Overview

The Royal New Zealand Foundation of the Blind (the Foundation) is a disability support service constituted under the Royal New Zealand Foundation of the Blind Act 2002. It is the primary provider of habilitation and rehabilitation services to over 11,500 blind, vision-impaired and deafblind New Zealanders.

Our vision is that blind and vision-impaired people have the same opportunities and choices as other citizens to participate fully in society. Our mission is to remove the barriers faced by blind or vision-impaired individuals and to promote their participation in all aspects of life. We work in a range of partnerships to ensure that the incidence of preventable blindness is minimised.

Services we provide include specialist assessments, orientation and mobility training for adults and children, communication and adaptive technology instruction, guide dog services, talking book and braille library services, instruction in the techniques of daily living, and vocational services. We operate services specific to the needs of Māori and of Pacific communities. We provide advice and training on access and disability issues.

The Foundation welcomes this inquiry into Obesity and Type Two Diabetes in New Zealand and believes that it provides an opportunity to consider primary prevention opportunities, secondary screening to minimise the effects of type 2 diabetes as well as giving timely consideration to the likely impact of type 2 diabetes on the community including the Foundation and its members.  The Foundation is specifically concerned about the impact of blindness, deafblindness and vision-impairment.  Our submission is therefore limited to these effects, however we acknowledge the considerable personal and societal costs caused by obesity and type 2 diabetes and would wish to see these minimised by a range of primary prevention measures.

1.     The effect of type 2 diabetes with respect to blindness and vision-impairment

Currently, approximately two percent (246/11526) of the Royal New Zealand Foundation of the Blind membership has a diabetes related vision-loss or blindness.[1]   Our database information does not differentiate between type 1 and type 2 Diabetes. Australian data show that four percent of vision-impairment in the over 40 years of age is caused by diabetic retinopathy and ten percent of blindness in the over 40 year old age group is causally linked to diabetes. [2] 

Available Diabetes prevalence figures show that 12 percent of the total Maori population, 10 percent of Pacific peoples and 6 percent of other ethnic groups in New Zealand have Diabetes, and this is expected to increase.[3]  All diabetics are prone to developing eye complications, with over 60% of type 2 diabetics expected to have some degree of retinopathy after 20 years.[4] 

A simple calculation of the future prevalence of sight-threatening diabetic retinopathy based on New Zealand data prepared by Reda et al (2003) and 2021 Statistics New Zealand population projections for the population 40 years and older, but making no adjustment for increased rates of type 2 diabetes in the population, suggests that nearly 10,000 individuals may have sight-threatening diabetic retinopathy by 2021.  Of these, 819 could be expected to have proliferative diabetic retinopathy.[5]  This represents an increase of over 300 percent based on the Foundation’s current membership numbers of blind and vision-impaired caused by Type 2 Diabetes.  

While we appreciate that such calculations require sophisticated modelling beyond the scope of this organisation for the purposes of this submission, we wish to stress that, left unchecked, the burden of type 2 diabetes, in terms of the costs in vision-loss or –impairment alone, will be overwhelming.

Consequently, the Royal New Zealand Foundation of the Blind applauds the Health Committee for under-taking this inquiry into obesity and type 2 diabetes and makes the following recommendations to the Health Committee.

2.     Recommendations

 The Foundation makes three recommendations to the Health Committee.

2.1. The Foundation recommends that a range of primary prevention strategies are introduced with urgency to reduce the extent of type 2 diabetes in New Zealand

Design and quality of the built environment is of concern to the blind and vision-impaired community.  Enhancements that improve the environment for the vision-impaired have the potential to improve the safety of the environment for other users.  This can support increased levels of physical activity such as walking to school/work.  Consideration needs to be given to the sufficiency and adequacy of pedestrian crossings, clear walk-ways and lighting features that enhance safety for all users, including the blind and vision-impaired.

Effective and accessible public transport networks similarly improve the mobility of blind and vision-impaired individuals but also encourage other users to leave their cars and hence attempt at least some of their journey to school or work on foot.

Increased awareness of the complications of type 2 Diabetes, including blindness, need to be promoted to inform both primary and secondary prevention initiatives.  Previous efforts by the Foundation to attract Government funding for Pacific services for this purpose have been unsuccessful 

2.2. The Foundation recommends that screening for diabetic retinopathy be formalised as a tertiary prevention strategy

The Foundation recommends that a type 2 Diabetes control strategy, similar to the cancer control strategy be implemented and charged with reducing the incidence, morbidity and mortality associated with type 2 Diabetes.  One element of such a strategy would include increasing the uptake of screening for diabetic retinopathy to promote earlier interventions.

2.3. The Foundation recommends that planning for increased resourcing be undertaken to cover the rehabilitation and adaptive costs associated with diabetic retinopathy

The Foundation is a national organisation that provides a range of services to the blind and vision-impaired on a regional basis.  Some of these services are funded through Vote: Health.  The current funding environment is already unsustainable for the Foundation due insufficient volumes being funded compared with demand and actual service delivery volumes; unsustainably low pay rates paid to professional staff employed by the Foundation by comparison with the state-sector led increased pay rates for DHB nursing staff, and; increasing numbers of members due to demographic trends.  Additional demands placed on the Foundation due to the anticipated impact of type 2 Diabetes will not be able to be met by the Foundation in the absence of increased total government funding. 

3. Conclusion

The Foundation applauds the Health Committee for undertaking this inquiry into obesity and type 2 Diabetes and expresses serious concern to the Committee regarding the likely effects of type 2 Diabetes if significant steps are not taken through primary, secondary and tertiary prevention initiatives.  In particular, the Foundation asks the Committee to note that, given the funding pressures already experienced by the Foundation, the Foundation will not be able to cope with the additional pressures caused by the down-stream effects of type 2 Diabetes in terms of rehabilitation and adaptive services to the blind and vision-impaired.

The Foundation requests that its recommendations are considered and that the findings of the Committee be conveyed to the Foundation.

Paula Daye
Chief Executive

[1] Royal New Zealand Foundation of the Blind. 2005. Annual Report 2004-2005. pg.30.

[2] Eye Research Australia. August 2004. Clear Insight: The Economic Impact and Cost of Vision Loss in Australia. pp. 34-5.

[3] Reda E et al. 2003. Screening for diabetic retinopathy using the mobile retinal camera: the Waikato experience. NZMJ 116(1180). Pg 2,5.

[4] Ibid.pg 2.

[5] These figures are calculated using the following figures and assumptions:

• the population totals projected to 2021 (base 2001) by ethnicity produced by Statistics New Zealand and including only adults aged 40 years and older only.  This age grouping is selected as the effects of type 2 diabetes are described for the period 20 years following onset
• the prevalence of diabetes amongst the population of 12% Maori, 10% Pacific and 6% others 
• the prevalence of  sight-threatening retinopathy amongst the diabetic population of 3.1% (5080) observed in Waikato DHB by Reda et al and 6.0% (9833) cited in their paper . (Higher prevalence figures were also cited in their paper.)
• the prevalence of 0.5% in type 2 Diabetics of proliferative diabetic retinopathy.