The debate over the causes is complex and encompasses areas of personal responsibility over health (e.g. “no one forces people to over-eat”) as well as societal or governmental responsibilities for deleterious changes to our living environment. It is clear that people do need to accept greater responsibility for their wellbeing but at the same time whole-of-government action is needed to create the conditions for a healthy living environment.

Governments have been slow to recognize that chronic diseases are better prevented rather than treated. The failure of the World Health Assembly Resolution on ‘Diabetes’ and on ‘Diet, Physical Activity and Health’, and of the World Health Report on ‘Preventing Chronic Diseases: a vital investment’ to stem the diabetes epidemic has led to the realization that the diabetes world must participate in the debate, take a leadership role, and be part of the solution and not simply accept the present unsatisfactory situation which exists. For the first time, there are now evidence-based cost-effective strategies to reduce or prevent diabetes complications and evidence that much of type 2 diabetes can be prevented. Public health strategies to improve nutrition, prevent overweight and obesity, increase physical activity and reduce smoking can prevent not only diabetes but many of the chronic diseases.