HEALTH MATTERS. Here is our big fat problem

Diabetes is one of the most serious problems that plague the world today. It is already recognised as the 21st century’s fastest growing epidemic, and kills millions every year. It places a disease burden on world economies that runs into the tune of trillions of dollars. The disease is increasingly becoming rampant in new geographies and demographics.

The economic growth seen by India over the past two decades has lifted over 400 million people into the middle class bracket. But genes shaped over generations for malnutrition and manual labour are now leaving Indians unable to cope with high calorie food and a largely sedentary lifestyle. Obesity, one of the major causes of diabetes, is reaching epidemic proportions among India’s middle-class children and adolescents.

In a recent study, Indian Council of Medical Research projects that India would have over 62.4 million people with diabetes pre-diabetes. Several alarming statistics demonstrate this dire scenario — diabetes is hitting India’s population at an average age of 42.5 years (about a decade earlier than it strikes people in Europe).

The disease costs India the equivalent of 2.1 per cent of the GDP, mostly from lost earnings and productivity. To add to the situation, an estimated 77.2 million people in India are suffering from pre-diabetes — a condition in which patients have high blood glucose level but are not in the diabetes range. As per the study, the take-off point in prevalence is at 25-34 years with a decline after age 65.

The decrease in prevalence of diabetes after 65 years is possibly due to survivor bias, possibly reflecting deaths at earlier ages due to complications of diabetes. The high prevalence of prediabetes is worrisome as it implies a huge population at risk of developing diabetes in the near future.

While the basics of diabetes are becoming well-known, there are several startling facts about the condition that are largely unknown. One such fact is that Indians in particular have a significantly larger genetic disposition to diabetes, even though China tops global diabetes figures with 90 million people living with diabetes.

There are 400 million adults worldwide who are obese and one billion who are overweight. Children are getting increasingly overweight too. Worldwide, 17.6 million children under five are estimated to be above optimal weight. The big lifestyle shift that occurred in the latter half of the 20th century has been the primary driver of this malaise — we moved from plant-based diets to high-fat, energy-dense animal-based diets while at the same time becoming physically inactive.

Overweight people are at high risk to develop hypertension, diabetes and atherosclerosis.

The incidence of heart disease too is increasing at a rapid rate. From a very manageable 1.09 per cent in the 1950s, it increased to 9.7 per cent in 1990, and 11 per cent by 2000. This rising trend will make India the front- runner in the global incidence of heart disease too.

Today, Indians face a dual risk of heart disease and diabetes. The risk of death due to myocardial infarction is three times higher in diabetics as compared with non-diabetics. Life expectancy too is reduced by 30 per cent in diabetics as compared to non-diabetics.

The costs involved in the care and management of diabetes are considerable for both the individual and the healthcare system. Caring for diabetics involves a direct cost borne by the affected individuals, their families and healthcare authorities. While these by themselves are high, the indirect and intangible costs are much higher.

The indirect costs result from lost production as a result of frequent absence from work, an inability to work because of disability, premature retirement and even premature mortality as a result of complications. Intangible costs are those that reduce the quality of life, because of pain, anxiety and stress. As a society, all of us have to bear the cumulative costs of diabetes.

In India, a study showed that total annual expenditure by patients on diabetes care was, on average, ₹30,000 in urban areas and ₹6,260 in rural areas. The medical costs incurred by a person with diabetes are two to five-fold higher than those incurred by people without diabetes. Therefore, the estimated annual cost of diabetes care would be about ₹180 billion.

In India, nearly 85 per cent of all healthcare costs are borne by individuals and their families. Obviously, the lowest income groups bear the greatest burden, paying a larger proportion of household income toward diabetes care. Direct expenses can consume 27-34 per cent of household incomes of rural and urban poor people.

And year-on-year increases in this proportion are greater in impoverished groups, with the worsening of diabetes, presence of complications, hospitalisation, surgical therapy and glycemic control requiring insulin. Delay in the initial diagnosis of diabetes results in unexpected complications, which in turn leads to average annual diabetic care costing anything between ₹3-6 lakhs. Also consider that with the rise of diabetes in young people, the economic cost to the nation is only going to increase.

We are faced with a situation where is the prevalent conditions go unchecked India’s tremendous demographic dividend could we be blunted with this disease burden.

Our healthcare system has to look at diabetes with sense of urgency and wake up to the fact that diabetes is no longer a disease of the rich and affluent. We need large-scale programmes to generate awareness about the risk of diabetes and educate people about their lifestyle choices.

An effective method of combating diabetes is also linked to its early diagnosis. Diabetic complications (secondary prevention) can be especially beneficial in terms of patient quality of life and cost-effectiveness. Any measure that can reduce hospitalisation will reduce the major expenditure associated with advanced diabetes. Several studies have estimated that cost savings of up to 75 per cent can be made by re-focusing the provision of care toward an outpatient basis.

With a high ethnic susceptibility for developing diabetes, a national screening programme could also be a vital and cost effective measure for lessening the impact of diabetes.

Taking the fight to diabetes, and formulating a robust plan to counter the epidemic, is one of our key priorities as a nation. Ignoring this imperative will have catastrophic effects on both our nation’s health and wealth. It’s time for all the stakeholders in the Indian healthcare ecosystem to come together and walk the talk.

The writer is the founder and chairman of Apollo Hospitals Group