The lazy killer

PublishedApr 7, 2016, 2:16 am IST

UpdatedApr 7, 2016, 2:16 am IST

Diabetes kills more people around the world every year than terrorism.

 Diabetes is a silent killer, while terrorism is a loud one. (Representational image)

Do you have diabetes? You better find out. You live in the world’s diabetes hotspot. And if you live in a city, have a sedentary lifestyle and an unhealthy diet — especially lots of fried food and sugary drinks — you really better find out, fast. Not only should you find out for your own sake and act now, even the Prime Minister wants you to defeat diabetes. During his Mann ki Baat radio session last month, Narendra Modi spoke about diabetes. He said working to prevent, detect and treat diabetes is critical to the country’s development and asked fellow Indians to adopt a healthy lifestyle to beat the disease: “Please defeat diabetes this time. India was home to around 6.5 crore diabetics in 2014. The disease brings many other problems with it and it was responsible for more than three per cent deaths in our country.”

It was a timely reference. Beating diabetes is the theme of this year’s World Health Day, April 7. But let us be honest. Healthy lifestyle sounds like a great idea, everyone nods wisely, but far too many of us do not follow it. Many do not even quite understand what it means. Not everyone has the same ideas of how one goes about adopting a healthy lifestyle. If his radio address is any indicator, Mr Modi’s idea of a healthy lifestyle to beat diabetes is lots of yoga and exercise. That takes care of part of the problem. But why leave out unhealthy diet? Aren’t fizzy drinks, fast food, sugary snacks and so on equally responsible for diabetes and a host of other lifestyle related ailments?

Given the alarming rise in the prevalence of diabetes and other lifestyle diseases in this country, why doesn’t the political class talk more about Indians’ eating habits. Perspective. Diabetes kills more people around the world every year than terrorism. Diabetes and related symptoms kill more than three million people each year. According to the Economist, terrorist attacks claimed 32,700 lives last year. So why is this not big news? The only explanation — diabetes is a silent killer while terrorism is a loud one.

Terrorism leaves behind powerful images. It is hard to forget the terrifying pictures of the 2008 terror attacks in Mumbai — the billowing plumes of smoke from the top of the landmark Taj Hotel, the injured security men at Chhatrapati Shivaji Terminal railway station. And there have been so many more, before and after. Most Americans don’t just remember where they were on September 11, 2001, they remember the feel of being frightened. The anger, the memories linger. But diabetes? There are masses of statistics. Everyone knows someone who suffers from complications arising from diabetes. But chances are that it still comes across as a distant threat, not a killer.

To change your mind, consider these:

India has some 6.5 crore diabetics, as Mr Modi pointed out. This is second only to China. Most diabetes cases in our country are of Type 2. According to the World Health Organisation, in India 75,900 men and 51,700 women between 30 and 69 years died of diabetes last year. This may not seem to be a massive number in a country of 131 crore, but the real worry, as health professionals point out, is that a very large number of those with diabetes don’t even know that they have it. Even when they know it, far too often they do not take it seriously. Diabetes can lead to lots of complications, before death. It may cause blindness, kidney failure, loss of limbs...

Diabetes also digs a massive hole in one’s pocket due to the huge cost of treatment as well as reduced ability to work once the disease has advanced. Projections suggest that over 10 crore Indians between 20 and 79 years will be living with diabetes by 2030. The economic impact of this will be devastating, especially in a country where most people have to pay for their own medical treatment. According to the health ministry, out-of-pocket health expenses due to just lifestyle diseases, including diabetes, by individual households shot up from 31.6 per cent in 1995-96 to 47.3 per cent in 2004. Over half of what people spend out of their pockets goes on diagnostic tests, medicines and buying medical appliances. This can fell families.

Can we do something about this?

The good news is that we can. We know why there are more cases of diabetes and other lifestyle diseases than before — rapid urbanisation, sedentary lifestyle, unhealthy diet, and last but not the least, the very fact that we are living longer than before. Sedentary lifestyle and unhealthy diet are preventable at the individual level. Such prevention will also keep heart diseases — the other big killer — in check. At the policy level, urban planners have to take such lifestyle diseases into account and provide facilities for exercise.

Regular and adequate physical exercise is critical to arresting the spread of diabetes and other lifestyle diseases. Equally important is tackling unhealthy diet. But behaviour does not change easily. It changes only after sustained public awareness campaigns and a supportive policy environment. What we are seeing is the opposite. Since 1998, the consumption of sugary beverages has been increasing by 13 per cent every year. There is an urgent need to do something about this. A January 2014 study said that given the current sales of sugar-sweetened drinks in India, a 20 per cent increase in taxes will reduce diabetes by 1.6 per cent (4 lakh) between 2014 and 2023.

Why do we not seriously consider introducing additional taxes on sugar-laden drinks, alongside encouraging more physical activity? Without public awareness, a sin tax will not change things dramatically, but it will help. Diabetes can derail India’s emerging economy. It is not someone else’s problem; it is ours. We have to check its spread among the young generation. Health ministry officials are happy to share their laundry list of things that need to be done to beat diabetes and other lifestyle diseases. These include subsidy for healthy foods, steep prices of unhealthy food, control of salt and sugar content in processed foods, with labels indicating contents, replacement of trans-fats and saturated fats with polyunsaturated fats, provision of facilities and promotion of physical activity especially for the young, a firm policy for tobacco and alcohol, controlling air pollution and public awareness about healthy lifestyle.

It is a do-able list. But will it be done? What is the cost of ignoring the threat of diabetes and other lifestyle diseases? Quoting a 2013 Harvard study, the health ministry puts the cumulative economic cost associated with heart diseases, diabetes, chronic respiratory diseases and mental health between 2012 and 2030 at a mind-boggling Rs 38,302,200 crore at the 2010 value of the rupee. If that’s not a killer, what is?

The writer focuses on development issues in India and emerging economies. She can be reached at patralekha.chatterjee@gmail.com

 India sees alarming rise in diabetic population

DECCAN CHRONICLE. | TEENA THACKER

PublishedApr 7, 2016, 9:05 am IST

UpdatedApr 7, 2016, 2:28 pm IST

Moreover, the prevalence of diabetes has more than doubled for men in India and China.

 Keeping in view the dramatic rise in the number of diabetic cases, experts say that the probability of meeting the UN global target of 2025 is “virtually non-existent”. (Photo: AFP)

China, India and USA are among the top three countries with a high diabetic population. According to the recent Lancet study, the numbers climbed from 20.4 million in China in 1980 to 102.9 million in 2014 and in India from 11.9 million in 1980 to 64.5 million.

Ironically, the prevalence of diabetes has more than doubled for men in India and China (3.7 per cent to 9.1 per cent in India and 3.5 per cent to 9.9 per cent in China). It has also increased by 50 per cent among women in China (5.0 per cent to 7.6 per cent) and 80 per cent among women in India (4.6 per cent to 8.3 per cent). Worryingly, no other country saw a significant decrease in diabetes prevalence, claims the Lancet.

Ahead of World Health Day (April 7), the Lancet study disclosed that there has been a fourfold rise in the number of diabetics – from 108 million in 1980 to 422 million in 2014 with half of them living in India, China, USA, Brazil and Indonesia. The fastest increase has been seen in low and middle income countries. The prevalence of overweight people too jumped in China to 35.4 per cent and 21.4 in India. As per the data 7.3 per cent people in China are obese and 4.7 in India.

Keeping in view the dramatic rise in the number of cases, experts say that the probability of meeting the UN global target of 2025 is “virtually non-existent”. “Rates of diabetes are rising quickly in China, India, and many other low and middle income countries, and if current trends continue, the probability of meeting the 2025 UN global target is virtually non-existent,” said Professor Majid Ezzati, senior author from Imperial College London, London, UK.

The study includes data from 751 studies totalling 4.4 million adults in different world regions. According to the study, between 1980 and 2014, diabetes has become more common among men than women. In fact, the global age-adjusted prevalence of diabetes doubled among men (4.3% to 9.0%) and increased by two-thirds among women (5.0% to 7.9%).

Although there was an increase in overall rates (crude prevalence) of diabetes in many countries in Western Europe, age-adjusted rates were relatively stable suggesting that most of the rise in diabetes in Western Europe between 1980 and 2014 was due to the ageing population. In contrast, rates of diabetes increased significantly in many low and middle income countries – including China, India, Indonesia, Pakistan, Egypt and Mexico.

The study did not differentiate between type 1 and type 2 diabetes, but most (85-95%) of cases of adult diabetes are type 2 so the observed rise is likely to be due to increases in type 2 diabetes.

Major takeaways from the Lancet study:

*Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia. In the US, age-adjusted prevalence of diabetes in women increased by 50% (4.3% to 6.4%), and 80% in men (4.7% to 8.2%).

*In the UK, 4.9% of women had diabetes in 2014 (compared to 4.0% in 1980). Prevalence has increased more among men, from 4.8% in 1980 to 6.6% in 2014.

*Northwestern Europe has the lowest rates of diabetes among women and men, with age-adjusted prevalence lower than 4% among women and at 5-6% among men in Switzerland, Austria, Denmark, Belgium and the Netherlands.  Prevalence of diabetes was highest in Polynesia and Micronesia (age-adjusted prevalence is over 20% in men and women). In American Samoa, nearly one third of the adult population have diabetes.

*The greatest increases in diabetes prevalence were in Pacific island nations, followed by the Middle East and North Africa, in countries like Egypt, Jordan and Saudi Arabia.

*Pakistan, Mexico, Egypt and Indonesia are all now in the top 10 countries with the largest number of adults with diabetes. Age-adjusted prevalence of diabetes doubled in Pakistan (4.9 to 12.6% for men and 5.9 to 12.1% for women), Mexico (6.5 to 10.9% for men and 6.5 to11.5% for women), and Indonesia (3.2 to 7.4% for men and 4.1 to 8.0% for women) and nearly tripled in Egypt (6.5 to 16.0% for men and 8.0% to 19.8% for women).