Once considered as a disease of the rich, diabetes is now sweeping the whole world with 80% of diabetics living in developing countries.

The costly and prolonged treatment of diabetes raises the equity problem between and within countries. Diabetes care goes beyond simply injecting insulin or swallowing oral tablets. The treatment of diabetes assumes availability, accessibility and affordability not only of/to insulin or oral tablets but also of/to all means of blood control (glycemic monitoring, urine tests, biological analyses, healthy diet, etc.). Besides the need for efficient health systems, good control of diabetes depends on other social determinants of health such as education and income. Consequently, there is a requirement of good participation from individuals and communities in order to support and complement medical treatments suggested by doctors and qualified medical staff.

In this paper, we consider prevention and care of diabetes as an example of health promotion in developing countries.

Health promotion was considered in eight Global WHO Conferences (Ottawa Charter, 1986; Adelaide Statement, Australia, 1988; Sundsvall, Sweden, 1991; Jakarta, 1997; Mexico City, 2000; Bangkok, 2005; Nairobi Call for Action, 2009 and Helsinki, 2013).

All the conferences followed and tried to implement the five action areas for health promotion defined in the Ottawa Charter, namely:

– building healthy public policy;

– creating supportive environments;

– strengthening community action;

– developing personal skills;

– re-orienting health care services toward prevention of illness and promotion of health.

Unfortunately, thirty years after the launch of Ottawa Charter, very few developing countries have implemented the charter actions in terms of diabetes care.

Struggling to get the minimal subsistence in terms of insulin and oral drugs, poor, rural and non-educated people with diabetes can neither afford the (out-of-pocket) cost of a regular blood control neither the access to a healthy diet. More generally, all people with diabetes are in need of personal skills especially with the help of community.

Last but not least and more than ever, developing countries must re-orient health care services toward prevention of illness and promotion of health by acting on risk factors like obesity, lack of physical exercise, smoking, alcohol, etc.