The Diabetes Epidemic in India: A Vision of the World’s Future

India has the largest number of people with diabetes in the world. According to the International Diabetes Federation, the number of diabetics rose from its already high 1995 rate of 19 million to over 62 million in 2011. An estimated 11% to 20% of India’s urban population has diabetes, and 3% to 5% of the adult rural population has the disease. Estimates from the World Health Organization say that the disease currently costs India about $250 billion per year, and that in the next ten years this figure will skyrocket to $335 billion.

Clearly, India has a diabetes problem. But the real issue is that it’s a predictor of a growing global problem. According to the International Journal of Diabetes in Developing Countries, the alarming increase in diabetes “has gone beyond epidemic form to a pandemic one.”

India is just the “canary in the coal mine,” warning miners of dangers they cannot see. The rise of diabetes in India is being seen by health experts as a precursor of what we can expect to see happen all over the world in coming years.

What are the causes of this diabetes pandemic?

Because most of the newly-diagnosed cases in India are of Type 2 diabetes (formerly called non-insulin-diabetes), the root causes there are the same as they are in America – poor diet overloaded with fat, sugar, and calories, obesity, stress, and a sedentary lifestyle, in which people don’t get enough exercise. These causal factors are amplified in India by genetics (in which many people seem to be prone to the disease because their parents and grandparents were) and cultural factors (what is considered “fat” in America is considered normal in India, and what America considers a normal weight is considered in India “too skinny”).

It has also been triggered by the large-scale importation of a Western lifestyle. Everywhere you go in India, you see roadside stands and carts selling sweets and samosas and pakoras deep-fried in “bad fats.” These vendors compete with fast-food franchises selling Western-style hamburgers and french fries. At the same time, people can now afford to travel via scooter or buses, and thus don’t walk as much as they did a few years ago. When they get to work, they often sit at a desk talking on the telephone or working at a computer all day, and then when they get home, they sit in front of the television or play video games. It’s a lifestyle that is pretty much a blueprint for developing Type 2 diabetes.

Diseases once prevalent only among the wealthy now affect the poor

The result of all of this is that the diseases related to diabetes – hypertension, kidney failure, retinal damage, and ulcers – have also skyrocketed. And it’s all because India’s base standard of living has improved. People who were considered poor a few years ago had a diet driven by necessity, but which was relatively healthy – beans, rice, and vegetables. Now most people can afford the fast foods and processed foods, and their diets have become the same as those in the upper middle class, containing far too much sugar, fats, and “empty calories.”

Caroline Fall, a British professor of epidemiology, suggests that India reflects trends that we’re seeing in developing countries all over the world: “The biggest recipe for chronic disease is to have a very poor start in life and then to be in a situation where you’re rapidly transitioning towards excess nutrition and inadequate activity.” The more fast and processed foods that people in these nations moving to a more Western lifestyle eat, the less actual nutrition they get. And the young are most at risk. In the West, the onset of Type 2 diabetes is most commonly seen in adults in their 40s and 50s. In India, it’s affecting people in their early to mid 20s.

What can be done about this?

The answer to this question is as frustrating in India and in other developing nations as it is in America. Education programs sponsored by governments to teach people about what a healthy diet is and what an unhealthy diet is can help, as can government- and school-sponsored exercise programs. But that doesn’t counter the ever-increasing availability of cheap but nutritionally empty fast foods and over-processed foods. As long as these foods remain easier to obtain and prepare than healthier home-cooked foods, people are going to continue to eat them. And educators are facing an uphill battle, because among the people they’re trying to educate, eating healthier diets that they cook themselves and sitting in front of their computers and TVs less are seen as failure – “going back” to a previous, less prosperous, and less Western era. Sadly, their desire to become more Western may be killing them.

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Juliette Siegfried, MPH

Juliette Siegfried, MPH, has been involved in health communications since 1991. Shortly after obtaining her Master of Public Health degree, she began her career at the National Institutes of Health in Bethesda, Maryland. Juliette now lives in Europe, where she launched ServingMed(.)com, a small medical writing and editing business for health professionals all over the world.

Juliette's resume, facebook: juliette.siegfriedmph, linkedin: juliettes, (+31) 683 673 767

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