Why is Urban India grappling with the epidemic of diabetes?

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Tahira Noor Khan and Rajat Mishra-


Urban poor and children from well-to-do background are in the clutch of diabetes like never before

While India is one of the fastest growing economies in the world, its urban population does not reflect prosperity in health. Global Burden of Disease (GBD) puts India healthcare at 154 position out of 195 nations. One of the many reasons for this poor performance is diabetes. The disease has witnessed a phenomenal growth in recent years. GBD shows 11.9 million people suffered from diabetes in 1980 in India, which has risen to a staggering 64.5 million in 2014.

Although diabetes is the sixth leading cause of deaths per year worldwide, it also acts like a catalyst for conditions like stroke, kidney failure, heart attacks etc.– the other leading causes of fatalities.

The rise in diabetes is uneven between the rich and the poor in the metropolitans of India. According to a study published in the Lancet in 2015, diabetes is growing more rapidly among the urban poor in India in comparison to the rich. Various socioeconomic and educational factors are responsible for this phenomenon, which dangerously affects the already disadvantaged group.

Dr Anoop Misra, Chairman of Fortis C-DOC Centre of Excellence for Diabetes, says, “Urban poor are often unaware of what diet and food articles are best for their lifestyle; hence, the diet of these populations is often unhealthy.”

According to Dr Misra, the mental attitude of this section is also a problem. They have a “fatalistic attitude” and hold God responsible for whatever happens to them, not giving healthcare and treatment its due importance.

The other dangerous trend on assent is the humongous rise in the number of children contracting diabetes. It unlike in the case of ‘urban poor’, is observed more often in children who can afford private schools, i.e., kids who come from a well-to-do-background.

Sedentary lifestyle, junk food, lack of physical activity are its major causes. The single most important cause for this is obesity, Misra says. “One hundred per cent of children who develop type-2 diabetes are obese, often severely.”

Dr Misra stresses on the importance of awareness among teachers and parents to tackle this problem, giving a commonplace example of how ‘obese’ kids are called ‘healthy’ in the Indian society-thus completely ignoring the signs of malady.

Survey by Delhi Diabetes Research Centre shows nearly 44 per cent children drink at least one aerated drink daily and the preference for fast food seemed to grow with age, with the figures rising from 11 per cent in class III to 66 per cent in class V.

One of the major reasons for the rise in the preference of junk food among kids is the role played by media which has ubiquitous amount of advertisements glorifying the unhealthy food.

Dr Deepika Dabke, a psychologist and an Associate Dean of IBS Mumbai notes, that in India, celebrities are not less than gods and goddesses. There endorsements thus hugely impact the preferences.

Virat Kohli, the captain of the Indian cricket team, however, manifested an exemplar behaviour when he refused to renew his contract with PepsiCo asserting he cannot endorse a thing that he himself doesn’t use.

A nation wide awareness campaign is required to fight diabetes, Dr Misra pleads. “There should be a strong political will to start a movement against diabetes (like for ‘pulse polio’) by striking at multiple levels; increase exercise in schools, and more accent on healthy diets in school cafeteria; more playing grounds and bicycle paths; strong taxation on unhealthy oils and sugars; strong movement at primary care to screen for diabetes and health education.”

Everything is not bleak

Many studies suggest diabetes can be kept under control by following a proper diet, exercising and regular visits to the doctor. There is much higher optimism for people with prediabetes, a condition when the blood sugar level of a person is at the borderline and is often observed before the onset of diabetes.

“There is a great opportunity here. Those with prediabetes could revert to normal. But this should happen quickly; within the first six months of diagnosis of prediabetes. For reversion to normal, these individuals must lose 5-10% of their weight by intensive exercise and hypocaloric diets. Sometimes a drug called metformin is used to support this process of recovery,” says Dr Misra.

Diabetes sure is a menace to be fought, but it is not indefensible. Mexico is a case study in point. It  has a very high diabetes rate but Mexico implemented a tax on sugar-sweetened beverages (SSBs) in January 2014 and initiated various nationwide campaigns against junk food and towards healthier lifestyle. Plos medicine journal shows that the short-term impact of the tax has “substantially decrease morbidity and mortality from diabetes and cardiovascular diseases while reducing healthcare cost.” Further, Lancet estimates that this step would prevent nearly 190,000 new cases of diabetes over 10 years, at an average saving  $983 million (roughly 67396 million rupees) in related health-care costs.

So, as a  nation, if we give health the priority it deserves then surely we can keep the rise in diabetes at bay.


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