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Diabetes: Curbing the epidemic on our hands
We have all gone through the phase of making life goals to work out more and eat healthily. But many of us have failed. Staying outdoors is out of the question as the air is severely polluted, sidewalks are crowded with vendors and using private vehicle is much more comfortable than sharing public transportation. All these things beyond our personal choice that directly — or indirectly — affect our population’s health are called social determinants of health.
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In this file photo dated March 23, World Health Organization Director-General Margaret Chan delivers her speech during a conference in Lyon, central France. Chan said Wednesday April 6, 2016, that excessive weight, aging and population growth have recently driven a huge increase in worldwide cases of diabetes and called for stepped-up measures to reduce risk factors as well as improve treatment and care. (AP/Francois Mori)
T
he world celebrates World Health Day on Thursday and the WHO has decided to put diabetes in the spotlight for this year’s theme. Diabetes, along with other non-communicable diseases (NCDs), is the leading cause of death in Southeast Asia, taking the lives of up to 8.5 million people each year, one-third of whom are under 70 years old, leading to productivity losses.
As a developing country, Indonesia is facing a double burden of diseases. We are still fighting infectious diseases, without realizing that NCDs have grown silently to become the top killer.
In 2014, approximately 71 percent of deaths were attributed to NCDs and 6 percent of the total were due to diabetes. Yet, most of the population is still not aware of the urgency of combatting this disease.
Researchers have identified modifiable risk factors to prevent diabetes, i.e. maintaining normal body weight, eating a healthy diet and engaging in adequate physical activity.
The 2014 Global Status Report on NCDs revealed that 84 percent of Indonesian adolescents were physically inactive. The percentage of the Indonesian population that is overweight steadily increased from 2010 to 2014, from 17.2 to 20.7 percent and 24.4 to 28.1 percent for men and women, respectively.
Obesity also showed an increasing trend over recent decades and obesity prevalence in women has roughly doubled compared to that of men (7.8 percent vs 3.6 percent). Statistics showed a similar pattern in all other countries, which is why halting the epidemic should be our overarching goal now.
How did we end up like this?
First and foremost, this happened because of a lack of education. People still strongly believe that diabetes is a genetic disease; hence they embrace the diagnosis as part of inevitable heritage from their ancestors. Yes, genetic abnormality comes into play in type 1 diabetes. And yes, genetic hereditary may contribute to predisposition for type 2 diabetes, but the disease itself develops throughout one’s lifespan due to multifactorial causes.
People are also unaware of the early symptoms of diabetes, which usually include constant fatigue, thirst and cravings.
When you have a family predisposition to diabetes, it is better to get regular checkups and to start paying attention to your lifestyle.
Second, it is because we live in what public health experts call an obesogenic environment — an environment that promotes gaining weight and one that is not conducive to weight loss. Jakarta is a perfect example.
We have all gone through the phase of making life goals to work out more and eat healthily. But many of us have failed. Staying outdoors is out of the question as the air is severely polluted, sidewalks are crowded with vendors and using private vehicle is much more comfortable than sharing public transportation.
All these things beyond our personal choice that directly — or indirectly — affect our population’s health are called social determinants of health.
Over time, governments have made tremendous efforts to create a less obesogenic environment for us. We have seen an amazing transformation in Bandung, as well as improvement in public transportation and investment in green spaces in Jakarta.
What can we do to curb the epidemic?
We can start with ourselves and families, with good intentions to live long and healthy lives.
New research in India shows that consumption of white rice is the main culprit of the high prevalence of diabetes in India and more generally Southeast Asia. Nutritionists recommend red or brown rice.
The WHO has also released new recommendations for daily sugar intake of a maximum of 25 grams (six teaspoons) and integrating more than 400 grams of vegetables and fruits daily into the diet.
It is always better to avoid processed foods as they usually contain high salt, high sugar and high fat. Physical activity should be at least 150 minutes per week of moderate intensity exercise.
Or there is always the choice of taking the stairs, campaigned a few months ago at the WHO headquarters as #WalkTheTalk #StepUp.
Although the social determinants of our health mostly rely on policymakers and governments, we have the power to put pressure on this matter and urge them to address the problem. Governments must understand that globalization and urbanization play major roles in shaping our society.
Therefore, they need to work beyond health sectors intertwined with this problem.
Collaboration between transportation, urban planning, sport and education departments is necessary to reach physical activity targets. Amsterdam has not always been the cycling-friendly city we all know today, but people advocated for their rights and the transformation has been nothing short of great.
Multisectoral population-based action related to the production, distribution and marketing of food is also needed to protect our consumption patterns.
The UK recently undertook new measures in tackling childhood obesity by implementing a sugar tax on high-sugar drinks and allocating the surplus to fund sports programs in elementary school.
All in all, population health should be the priority in every process of creating new policies.
Time is pressing and the burden is growing. If we continue with business as usual, we know where this epidemic curve is heading.
As public health expert Majid Ezzati said regarding obesity: “Unless we make healthy food options like fresh fruits and vegetables affordable for everyone, and increase the price of unhealthy processed foods, the situation is unlikely to change.”
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The writer is a general practitioner at the Indonesian Red Cross (PMI) Hospital in Bogor, West Java, who graduated from the School of Medicine at the University of Indonesia. She obtained her Master’s of Health Science in public health from Erasmus University in Rotterdam, the Netherlands, and was an intern at the WHO headquarters in Geneva, Switzerland.
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