The St Vincent Declaration origins and perspectives. The notion that diabetes both Types 1 and 2 -was a major public health concern with important environmental, nutritional and behavioural contributions to aetiology and requiring social action, large, complex support systems and public awareness campaigns, was ยฎrst substantially expressed by the Expert Committee on Diabetes convened by the World Health Organisation (WHO) in the late 1970s. Its 1980 Report 1 recognised that diabetes affected populations all over the world, dispelling the myth that the disorder was the penalty of afยฏuence' and mainly a problem for wealthy countries. It gave clear notice that diabetes was not just a matter for health professionals but was an important issue for government concern, particularly involving national health departments. It gave prominence to the social and economic setting of diabetes and its complications and emphasized the central importance of empowering people with diabetes themselves to participate fully in their own care. It recommended the new, standardised diagnostic criteria for the disease, now internationally applied in modiยฎed form. The Expert Committee left WHO, with its challenging call for Health for All by the Year 2000', in no doubt that, with diabetes, it had an immense and growing problem on its hands.
WHO recognition that the size and nature of the diabetes problem varies enormously from one part of the globe to another and, hence, demands regional, national and local strategies for its solution, was embodied in the ยฎrst Recommendation of the 1985 WHO Study Group 2 , convened to review progress and update the 1980 Report. It stated: Health system planning for, and research into, diabetes must be adaptable to the wide variation in social, economic and medical conditions and structures. Community-based primary health care schemes should be linked to specialized levels to optimise the quality of care, depending on the requirements of the patient and the availability of resources....' Further recommendations included research into epidemiology and prevention.... appropriate for local conditions', programmes of systematic education for people with diabetes, vigorous campaigns to correct the known risk factors for arterial disease in diabetes and, most tellingly, a new call for active collaboration between WHO and the International Diabetes Federation (IDF) at regional level, giving substance to another wellworn but perceptive WHO slogan, `think globally, act locally'. Not entirely fortuitously, this last recommendation coincided with creation of formal regional structures of IDF, corresponding closely in number and location with the Regional Ofยฎces of WHO. It was in this new, European ยฎeld of diabetes activity, IDF Brussels and WHO Copenhagen, that the seed of the European St Vincent initiative was planted, germinated and grew.
Europe was ยฎrst off the mark with a regional diabetes programme. A 1987 letter from Professor Jak Jervell 3 as Chairman of the European Region of IDF proposed to Dr Jo Asvall, then European Regional Director of WHO in Copenhagen, that we should meet to discuss a joint diabetes strategy for Europe. The WHO Regional Ofยฎce, already interested in diabetes and supporting research into the evaluation of innovative technology and quality of patient care, responded warmly and positively. WHO's Dr Kirsten Staehr-Johansen readily picked up the challenge of a broadened commitment to diabetes and became a formidable driving force in the organisation of the St Vincent meeting and all that followed. It was soon agreed that a meeting should take place in the mountain township of St Vincent