An article in the September 13 issue of the New York Times reminds us that the U.S. is not alone in the fight against diabetes. Type 2 diabetes is “engulfing” India, afflicting 35 million people, or 6 percent of the country’s 1.1 billion population. The complexity of confronting diabetes in India is not only compounded by genetic and lifestyle factors, but also factors such as politics, a meek healthcare system, and religious and cultural norms.
The difference between the U.S. and India, however, is the relationship between income and diabetes. In the United States, there is an inverse relationship between income and diabetes prevalence. However, according to Kleinfeld, obesity and diabetes are dubbed “joint totems of success” in India. Dr. V. Mohan, chairman of the Diabetes Specialties Centre in Chennai, comments that at an upscale restaurant it is common to see a diner take out his kit and give himself an insulin injection.
One cannot become wealthy in India without the taste of diabetes. One example of the quick rise of diabetes is the urban city of Chennai. Experts estimate that 16% of the adults in Chennai have diabetes, which is three times the prevalence rate from twenty years ago.
India, with its booming economy and expanding middle and upper classes, is paying a huge cost at the expense of the health of its equally booming population. The managing director of the M.V. Hospital for Diabetes in Chennai says, “Diabetes unfortunately is the price you pay for progress.” In India, progress is also coupled with continuing poverty, malaria and AIDS. Much of the healthcare budget in India is allocated to communicable diseases and not to chronic diseases.
The burden of diabetes in India is falling on a younger population than traditionally seen in the West. Due to the genetic disposition of Indians to diabetes, many are 10 years younger than those in industrialized countries when they develop the disease. Since half of the population in India is under 25, this trend is particularly debilitating for the country.
The move from rural to urban life is causing residents to trade fresh vegetables for processed and fried foods. Like countries of the industrialized world, India too is a fast-food nation with eateries such as Pizza Hut and Nic-Nac Fast food. Coke and Pespi also abound. In a culture of giving, most Indians opt to offer traditional sweets for events such as birthdays, weddings, and funerals. With increasing waistlines come an increase in the number of diet centers and "stomach-shrinking operations.” Some Indians are finding peace in music, with CDs such as “Music for Diabetes” aimed at alleviating stress.
According to the article, a trend in India appears to be to become wealthy, then get diabetes, and then go broke. The article chronicles several stories of individuals who have had to sell their jewelry, homes and businesses to pay for the medical costs associated with treating their diabetes.
The migration of fast food corporations into India has been accompanied by an influx and/or establishment of several software support centers. Young employees at these call centers spend their nights in cushy office chairs, fielding calls from the other side of the Atlantic and leading very sedimentary lives. Many often discover that they have diabetes before they hit 30.
Health insurance in India is not only scarce but polices do not cover medical costs associated with diabetes. Those who have the option of buying health insurance often opt not to. Religion plays a major role in such decisions because many accept diabetes as “God-given”. Some Indians even blame diabetes for an increase in divorce rates or unhappy marriages, because they feel that diabetes prevents women from assuming domestic responsibilities or cause men to become infertile.
Diabetes is not only responsible for robbing the wealthy but also the poor. The rural and urban poor lack both the education and knowledge to realize that they may be afflicted. Those that are in the know do not have the resources to cover medical costs or the facilities to refrigerate insulin vials.
Misinformation and lack of education are challenges that some doctors have decided to confront. The challenge seems insurmountable due to a pervasive culture of using questionable home-based remedies or cures. According to the article, “much of the Indian population gravitates to cryptic beliefs threaded with untruths that are hard to nullify.”
If diabetes continues to rise as rapidly has it is, the future for the population of India is bleak. In exchange for material comforts, they may likely forsake health and sanity.