The lazy killer

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