Thailand and Denmark collaborate to transform diabetes management

The event, following a visit by a Thai health delegation to Denmark from November 19-21, 2024, brought together key stakeholders to explore innovative strategies for diabetes management and public health transformation with eleven Thai government officials embarked on this journey with a clear mission: to explore cutting-edge diabetes management strategies, innovative health reimbursement models, and the potential of public-private partnerships in healthcare.

The visit represented an interesting opportunity to address one of the most pressing health challenges facing Thailand today: the escalating diabetes epidemic. Current global projections are alarming, with diabetes cases expected to surge from 500 million in 2021 to an estimated 1.27 billion by 2050. For Thailand, the situation is also urgent. Over 6.5 million Thais—nearly one-tenth of the population—are currently living with diabetes, with a staggering 40% of type 2 diabetes cases remaining undiagnosed.

The delegation was particularly intrigued by Denmark's innovative reimbursement system, which embodies an inspiration for healthcare. The system is designed with three critical objectives: ensuring patients do not forgo necessary pharmacological treatments due to economic constraints, ensuring appropriate use of public healthcare expenses, and encouraging rational use of medicinal products.

The delegation included Dr Krisada Hanbunjerd, Director of the Division of Non-Communicable Diseases at the Department of Disease Control, and Assoc Prof (Adjunct) Sathit Niramitmahapanya, Director of the Institute of Medical Research and Technology Assessment, Department of Medical Services from the Ministry of Public Health, with prominent healthcare professionals who brought diverse perspectives to the discussions; Prof Emeritus Dr Wannee Nitiyanant, President of the Diabetes Association of Thailand and Assoc Prof Dr Petch Rawdaree, President of the Association of Thai NCD Alliance contributed critical insights into the challenges and opportunities for transforming healthcare strategies and highlighted the importance of constantly raising awareness, stressing that continuous public education and community engagement are fundamental to transforming health outcomes.

Dr Sunthorn Sunthornchart, MD, Deputy Permanent Secretary of the Bangkok Metropolitan Administration (BMA) provided local insight, revealing that childhood obesity rates are increasing, with 13.21% of school-aged children (6-14 years) now classified as overweight or obese, which required the urgent need to address metabolic health risks from an early age. The disconnect between health institutions and educational systems was particularly noted by Dr Suthee Saritsiri, MD, director of the 67th Public Health Center, BMA who emphasized the lack of health literacy and screening among young people.

Central to the discussions was the comprehensive approach to community health, recognizing that addressing diabetes requires a multifaceted strategy that extends far beyond traditional medical interventions. The delegation identified four critical areas of focus: community engagement, early health education, urban design for active lifestyles, and strategic public-private partnerships.

Community involvement emerged as a fundamental pillar in the fight against diabetes. The discussions emphasized the critical role of both healthy and at-risk populations in creating a supportive healthcare ecosystem. This approach recognizes that community support is essential in managing and preventing chronic metabolic diseases, requiring a holistic strategy that encompasses prevention, education, and ongoing care.

Education was identified as a crucial starting point, with particular emphasis on early intervention through schools. The delegation highlighted the challenging landscape of children's nutrition in Thailand, where high-sodium, high-fat, and high-sugar foods dominate dietary patterns. Fast food preferences and a disconnect between health and educational institutions pose significant obstacles to promoting healthy lifestyles.

Urban design emerged as another critical intervention point. The delegation explored how city infrastructures could be reimagined to encourage more active lifestyles, drawing inspiration from Danish urban planning strategies that seamlessly integrate physical activity into daily life. This approach recognizes that environmental design plays a crucial role in promoting health and preventing chronic diseases.

The Danish healthcare model presented a remarkable blueprint for innovative health management. Renowned for its digital leadership, Denmark boasts 2.9 million unique visitors to digital health platforms in 2023, with 78% of citizens expressing confidence in digital health solutions. The philosophy of "staying at home" - maximizing community-based and preventative healthcare - resonated deeply with the Thai delegation, aligning closely with Thailand's 30-baht healthcare policy aimed at universal healthcare accessibility.

A standout feature of the Danish approach was its innovative reimbursement system, designed with three fundamental objectives: ensuring patients can access necessary treatments without economic barriers, optimizing public healthcare expenditure, and promoting rational use of medical resources. The Steno Diabetes Center Copenhagen (SDCC) exemplified this approach with its visionary "Individualized digitally assisted need-based clinic" concept, emphasizing digital-first interactions and on-demand consultations.

The "Steno Detektor" remote monitoring system particularly impressed the delegation. This innovative platform allows patients to upload data from various devices, creating a comprehensive digital health ecosystem that enables more personalized and proactive care. Similarly, Denmark's "Health Bus" initiative - a mobile screening unit for detecting undiagnosed type 2 diabetes - presented an innovative approach to early detection that could be transformative for populations with limited healthcare access.

Technology and data management emerged as crucial components of the Danish healthcare model. The Danish Health Data Authority's approach, particularly the "MyLog" system, offers a fundamental model of transparency, allowing patients to track which healthcare professionals access their health records. This level of patient empowerment and data control represents a potential paradigm shift for healthcare systems worldwide.

Public-private partnerships were consistently highlighted as a key strategy for preventive healthcare. Mr Enrico Cañal Bruland, General Manager of Novo Nordisk Pharma (Thailand) Ltd. emphasized the need for a comprehensive approach that engages multiple sectors - healthcare providers, educators, families, economic planners, urban designers, and community leaders. This holistic perspective recognizes that addressing complex health challenges requires breaking down traditional institutional silos.

The event brought together an impressive array of expertise from various Thai institutions. While Dr Jadej Thammatacharee, Secretary General of the National Health Security Office (NHSO), who participated in the November Denmark visit, was unable to attend the embassy event, his office was well-represented by Dr Nithiwat Saengruang, Assistant Secretary General of NHSO, and Sarit Boonchu, a specialist in Planning and Budgeting from NHSO. The Comptroller General's Department made significant contributions through Ms Wilawan Payanoi, Advisor of Fiscal and Financial System Development, Sittichai Ngamkiatkajorn, Director of the Medical Benefits Division, and Rachata Unsuk, Director of Medical Benefits Legal Affairs Subdivision. Prof Dr Paweena Susantitaphong from Chulalongkorn University's Faculty of Medicine provided valuable academic and research perspectives, while Mr Ole Lindholm, Commercial Counsellor from the Royal Danish Embassy in Bangkok, played a crucial role in facilitating the international healthcare dialogue between Thailand and Denmark.

As the session concluded, a shared commitment to continued collaboration was evident. The participants recognized that addressing complex health challenges requires an integrated, multifaceted approach that brings together government agencies, healthcare providers, patient associations, and forward-thinking private sector partners.

This Danish-Thai healthcare collaboration represents more than a diplomatic exchange—it offers hope for improved health outcomes and enhanced quality of life for millions. By sharing knowledge, exploring innovative strategies, and fostering a spirit of international cooperation, both nations are taking significant steps towards a healthier, more sustainable future.