Considered a rich man’s common disease, diabetes rarely makes headlines, despite its debilitating impact on public health and the economy at large. We must re-calibrate our priorities and begin the fight against this epidemic
The greatest threats to public health are far from shocking or contagious. They are familiar and common. Globally, non-communicable diseases such as cancer, hypertension and asthma account for 38 million deaths per year. Of these diseases, diabetes — a condition that results from excess bodyweight and physical inactivity — is expected to increase rapidly to become the world’s seventhlargest killer by 2030.
Though this seldom makes headlines, and is as confronting to our vanity as it is our health, the implications are alarming. By preventing and managing diabetes, we can, however, chart a different reality.
In the World Health Organisation South-East Asia Region, the stakes are particularly high. Here, diabetes, which can cause serious damage to every major organ system in the body, resulting in heart attacks, strokes, kidney disease and nerve damage, is a major public health issue.
More than one out of every four diabetes-related death globally occurs in this region, while its prevalence exacerbates difficulties in the control of major infectious diseases such as tuberculosis. Though Type 1 diabetes is thought to be caused by genetic or environmental factors, Type 2, or ‘adult-onset’ diabetes, is primarily the consequence of lifestyle factors. Type 2 diabetes accounts for 90 per cent of all cases.
The negative by-products of the region’s vast social and economic changes are culpable. Sedentary lifestyles coupled with sugary, salty and fatty diets that are rich in starchy carbohydrates — including those from white rice and refined flours — are driving the epidemic, which primarily affects those who are in their productive prime.
Rather than being a disease solely of the middle classes of high-income countries, as is often imagined, diabetes affects all classes and countries, leading to adverse economic consequences in the developing world. Diabetes not only affects a person’s ability to work, but also limits the economy by creating an unhealthy workforce while consuming limited health budget resources.
There are individual steps that we must all take. Eating healthy and avoiding sugary drinks is a good place to start, and can be done by taking simple measures such as avoiding fatty snacks that are rich in calories but offer little by way of nutrition, choosing beverages without sugar and opting for water instead of a fizzy drink.
Vegetables, fruits and foods, high in complex carbohydrates, provide the fibre and nutrients necessary for taxing work schedules, while water rather than fizzy drinks aids hydration and helps avoid unnecessary calories.
Controlling portion sizes is also important. This can be achieved by better understanding the needs of our bodies and the caloric density of the foods we eat, as well as revising how we should feel when we are ‘full’. Instead of portion-sizes that match the size of our plates, they should match our energy needs.
Committing to regular exercise is also necessary. Adults aged 18-64 should do 30 minutes of moderate-intensity aerobic activity at least five times a week. This does not have to be a regimented process. Swimming, hiking, playing football or dancing, for example, are all great for aerobic fitness, and are best enjoyed in the company of others. For those with children, family-based activities are an excellent way to get exercise and promote healthy habits in kids. Also, simple changes in habit, such as taking the stairs or walking to work, can help mitigate the risk of diabetes.
Still, preventing the disease requires much more than individual action: It requires society-wide awareness and behavioural change. Community groups, such as those managing school or office canteens, can facilitate positive decision-making by offering healthy meal options. Schools and workplaces can similarly promote exercise by factoring physical activity in to the workday and providing the resources to facilitate it. They may also organise social sporting competitions and events.
Governments, meanwhile, should work with consumer groups and the private sector to regulate the marketing of food to children and explore innovative partnerships for transmitting positive health messages. They must also insist on accurate food labeling to help consumers make informed decisions. A tax on sugary beverages may also be considered.
Of course, to some extent, diabetes will always afflict public health due to non-modifiable risk factors such as ageing and genetics. Here, rarly detection is vital to limiting impact. For those who already have diabetes, strict adherence to diet, exercise regimes and timely medication is essential. Governments must also increase access to healthcare and make treatment less costly. Diabetes can be managed successfully and does not have to lead to fatal complications.
(The writer is regional director of World Health Organisation South-East Asia Region)