Let’s Beat Diabetes (LBD) is a catalyst for enhanced intersectoral collaboration, community partnerships and action, health innovation and social action, aimed at preventing or delaying the onset of Type 2 diabetes ("diabetes"), slowing the disease progression, and increasing the quality of life for people with type 2 diabetes in Counties Manukau. 

LBD: A Five Year Plan to Prevent and Manage Type 2 Diabetes in Counties Manukau, commissioned by Counties Manukau District Health Board (CMDHB), is a five year district-wide plan aimed at long-term, sustainable change to prevent or delay the onset of diabetes, slow disease progression, and increase the quality of life for people with diabetes.  The plan recognises the significant activity that already exists to prevent and manage diabetes in Counties Manukau, and creates a long-term vision to align existing activity and a context for new investment, based on evidence and best practice. 

 Download the LBD: A Five Year Plan (full version)

The LBD Operational Plan 2008/2009 outlines the interventions/initiatives that will be implemented over 2008/2009 as part of the process to meeting the long-term outcomes identified in LBD: A Five Year Plan.  It builds on the work done from 2005/06. 

Download the LBD Operational Plan 2008/2009 

Strategic Approach

A range of interventions/initiatives are proposed in the LBD: A Five Year Plan and Operational Plan 2005/2006, guided by the concept that a ‘whole society, whole life course, whole family/whanau’ approach is required to beat diabetes, and that focused effort will need to be sustained over decades.

• Whole society – Acknowledgment that we cannot beat diabetes without the motivation and support of the communities, institutions and businesses that make up the social fabric of Counties Manukau.
• Whole life course – A focus on supporting health and preventing and managing diabetes at all stages of disease progression.
• Whole family/whanau – Acknowledgment that an individual is part of a family/whanau (or household) which has a direct influence on environmental risks, choices and decisions. Wherever possible, working with families is central to the plan.

Guiding Principles

The principles of Partnership, Participation and Protection form the constitutional foundations of New Zealand through the Treaty of Waitangi. These principles are also fundamental to the practice of modern public health.

• Partnership – Institutions, organisations, communities, families and individuals must work together to beat diabetes. The scale of social response required for diabetes means that formal partnerships based on aligned goals and civic responsibilities will need to be developed and actively sustained.
• Participation – The prevention and control of chronic disease is enabled through self management and via the ongoing participation of family, community and health professionals in the lives of people with diabetes. Also, for strategies to be successful, families and communities must be able to participate in service design, development and governance.
• Protection – The current diabetes epidemic has been created by a new environment of obesity. The ‘obesogenic environment’ is a threat to the health and wellbeing of our children and families. There is an obligation on behalf of government, business and community leadership to protect citizens from this environmental hazard.

The Planning Process

The required outcomes of the planning and development process was to develop a plan for the Counties Manukau district as a whole (not just the health sector) and to build community momentum in support of the plan. Achieving these outcomes required a highly participative approach, creating the foundations for long-term relationships, collaborative partnerships and networks.

A steering group made up of community, professional and cross-sector representatives guided the development of both the LBD: 5 Year Plan and Operational Plan 2005/2006.  The plans are the result of 15 months of extensive consultation, with the process open and transparent at every stage i.e. all key planning documents developed, consultation and meeting minutes were posted on CMDHB's website (www.cmdhb.org.nz) to provide a fully public view of the ideas and participants guiding the planning process.

Key Planning Concepts

Six concepts influenced the planning approach:

1. Guiding principles of the World Health Organisation’s (WHO) Global Strategy on Diet, Physical Activity and Health (2004)
Whilst the global strategy is aimed at the international community and national-level strategies, it contains a discussion of principles to guide action and recommended areas of activity. The strategy provided an excellent starting point for developing a long-term change programme. Key principles taken from the global strategy include:

• Evidence-based strategies
• Multi-sectoral action
• Long-term approach
• Life course approach
• Broad, comprehensive efforts
• Priority on most vulnerable groups
• All parties accountable for policies and programmes
• Culturally-appropriate, and challenge cultural influences

2. Evidence of need and effective action
The plan has been developed on needs analysis, and evidence of effective interventions, whether it be international or local evidence. There are, however, some areas where there is a clear need for action but a lack of strong evidence for effective programmes. In these situations, it is critical that thorough evaluation be undertaken to develop new evidence.

3. Sector capacity and community motivation
The plan has identified where need, evidence and good ideas intersect with the local capacity and motivation for action. There is little point in proposing strategies where the community and organisations are not ready and/or willing to take up the call. Examples of finding fertile ground for action include the food industry being strongly motivated to develop tangible outcomes following the signing of the National Food Industry Accord; the new Family and Community Services division of the Ministry of Social Development wanting to work with the health sector in the area of vulnerable families; and Pacific church leaders wanting to be more involved in supporting the physical health of their communities.

4. Long term approach
The plan has thought about the long-term implications of actions. It took decades to make real inroads into the threat of smoking on health. The obesity issue is far more complex and will require broad changes to our environment, societal norms and health sector capabilities before substantial positive changes and outcomes are achieved. The emphasis has been on identifying areas where actions over the next five years will deliver positive benefit and align with a 15-year vision.

5. Alignment with national and CMDHB overarching strategies
Key documents such as Counties Manukau District Health Board’s Strategic Plan (CMDHB 2002), Healthy Eating Healthy Action Framework (Ministry of Health, 2003), He Korowai Oranga – Maori Health Strategy (Ministry of Health, 2002) the Pacific Health and Disability Action Plan (Ministry of Health, 2002), and emerging Ministry of Health frameworks for chronic disease management such as Leading for Outcomes, have influenced the planning approach and processes.

6. Building on lessons from past strategies and services
Counties Manukau has a long history of strategic planning and service innovations relating to diabetes.  In many areas, Counties Manukau service providers have developed innovative services, some of which have been sustained. One of the challenges for LBD has been to learn from this rich background and to create the systematic conditions that support sustainable programmes.

7. Building on existing strengths
LBD starts from a strong base. CMDHB has for the past five years invested in improved chronic care management in the primary care sector. The Chronic Care Management (CCM) programme is well advanced and involves primary care being supported by training, information technology (IT) and decision support tools to provide structured care in the community for people with advanced diabetes. CCM is supported by Middlemore Hospital's Whitiora Diabetes Service.  Primary Health Organisations (PHOs), Maori and Pacific providers, and niche diabetes providers are also increasingly providing community-based health promotion and education activities for their specific target groups.

There are also a number of local and central government intersectoral leadership forums working to enhance collaboration and coordination of programmes and services within the district.  Building on existing strengths is fundamental to the ownership, implementation and success of LBD.

Let's Beat Diabetes: A Five Year Plan