Healthcare systems everywhere are locked into a short term view, unable to shift the conversation to where its is needed: the long view.
For example, there is a rising tide of diabetes afflicting the world. The International Diabetes Federation (IDF) estimates 589 million people (20-79) live with the disease today and that this will rise to 853 million people by 2050. Over 4 in 5 adults (81%) with diabetes live in low- and middle-income countries1. A serious public health issue is emerging as type 2 diabetes mellitus (T2DM) cases surge among 15–34-year-olds, characterised by faster progression and higher complication rates.2
Why does this matter, and what does it tell us?
Poorly controlled diabetes is a leading cause of a host of other life shortening, debilitating chronic diseases. These include heart failure, kidney disease, blindness, and lower limb amputations. The consequences of this epidemic of diabetes for health care systems are dramatic and ruinous financially. Yet, Type 2 is preventable, and it is also possible to reverse entirely during its early stages. To do so, the patient undergoes a programme of rapid weight loss coupled to a low-carbohydrate diet.
For citizens worried about their healthcare system’s struggles to keep pace with demand and the ever-expanding possibilities of (often expensive) new treatments, this is salutary. Most healthcare systems remain rooted in ill-health treatments rather than prevention, which is a form of damaging short-term thinking. Policymakers need instead to focus on the long view of human health, the idea of not just longer lives for their populations, but longer and healthier lives. The madness of short-term thinking in this space is that it cannot head off ill-health and so it inevitably condemns citizens to unnecessary suffering. The irony is that in the long run it is also vastly more expensive too.
Policymakers often find taking the long view challenging
There are many reasons policymakers avoid taking the long view. We often measure the payoff for prevention in the long term (although some benefits accrue sooner), and any government will be long gone by the time the payoff arrives. They worry about claims of ‘nannying’ and are reluctant to take on corporate interests. Meanwhile, their populations become sicker and more miserable, and the pharmaceutical industry gathers in the harvest.
Ozempic and its family of GLA-1 medications is one more profit centre for the pharmaceutical sector. It has created a fresh funding dilemma for healthcare systems and citizens. And all of this pressure arising from a largely preventable disease, that is reversible by a change in diet and lifestyle.
The underlying conditions for the diabetes epidemic is to be found in the manufacture of a calorie dense environment, with synthetic, high sugar, high salt, synthetic processed food at its core. Evolution rigs our bodies to desire sweetness and certain kinds of fats. The ancient hunter gatherer that dwells in our genes worries that food will be scarce. So we consume more than we need. Insulin stores excess energy initially as glycogen in our liver, and when that store is full, coverts it to fat. Our bodies can switch between sugar and fat for energy, indeed it is this mechanism that helps to reverse early stage diabetes. Fat is simply energy stored for later.
Metabolic scientists and physicians, and indeed public health practitioners, understand these processes. The challenge they all face is to change the emphasis from treatment to prevention. Our reluctance to accept this medicine is an enormous opportunity cost for society. The ongoing medicalisation of our lifestyle choices continues to syphon resources away from other areas of government and private expenditure.
What is needed?
It is time for a new conversation about health. Policymakers should start by honestly explaining to their populations that healthcare systems everywhere are misnamed. They are not healthcare systems, but treatment systems.
Second, there are no limitations on the possibilities for treatment. In the lasts four decades, survival rates for many previously lethal illnesses have significantly improved. Our diagnostic capabilities continue to mushroom. The march of scientific progress means we will always find new treatments for what ails us. This is good, but if increased supply doesn’t decrease demand, costs will rise. This means less funding for other areas of government, or higher taxes (or insurance premiums) or both.
Third, failing to address the underlying causes for ill-health in our societies disproportionately affects the least well-off in society. This is an injustice that can no longer be tolerated, when the remedies are already available via better education and access to resources for the better-off.
Fourth, wellbeing is as important as good health. Increased informal caregiving for family members with avoidable illnesses for instance, decreases overall family wellbeing. No one wants to see a loved one suffering. There is a downward spiral affect here that includes acquired mental ill-health and other harms.
Fifth, better education and stronger, supportive communities are at the root of remedies for acquired physical ill-health. Both will drive improved social cohesion, likely lowering low-level crime and other manifestations of fragmentation.
In short, we need a new narrative that decisively separates us from the past and begins to take the long view. It is the description of a positive vision for a healthier, happier society. Time is running short, however.
How much longer can we avoid starting a new conversation?
Leading with the Long View
Be part of the first of our conversations about leading with the long view. We’ll look at how we can shift from the short-term to the long-term across several domains, incuding healthcare, prison reform and corporate governenace.
- International Diabetes Forum (n.d.) Facts & figures. [Online] [online]. Available from: https://idf.org/about-diabetes/diabetes-facts-figures/ (Accessed 13 April 2025). ↩︎
- Zhou, Y., Chen, Y., Tang, Y., Zhang, S., Zhuang, Z. & Ni, Q. (2025) ‘Rising tide: the growing global burden and inequalities of early-onset type 2 diabetes among youths aged 15–34 years (1990–2021)’, Diabetology & Metabolic Syndrome, 17(1), p. 103. ↩︎
