't

think I'm desperate or sound

overwhelmed at all. I'm just

telling you that this is a huge

issue that I'm prepared to walk

the line with, and I'm asking

other people to walk the line

with me. And I think the Australian people want us, they

want people with vision and

good strategy to make a

difference, and actually the

science and the theory behind

what can work is really well

and truly embedded. But we

just need people with vision

and leadership to make it

happen. A question from Morris

Reilly. Dr Deed you've

mentioned in your speech some

of the issues, diet and

exercise, and smoking. Federal

Governments look like raising

taxes on smoking which I'm sure

you'll applaud. I'd like to

deal with what you think about

taxes, about taxes on foods

that are going to create

obesity. Do you support that?

And should we have some subsidy

for encouraging exercise? It

gets back to death and

taxes? Absolutely. Will you be

making a submission to the Ken

Henry Review, for example? A

very important fact. It's not

just death and taxes, but it

will be diabetes that will be a

certainty in many of our lives,

a sad point. When you want to

change social structures and

certainly individual behaviour,

it should be an incentive-based

system, not a penalised-based

system, so I believe that

particularly in workforce for

instance, we could develop

systems which encourages your

employer or your workplace to

make you more physically

healthy, and if not, to be

encouraged so that you have the

choice to be. So for instance,

there could be instead of we're

giving, taxing people, but

giving tax relief to those

organisations such as I

mentioned today, people that employ truck drivers for

instance. If they employ

healthy work practices that

encourages their workers to be

more healthy, why couldn't they

get a tax break for that?

There's current systems in

Japan that are looking at that, encouraging healthy work

practices as a positive tax

incentive rather than an

additional tax. I believe that

healthy food is important to

healthy lifestyle choices. Not

only trying to remove the

burden of unhealthy

energy-dense food, but as I mentioned, there are

communities here in Australia

in our own capital cities, let

alone remote areas, who don't

have access to healthy food at

the same cost as you can go

down to a supermarket here in

Canberra. That is inequity.

That can be addressed if you

are of strong mind and strong

leadership. Why should some

people pay to eat healthy food

more than you do? That is not

right, and it requires not

extra taxation, but a

leadership with vision to make

it happen. Dr Deed, let me ask

you the last question of the

day, and it's based on this,

the overwhelming discussion of diabetes seems to be about

management, but you did at one

stage mention your hope for an

eventually cure and talked

about it being a matter of

unravelling the link between

genetics and lifestyle. Tell

us how that's possible? Does

the genetic effect govern the lifestyle characteristics that

the person takes up? Are they

more predisposed to drink,

smoke and eat unhealthily, or

is there something beyond

lifestyle characteristics

that's involved? I think a very

important point again. We are

all born from a genetic pool so

to speak, and I certainly come

from a south Asian pool which

puts me at greater risk of

diabetes, and thus I developed

diabetes. But I have siblings

who don't have diabetes, so

there is something that occurs

in the individual in an environment that is either

obese will have ogenic. That

is encourages me to put on more

weight than a similar person,

or encourages me to be less

physically active, and,

therefore, the real issue isn't

that I was born from a genetic

pool, but I was given the

opportunity and the environment

that promoted me to be healthy.

It allowed me to make healthy

choices rather than unhealthy

choices. I know from my

childhood I probably would have

made healthier choice ifs the

opportunity was there. There

was no school program

encouraging me to be involved

in afterschool activity, other than what was available as

sports. But there are some

children given that opportunity

will choose healthy options if

they're given healthy food,

they will eat healthy food. If

we provide the social

environment for allowing them

to be physically active, to

make healthy choices through

food and if the food is

affordable. So it is largely

under the influence of where we

live, work and play that brings

out the genetic predisposition,

and for all of us Government

policy, school policy industry

policy determines how we live,

work and play largely, and

wouldn't it be fies if we

started to coordinate better to

give people at least the opportunity to make a healthy

choice. You can make a choice

at the end of the day to smoke

or not smoke, but for instance

now, the joined up legislation

that allows people to go out to

a social environment not to be

exposed to smoking is a wonderful opportunity to show

people that I can still enjoy

myself and be healthy. It's a

joined up legislation promoting positive health. That can

happen in diabetes. You can

have your children, our future

and our children going to

healthy schools. Not going to

a school which provides

unhealthy tuckshop choices or unhealthy lifestyle choice around activity. We can make a

difference by giving those

children those healthy choices

and by working together with

Government, industry, school

and individuals. I believe that's possible. Thank you very

much. APPLAUSE

Thank you very much, Dr Deed.

I'm sure a lot of people have

realised how little they knew

and how much more they need to know about diabetes in this

past hour, and we thank you for

it. This membership card might

bring him back to tell us how it's going. Thank you very

much.

APPLAUSE Closed Captions by CSI

THEME MUSIC 'On Talking Heads: the new king of swing, David Campbell.' # You're just too good to be true...#

'He grew up in the spotlight, after discovering his dad was Jimmy Barnes. After an often difficult journey to find himself and his groove,

David Campbell's infectious energy has made him one of the hottest entertainers in Australia.' David Campbell brought new energy to the classic songs of the '50s and '60s. But he's no lounge lizard. He's the sort of chap who asked his girlfriend's father for permission to marry, then proposed with a bunch of lilies, overlooking the Paris Opera House. Perhaps I should be wearing black tie this evening. David Campbell, welcome to Talking Heads. Good to be here, Peter, thanks for having me. Now, Barbra Streisand. That rings a bell, doesn't it? Because Time Out magazine in New York called you the new Streisand,

which is enough to put your head in the clouds, I imagine. Yeah, it puts it up there. It was quite a strange quote, considering I'm not really that big a fan. But my family were, you know, Yentl and all that, but I was never really a big fan. But it was great and it certainly was amazing for business. I went from doing no business to a lot of show business. Rock, musicals, cabaret. You're now director of the Adelaide Cabaret Festival. What are you best at? I think I'm best at interpreting songs, as a singer. I think that's really the best thing I do. But you have to diversify. Well, you've never been at risk of being typecast, have you? It's been a minor thing. Cos you keep slipping and sliding around. Ziggy, zaggy. I try to keep abase by being mercurial with the whole thing. But I think it's best, cos you know, I got scared when I was in New York, of being typecast.

I started getting cast and only getting auditions as the boy next door. Mickey Rooney, wide-eyed, smiley boy roles. And I thought, "I'm never going to break this,"

so that's one of the reasons why I came back to Australia. You did Shout. Mm. And that's taking on the role of Johnny O'Keefe, the great rock legend. Certainly not a boy-next-door character. Yeah, well... A little bit. Larrikin next door. That's not you, though, is it? No, I'm no Johnny O'Keefe. I'm no wild man of rock, or anything like that. But I am descended from one and I think that helps. We did a lot of stuff on Johnny and we were looking at the script in the early days, I did take a lot of stuff from Jimmy and used a lot of that. The comment has often been made that you're very good at actually engaging audiences, of being fully there, fully in the performance. To what extent are you the subtotal of your experiences, I suppose? Because some of those experiences have been very tough. They have been, I think, but I think that makes you. Some of the best performers like Garland or Sinatra.

It was actually their demons that made them better. My father's another one of those people. Now I suppose, in a way, I've used my past and my humour. I've been the first one to attack it,

so I've made the joke first in my shows. That's been my way of dealing with it. But now, it's become quite a well honed device. I'm not Don Rickles, by any stretch of the imagination, but I do like to be completely in the moment.

I think it's important as a performer, to aspire to those greats. 'I think I always wanted to perform. I just wanted to show off, really. It's pretty widely known that I was adopted by my grandmother and she brought me up as her son.

For the first 10 years or so, 10, 11 years, I thought that she was my mother.

I knew I was adopted and she instilled that in me, the feeling that adopted kids are wanted. She brought me up on a pension. I didn't realise how hard that was until I got older. But I didn't notice it, as a kid. She really made me feel quite safe.' # Let there be you...#

'I didn't know I could sing as a child. My grandma, she obviously knew.' Probably the most burning memory I have, is not of Mathis or Sinatra or any of those guys. Probably my grandmother standing me in front of a room full of people, when I would have been maybe four, five, at a party and having to sing this song from the wonderful movie, Watership Down. # Bright eyes, burning like fire...# ROCK MUSIC PLAYS 'I remember this guy, Jimmy Barnes, visited once or twice, when I was quite young. I just remember this hair on legs coming in, dropping off a cassette and being fun and loud.' I put this tape on and thought, "That's not for me, that's terrible, that stuff, it's very loud and offensive." What a precious little nonce I was. '10 or 11 is when I found out about my dad. It was quite a shock. It was probably more a shock finding out that my mother was my sister. It certainly opened up a