The Hindu : Tamil Nadu News : India is diabetes capital: WHO medical officer

Online edition of India's National Newspaper
Wednesday, Dec 08, 2004

Tamil Nadu

Tamil Nadu

India is diabetes capital: WHO medical officer

By Ramya Kannan

Nigel Unwin. — Photo:V. Ganesan

CHENNAI, DEC. 7. The World Health Organisation (WHO) has defended its prediction of a high level of diabetes in India and claimed that the only complaint that can probably be levelled against it is "underestimation," not overestimation.

A section of diabetologists dissented with the WHO's forecast, terming it "alarmist" and not representative of the true picture. (See `Who is afraid of diabetes?' by Dr. C.V. Krishnaswami in The Hindu dated November 14, 2004).

Responding to that, Nigel Unwin, WHO's medical officer for diabetes, made it clear that the problem was one of "numbers" and not of "prevalence." There were other countries, which had a higher prevalence in the general population, but India's one-billion population swelled the numbers. Therefore, even with a lower prevalence, the total number of people living with diabetes in India would be higher than in most nations, making it the "Diabetes Capital" of the world. China, which also has a one-billion population, came a close second, Dr. Unwin said.

Obesity factor

"We take into account the population growth and trends in urbanisation, but we do not factor in rising obesity levels. We are trying to, but it is not easy. The relationship between obesity and diabetes is well documented, so by leaving it out, we are only arriving at conservative estimates," he explained.

Speaking to The Hindu during a short trip to Chennai to deliver the 11th MVDSC Gold Medal Oration, Dr. Unwin said studies proved that a healthy lifestyle and diet could prevent the onset of Type 2 diabetes up to 60 per cent. "Much of the projected disease is preventable. But the key is how can you make it happen."

"The best part is that simple things work very well. Maintaining good blood glucose, blood pressure control and ensuring foot care can have huge benefits, especially in resource-strapped settings," he said. Organising medical care systems, training general practitioners and educating the public would have to be taken care of.

`Make it easy'

In yet another attempt at addressing these issues, all WHO member-countries, including India, have adopted a Diet and Physical Activity Strategy. It targets the entire range of stakeholders, from policy environment to the individual.

"Changing the policy is important. Merely giving them information is not enough; you have to make it easy for them," Dr. Nigel said.

Policy changes would incorporate regulations on advertisements, pricing of food commodities, promoting physical activity and even putting the public transport systems in order. Some countries are already evolving their own policies to cut down obesity. For instance, the United Kingdom is considering placing a restriction on advertisements for fast foods and in the United States a campaign is on to remove fast foods from school canteens.

Validating the globalisation argument, Dr. Unwin highlighted the tremendous influence wielded by transnational companies in promoting unhealthy products. "We are going to have to work with them. And to address the issue effectively, there has to be an international agreement," he said. Some companies had begun making marginal changes in response to consumer demands and in an effort to be seen as "healthy."

Dr. Unwin was certain that the onslaught by the fast food culture could be countered by promoting healthy eating and living — much like the campaign against smoking.

In some countries such as New Zealand and Ireland, the smoking habit had apparently fallen, thanks to proactive measures including levying a high tax on cigarettes and banning advertisements and smoking in public places.

Access to drugs

The WHO would launch a Global Initiative for Treatment (GIFT) to ensure equity of access to drugs, Dr. Unwin said.

Implicit in this was the world body's recognition of manipulation of prices by the pharma industry and an attempt to ensure that drugs were delivered to the needy.

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