Report on the Socio-Economic Impact of Diabetes Management Costs in Australia and Alignment with Sustainable Development Goals

Introduction: The Intersection of Health and Economic Sustainability

The management of diabetes in Australia presents a significant challenge to the nation’s progress towards key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 1 (No Poverty), and SDG 10 (Reduced Inequalities). The high out-of-pocket costs for essential diabetes technologies, such as insulin pumps and continuous glucose monitors (CGMs), create substantial financial burdens and inequitable access to care for two million Australians living with the condition. This report examines the economic strain on individuals, systemic policy gaps, and the broader implications for public health and equality, based on recent findings and personal testimonies.

Barriers to SDG 3: Ensuring Good Health and Well-being

The prohibitive cost of diabetes supplies directly undermines the objective of SDG 3 to ensure healthy lives and promote well-being for all at all ages. Access to affordable, essential medical technology is a cornerstone of this goal, yet many Australians are forced to make difficult choices between their health and financial stability.

Case Study: The Financial Burden of Type 1 Diabetes Management

Sammy Haigh, a 26-year-old early childhood educator, exemplifies the challenges faced by adults with type 1 diabetes. Her case highlights a critical failure in providing universal access to essential health services.

• Annual Cost: Ms. Haigh’s minimum annual expenditure on diabetes supplies is nearly $5,000, even after government subsidies from Medicare and the National Diabetes Services Scheme (NDSS).
• Weekly Burden: This equates to approximately $103 per week, a cost she notes is “more than half of my rent.”
• Comprehensive Expenses: The total monthly cost of $400 to $500 includes private health insurance (a prerequisite for accessing an insulin pump), diabetes technologies, and specialist appointments.
• Impact on Well-being: The financial strain forces a choice between critical health management and long-term financial security, directly impacting her quality of life and ability to participate in social activities.

Case Study: Inequitable Access for Type 2 Diabetes Patients

The experience of Pete Holland, diagnosed with type 2 diabetes, demonstrates how technology access disparities affect different patient groups. Despite describing a CGM as a “game-changer” for managing his condition, the lack of subsidy made it unaffordable.

• Unaffordable Technology: The cost for a non-subsidised CGM exceeds $200 per month.
• Forced Discontinuation: Due to rising living costs, Mr. Holland was forced to stop using the device, compromising his ability to effectively manage his health.
• Preventative Care Failure: This situation illustrates a missed opportunity for preventative care, which could reduce the long-term burden on the public health system, a key target of SDG 3.

Challenges to SDG 10: Reducing Inequalities

The current subsidy model for diabetes technology in Australia creates significant disparities, running counter to the principles of SDG 10, which aims to reduce inequality within and among countries.

Systemic Disparities in Access to Care

Inequalities are embedded within the current healthcare policy framework:

• Age-Based Inequality: Insulin pumps are subsidised for individuals with type 1 diabetes only if they are under the age of 21, leaving adults like Ms. Haigh to bear the full cost.
• Disease-Based Inequality: CGMs are subsidised for type 1 patients, but not for those with type 2 diabetes, creating a two-tiered system of care.
• International Disparity: Australia lags behind other developed nations, including the United Kingdom and Canada, which subsidise insulin pumps for all individuals with type 1 diabetes, viewing it as a standard of care.

Professor David Simmons, Chief Medical Officer for Diabetes Australia, notes that this technology is “seen as normal care” in other countries, highlighting Australia’s failure to provide equitable access.

Economic Ramifications and Parliamentary Recommendations

The failure to adequately subsidise diabetes technology has broad economic consequences, affecting not only individual financial health (SDG 1: No Poverty) but also the efficiency of the national health system.

The Economic Case for Investment

Diabetes Australia estimates the disease costs the health system $9.1 billion annually. Professor Simmons argues that increasing access to insulin pumps and CGMs is a sound economic investment. By enabling stable blood glucose management, these technologies reduce the risk of costly long-term complications, such as intensive care admissions and dialysis treatments. This preventative approach aligns with creating sustainable and resilient health systems.

Parliamentary Inquiry and Government Inaction

A 2023 parliamentary inquiry into diabetes produced a report with key recommendations to address these inequities. However, a year after its release, the federal government has yet to issue a formal response.

1. Recommendation 1: Make insulin pumps available at a low cost for all people with type 1 diabetes, regardless of age.
2. Recommendation 2: Expand access to subsidised CGMs to include individuals with type 2 diabetes.

A spokesperson for the Federal Health Minister acknowledged the report “shines a light on a serious public health issue” and stated it was being “carefully considered.”

Conclusion: An Urgent Need for Policy Alignment with Global Goals

The high cost of diabetes management technology in Australia poses a direct threat to the achievement of multiple Sustainable Development Goals. It creates financial hardship that contravenes SDG 1, fosters health inequalities that undermine SDG 10, and erects barriers to the universal health coverage central to SDG 3. Expanding subsidies for insulin pumps and CGMs is not merely a healthcare expenditure but a critical investment in a healthier, more equitable, and economically stable society. Urgent government action is required to implement the recommendations of the parliamentary inquiry and align national health policy with Australia’s commitment to the global SDGs.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  • The article’s primary focus is on diabetes, a major non-communicable disease, and the challenges individuals face in managing their health.
  • It emphasizes the need for access to essential medical technologies like insulin pumps and continuous glucose monitors (CGMs) to maintain health and prevent life-threatening complications.

• SDG 10: Reduced Inequalities

  • The article explicitly details inequalities in healthcare access. Subsidies for insulin pumps are restricted to patients under 21, and CGM subsidies are not available for those with type 2 diabetes.
  • This creates what the article calls “inequitable access” based on age and health status, a direct concern of SDG 10, which aims to reduce inequality within and among countries.

• SDG 1: No Poverty

  • The article highlights the significant financial hardship caused by high out-of-pocket medical expenses. Sammy Haigh’s costs of nearly $5,000 per year are described as “more than half of my rent.”
  • This financial burden, forcing individuals to make difficult choices between their health, daily expenses, and “long-term financial security,” directly relates to preventing people from suffering financial hardship due to health shocks.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   • This target is central to the article’s argument. The high costs of diabetes supplies ($103 per week for Sammy Haigh) and the unaffordability of CGMs ($200 per month for Pete Holland) demonstrate a lack of financial risk protection for individuals. The call to subsidize these technologies is a direct appeal for affordable access to essential health services.

2. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   • The article addresses this target by focusing on the effective treatment of diabetes. Professor David Simmons states that providing access to insulin pumps helps keep blood glucose levels stable, which “reduces the risk of long-term health complications” and prevents people from ending up in “intensive care units or on dialysis,” thereby reducing premature mortality.

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.

   • The article critiques current government policies that create unequal health outcomes. The fact that access to subsidized technology is dependent on a person’s age or the specific type of diabetes they have is an example of a policy that leads to “inequitable access.” The parliamentary inquiry’s recommendations, which the government has not yet acted on, represent a call to reform these policies to ensure more equal opportunities for health.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator 3.8.2: Proportion of population with large household expenditures on health as a share of total household expenditure or income.

   • The article provides specific, quantitative data for this indicator. Sammy Haigh’s annual spend of “almost $5,000” on diabetes supplies, which she states is “more than half of my rent,” is a direct measure of large out-of-pocket health expenditure. Pete Holland’s statement that he “can’t afford to be paying” over $200 a month for a CGM due to the “cost of living” further illustrates this financial burden.

2. Indicator of access to essential medicines and technologies.

   • The article provides qualitative and quantitative data on the lack of access. It is explicitly stated that insulin pumps are only subsidized for those under 21 and that CGMs are not subsidized for type 2 patients. This lack of universal access to what is described as “normal care” in other countries (like the UK and Canada) serves as a clear indicator. Progress would be measured by the expansion of these subsidies.

3. Indicator of health system costs associated with non-communicable diseases.

   • The article mentions that diabetes costs the Australian health system “$9.1 billion each year.” This figure serves as a baseline indicator. The argument that subsidizing technology would “reduce costs for the health system” in the long run by preventing complications suggests that a reduction in this overall cost could be a measure of successful intervention.

4. Summary Table of SDGs, Targets, and Indicators

Source: abc.net.au