New figures show diabetes causes more than 1000 amputations every year in New Zealand, and a raft of other health problems including blindness, kidney failure and death.
In an exclusive interview, Associate Health Minister Peeni Henare says measures like a sugar tax should be considered to drive up the cost of junk food and drink, along with warning labels.
Growing up, speakers on Henare's Northland marae would lose legs to diabetes, and tell him and other children tall tales about shark bites or other events.
"It was something that wasn't discussed. But you knew it was there. I know these people, I know them well, I'm related to them," he says of the disease's silent and growing toll.
Sugar taxes and warning labels should be considered to "turn the tide" on a diabetes disaster now causing more than 1000 amputations every year, the Associate Health Minister says.
In a wide-ranging interview with the Herald, Peeni Henare, also MP for Tāmaki Makaurau, spoke of how diabetes had cost his own relative's limb and health. He also:
• Revealed talks with Pharmac about funding better drugs to treat and prevent diabetes and related illness. Drugs currently available are among the worst in the developed world.
• Said he wants to use his role as Minister responsible for the Health Promotion Agency to suggest a major campaign around the threat of diabetes, similar to past efforts on drink-driving and smoking.
Henare met the Herald before touring Middlemore Hospital dialysis wards, and after the Ministry of Health confirmed diabetes-related amputations hit a record 1067 in 2018, a 22 per cent surge over five years.
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"The smoking cessation campaign had blunt tools and it had sharp tools in its arsenal that really made a significant difference. And I'm seriously of the opinion that that's what it's going to take for diabetes," he said.
"I've been approached by people who want to talk about a tax on sugar and fizzy drinks and those things. Those are all parts of the consideration that we have got to have."
Asked if he would like measures such as warnings on packaging and price increases extended to sugary drinks and unhealthy foods, the Associate Health Minister said he would - and he'd lobby Health Minister David Clark and others on the issue.
"It is something I'd like to see. I'm a parent [with] young kids. As much as we try and encourage them to live healthy lives they are exposed to these things all the time... those are, I think, tools that should be considered."
In a statement, Clark said Henare's position "shouldn't come as any surprise", and his concerns were "shared across the Government".
Clark said the Government was working with the food industry itself in the first instance, to reduce sugar levels in processed food and drink. A new food labelling system is also being developed.
Katherine Rich, chief executive of the NZ Food & Grocery Council, said taxes to artificially raise the price of energy-dense foods hadn't worked anywhere in the world.
"For example, sales data shows that in Mexico, where a 20 per cent tax was introduced in 2014, consumption of sugary drinks initially dropped by a small amount, but within a year it had climbed back to pre-tax levels.
"Extra taxes on treats such as chocolate or other high-calorie foods... will make New Zealanders artificially poorer as they try to feed their families, but is the wrong sort of policy to try and nudge people towards a healthier diet."
The council and its members were working with the Government on a raft of measures, Rich said, including making thousands of products healthier, school and community healthy eating initiatives and furthering the health star rating system.
Henare, whose Associate Health portfolio includes responsibility for diabetes, attended a crisis summit of clinicians and health bosses in South Auckland in July, where analysis of 25 years of medical data was presented as showing the fight against diabetes had gone backwards in crucial areas.
Counties Manukau DHB chief executive Margie Apa told the meeting her organisation might be called "diabetes district health board", because of the "astounding" numbers of diabetics (46,000) within South Auckland.
"It is such a part of our lives we are almost desensitised to it," Apa told the gathering, saying "all the tools in the tool-box" were needed, including regulation and legislation.
A Herald investigation into diabetic amputations has found diabetes' rapid advance is already overwhelming health defences. However, some DHBs have stopped hundreds of amputations, including at Counties Manukau, where podiatrists regularly work on dialysis patients.
Henare said he was committed to "turning the tide": "It's affecting my people. Not just in the electorate, I mean Māori people, Pacific people."
Growing up, speakers on Henare's marae in Northland would be missing a limb, and tell him and other children tall tales about shark bites or other events.
"It was something that wasn't discussed. But you knew it was there. I know these people, I know them well, I'm related to them. Having seen the impact on them as individuals and their families... it was huge."
Dr Brandon Orr-Walker, clinical head of endocrinology and diabetes at Counties Manukau DHB, said more action was needed, including better publicly-funded diabetes drugs.
"As a clinician, there is something wrong if we aren't using things that are the best treatment to prevent something like end-stage renal failure. Then, we are happy to offer world-class dialysis when you hit the bottom of the cliff."
Why amputations happen
Nearly a quarter of a million Kiwis have diabetes, and another 100,000 are thought to be undiagnosed. About 90 per cent have type 2, the sort mostly brought on by lifestyle and linked to obesity.
If the disease isn't controlled over the long term, too much glucose in the blood ravages nerves, organs and tissue, risking heart attack, stroke, kidney failure and blindness.
Skin turns brittle. Pain, the body's warning system, is silenced as nerves are damaged, first in the feet. Injuries go unnoticed. Walking on hot sand or concrete, putting feet too close to a heater, getting a blister from gumboots while gardening - all can be a first, unfeeling step towards amputation.
Poor blood flow delivers fewer infection-fighting cells. Amputation is a last resort to stop infection spreading.
Trauma concentrates in poorer communities, and men are almost 40 per cent more likely to lose a leg to diabetes than women. Dr Orr-Walker said that was partly due to not being as careful or proactive about their health.
"It's an issue across many areas of health including heart disease. Men are also often in more risky environments for their feet and tend to take a bit of latitude there - the old jandals when they need work boots, and so forth."
Henare said a poor attitude to looking after yourself had been a problem for his own father, Erima Henare, who was head of the Māori Language Commission and died in 2015.
"That's probably one of the big challenges - how do we get more men engaged in making sure they are healthier and look after themselves better? I think of my dad - survives bowel cancer, found late because he didn't do anything about it, and ended up dying of a heart attack because he did nothing about it. And there's a man who worked in the health sector."