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Half Lives

Debilitating diabetes is spreading fast among the poor.

A disease that mainly affected the rich has now afflicted the poor in India. This is the disturbing finding of a major study conducted by the Indian Council of Medical Research (ICMR). Until some years ago, Diabetes Mellitus was considered to be a lifestyle disease that mainly afflicted the socio-economically better off sections of society. The “epidemic” sweeping large swathes of Asia was assumed to target consumers of high-fat and sugary foods, the overweight and the sedentary. However, recent studies have found that the urban poor both in the developed and the developing world are increasingly becoming diabetic. Termed the diabetes capital of the world, India too is going the same way. The largest national study conducted by the ICMR and the Ministry of Health and Family Welfare has found that in the urban areas of the more economically advanced states, diabetes is higher among people from lower socio-economic status than those from the upper strata. However, in all the states, in the rural areas the disease was seen among those of a higher socio-economic status. The findings imply that overall the disease is spreading to sections that were hitherto considered unaffected or less affected—poorer urban dwellers and better off rural dwellers.

This is a cause for not just concern but even alarm. Diabetes is a “high maintenance” disease that leads to severe damage to the heart, kidneys and eyes apart from risk of gangrene if mismanaged. Given the state of the public health system in the country, and the fact that the poor have to pay for healthcare, the findings must be treated as a distress signal on an urgent basis. According to the ICMR study, while the overall prevalence of diabetes in all 15 states was 7.3%, it varied from 4.3% in Bihar to 10.0% in Punjab. With a sample size of nearly 60,000, the study noted that since 70% of the population lives in rural areas, even a small increase in percentage adds up to a large number of people who need sustained medical attention but have access to poor health services.

In seven affluent states, including Chandigarh, Maharashtra and Tamil Nadu, the prevalence was higher in those from the lower socio-economic strata in urban areas. This finding could relate to greater awareness about the disease in urban areas among the economically better off and their ability to spend more on managing the disease.

Nutritionists have pointed to the greater availability of “junk food” at affordable prices in cities as a possible cause of a high-fat diet among those of a lower socio-economic strata but there are other factors that must be considered. For many poorer people in cities, nutritionally well-balanced food may not be within their means. Eating “junk food” is thus not a matter of choice or taste as much as affordability. Similarly, the study points to factors like higherincome levels, less physically demanding occupations and increased availability of mechanised transport and household appliances among urban dwellers to possibly explain the higher incidence of the disease in urban areas. The pressure of commuting long distances to work and the need to use the public transport system is also not a matter of choice in cities. These issues lead to the build-up of stress—another factor that is among the causes of the disease.

The onset of Type 2 diabetes among South Asians occurs at a much younger age as compared to other populations, thus straining the healthcare services. The study also points to another known fact: Asian Indians progress faster through the pre-diabetes stage than those of other ethnic groups. Also, as in other countries where diabetes is spreading rapidly, in India too, recreational physical activity is very low, more so, among women from all sections.

This study backs with data what has been surmised and found in earlier but smaller studies. For instance, the National Programme for Control and Prevention of Cancer, Diabetes, Cardiovascular Disease and Strokes has been active since 2010. But the ICMRfindings call for urgent short- and long-term interventions. The government, non-governmental organisations (NGOs), the medicalcommunity and diabetics will have to join hands to ensure that community involvement is encouraged. Starting with the availability of nutritious food and facilities for physical recreational activities, a sustained campaign to spread awareness of the disease is needed. These in turn call for more long-term policy interventions that go beyond packaging and advertising of fast food.

Infectious diseases remain the largest concern in developing countries. However, non-communicable diseases like diabetes (known appropriately as the silent killer) are spreading at a frightening rate. Before the discovery of insulin in 1921, having diabetes meant a sentence of death and after it, until some decades ago, a 50% chance of survival. In the 21st century, if we are not to sentence large sections of the population to a half-life, we must act quickly and in concert.

Updated On : 16th Jun, 2017

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