Diabetes in Developing Countries
Type 2 diabetes results from the body’s ineffective use of insulin, a hormone that the pancreas makes and allows the body to either convert glucose into energy or store it. Insulin prevents one’s blood sugar from getting too high since it effectively removes glucose from the bloodstream. Diabetes is a major cause of blindness, kidney failure, heart attacks and stroke among other conditions. While there are many risk factors for diabetes, physical inactivity and excess body weight are two of the most significant contributors to type 2 diabetes across the globe. However, there is an increasing prevalence of type 2 diabetes in developing countries where investments in health care are often inadequate.

Diabetes in Developing Countries

Globally, the number of people with diabetes increased from 108 million in 1980 to 433 million people in 2019. Estimates determine that the global prevalence of diabetes is 9.3 percent, and about one in two people with diabetes are undiagnosed. The International Diabetes Federation projects that global prevalence will increase by 25 percent in 2030 and by 51 percent in 2045 if prevention methods and treatment programs remain unchanged.

Type 2 diabetes relates to obesity and overeating. Therefore, people in the past have associated it primarily with high-income countries, but this viewpoint is changing. The prevalence of diabetes in developing countries has been rising rapidly. In 2019, 79 percent of adults with diabetes were living in middle-low income countries.

Risk Factors of Diabetes in Developing Countries

A majority of type 2 diabetes cases are in advanced nations. However, the disease is becoming a serious problem in developing countries. Diabetes prevalence in low-middle-high SDI countries is 1.48, 3.74, and 3.42 percent, respectively. SDI refers to the Sustainable Development Index as an updated version of the human development index and measures the ecological efficiency of human development. Middle SDI countries also have the highest annual rate of increase in prevalence. The prevalence of diabetes in developing countries is growing with westernization and with the urbanization of rural areas. In Pakistan, for example, a recent study found that urban areas have a prevalence rate of 28.3 percent which was just higher than the rate of 25.3 percent in rural areas.

Obesity, a main contributor to the diabetes epidemic, is increasing rapidly in developing countries. This shift also connects with the nutrition transition. The nutrition transition results from changes in agricultural systems. Specifically, there is a decrease in fruit and vegetable consumption. There is also a rise in processed foods such as refined carbohydrates, added sweeteners, edible oils and animal products.

In many Asian populations, the risk of diabetes starts at a lower BMI than for Europeans. Additionally, increased intake of meat, oils, highly saturated ghee (a type of butter used in Asian cooking) and added sugar have also marked diet shifts in Asia. Before urbanization, physical activity counteracted the effects of high fat and sugar diets. Unfortunately, physical activity has also decreased as a result of the shift from agricultural labor to working in manufacturing services.

Preventive Methods

The current trends show that type 2 diabetes in developing countries will likely significantly increase, but these outcomes are preventable through lifestyle and dietary changes. Since treatments such as drugs and insulin are costly and developing countries have limited resources, people must prioritize prevention. It is crucial to raise awareness about the effects of lifestyle shifts on obesity and type 2 diabetes globally. Low-cost innovations include training non-medical health professionals and using mobile devices to spread awareness about type 2 diabetes prevention. In addition to technology, countries should develop solutions using networks of community health workers.

Accredited social health activist (ASHA) workers are an example of this type of intervention in Asia, where 70 percent of the population lives in rural areas with very limited access to health care facilities and skilled health workers. ASHA workers are health educators in their own communities and have the ability to care for patients at home while also providing guidance regarding diet and physical activity. Telemedicine and the use of technology support this system and keep the ASHA workers in touch with medical professionals. This intervention also offers employment to people with some medical knowledge. ASHAs are able to make money by charging low fees for their services and provide for their families.

Making cities more walkable or cyclable through urban planning can increase physical activity while taking some of the prevention weight off of health systems, especially in countries with limited health resources. Making healthy food more affordable through redesigning subsidies needs to be a priority. This is because industrialization makes processed food cheaper and more accessible. These actions require political will and an understanding of the negative implications of the growing diabetes prevalence. Such actions could make a significant difference in decreasing the epidemic globally.

Maia Cullen
Photo: Pixabay

Soda Tax in Mexico

Type 2 diabetes recently became one of the leading causes of death in Mexico. The number of diabetes-related deaths will continue to rise. Furthermore, scientists have predicted that at least half of Mexico’s population will have diabetes by 2050. Conditions such as being overweight and obesity have strong links to the development of Type 2 diabetes. In response to the growing health concerns associated with obesity and diabetes, the soda tax in Mexico has been implemented to reduce liquid sugar consumption and promote healthier lifestyle choices.

Tax on Soda

Mexico has historically been a top consumer of sugar-sweetened beverages. In 2012, the average person consumed 176 liters per year. Mexico made the world’s top consumer of soda per capita.

The popularity of sugary drinks has come with negative consequences. As soda consumption rose, the number of people suffering from obesity and diabetes in Mexico also increased. While sugar-sweetened beverages were not the only drivers of the weight-related problems plaguing the country, they did receive the most attention from health officials.

In 2014, Mexico began taxing all sugar-sweetened drinks. The tax roughly increased the price of the sugary drinks by one peso per liter. The purpose behind the soda tax was twofold:

  1. Reduce the consumption of liquid sugar that contributed to high obesity and diabetes rates.
  2. Increase funding for public health-based programs to promote healthy lifestyle choices.

Mexico’s Struggle with Diabetes

The soda tax in Mexico was an important step in the country’s fight against diabetes. In 2018, a report found that nearly one-third of the Mexican population was living with diabetes. The most common form diagnosed was Type 2 diabetes, which causes blood glucose (sugar) levels to be higher than normal. The exact cause remains unclear, but obesity was strongly linked to the development of Type 2 diabetes.

Link Between Obesity and Diabetes

The World Health Organization (WHO) reported that a healthy diet includes the consumption of about 2,000 calories per day. The average Mexican adult consumes over 3,000 calories per day. Mexico has one of the highest obesity rates in the world. The number of Mexican adults suffering from obesity rose from 20.5 million in 2012 to 24.3 million in 2016.

Food insecurity and undernourishment were the leading causes of obesity, especially among the poor. The United Nations Food and Agriculture Organization (FAO) found that unreliable access to food contributed to multiple health conditions. In addition, much of the food produced in Mexico was high in carbs and fats. Mexican farmers favored crops that were cheap and easy to grow (like corn) instead of focusing on their nutritional value. Consequently, the average Mexican diet has higher carbs and fats than recommended.

The poor have been the most vulnerable to obesity. A study found that poor communities had obesity rates 145 percent greater than wealthy communities. The stress of food insecurity and undernourishment impair the poor from making the best food choices for their health.“When household resources for food become scarce, people choose less expensive foods that are often high in calories and low in nutrients,” explained the FAO.

Did the Soda Tax Work?

Diabetes has no cure. While medication is a big part of treatment, most doctors recommend a lifestyle change for diabetics looking to keep their blood glucose levels under control. The “Soda Tax” sought to help with the lifestyle change by saving people who avoided sugary drinks money.

Since 2014, the sales of sugar-sweetened beverages have dropped throughout Mexico. Sales dropped by 5.5 percent the first year. By the second year, sales were down by 9.7 percent. The sales of untaxed beverages increased by about 2 percent. However, the calorie intake of the average person has remained unchanged.

– Paola Nuñez
Photo: Flickr

Insulin for Life
Life with Type 1 diabetes can be quite difficult. As any person living with diabetes — including the author — can attest, to live with diabetes means constantly balancing food intake with insulin injections, deciding whether or not to exercise based on one’s blood sugar number, and becoming comfortable with life-or-death situations that arise when one inevitably does something wrong. However, all of these challenges are made even worse if one happens to live in a poor country where diabetes supplies are rare, expensive or both. Fortunately, Insulin for Life gives diabetes supplies to poor countries, giving diabetics around the world a chance to live their lives.

Origin of Insulin for Life

Dr. Mark Atkinson and Dr. Francine Kaufman both specialize in diabetes care, and for many years, they helped diabetics in the U.S. obtain supplies. However, as their careers progressed, they became aware that many diabetics in developing countries lacked access to insulin. The harder they worked to help local diabetics, the more aware they became of diabetics in places like Ghana who could not do insulin injections and, thus, were doomed to die.

Finally, they couldn’t stand it anymore. On August 5th, 2012, the two doctors gathered together a group of board members and founded Insulin for Life U.S.A — the non-profit organization responsible for giving new life to diabetics in low-income countries. The Borgen Project recently had the opportunity to interview Insulin for Life’s Carol Atkinson in January of 2019, and her responses are embedded throughout this article.

About Insulin for Life

Insulin for Life gives diabetes supplies to poor countries such as Mexico or Tonga by accepting donations of unneeded diabetes supplies. These supplies are shipped to the organization’s office in Gainesville, Florida, and then to their international partners and places that need disaster relief.

As of 2018, Insulin for Life gave supplies to Cambodia, Cook Island, Ecuador, Ghana, India, the Philippines, Tonga, Haiti, Nigeria, Cayman, Belize, Barbados, Guyana, Jamaica, Mexico, Nicaragua, Uganda, the Gambia, Liberia, Togo and Rwanda. More countries are sending in applications, but Insulin for Life cannot compile a list of recipients for 2019 until they are sure they can accommodate them all (Carol Atkinson).

Internet Presence & Resource Management

In addition to their website, Insulin for Life has a strong presence both on social media and in disaster relief (Carol Atkinson). This online presence has attracted a number of sponsors, one of which being Total Diabetes Supplies, an online store that sells diabetes supplies ranging from continuous glucose monitor supplies to insulin syringes for pets. Another sponsor is Medtronic, a company that uses and develops biomedical engineering to improve the lives of people in general. All of Insulin for Life’s sponsors work with the non-profit organization to solve the problem of getting insulin to diabetics in low-income countries.

Every year, Insulin for Life sets a supply goal for the amount of insulin and the number of blood sugar test strips they plan on receiving and distributing. In 2018, that goal was 125,000 ml of insulin and 475,000 test strips. By the end of the year, they received 128,808 ml of insulin and 556,384 test strips. There is no official goal posted for 2019 as of this writing, but the eventual goal will be to receive more insulin and test strips than they did last year (Carol Atkinson).

The only supplies that Insulin for Life does not currently accept are pumps and continuous glucose monitor supplies, mainly because many of their recipient countries lack the electricity and infrastructure necessary to run these devices. While they are making plans to eventually start accepting these supplies, they simply cannot distribute them to many of their recipients at this time (Carol Atkinson).

Providing Support for Diabetics

Life with Type 1 diabetes is hard enough without having to worry about whether or not you can get your hands on life-saving supplies. Luckily, Insulin for Life gives diabetes supplies to poor countries whose citizens might not otherwise receive them. This allows diabetics in low-income countries to lead relatively normal lives, a reality that would not be possible without blood sugar and insulin supplies. Thanks to Insulin for Life, a Type 1 diabetes diagnosis no longer guarantees death in developing countries.

– Cassie Parvaz
Photo: Flickr

Global Health
With the many advances in science and medicine over the last century, it is no surprise that overall global health has been positively impacted. From the discovery of penicillin to the creation of the X-Ray machine, dedication to healthcare and these advancements have proved beneficial for both scientists and patients. The following is a discussion of the top five improvements in global health trends and their impacts on the global health conversation.

Top Five Improvements in Global Health Trends

  1. HIV/AIDS is no longer the leading cause of death in Africa. There has been a long-standing notion that the transmission of HIV was among the worst diagnoses imaginable and, furthermore, that the disease was becoming more and more rampant in many areas, especially poorer ones. However, many advancements have been made for prevention and treatment, which include newer and more effective medications, sexual education and safer sexual practices. These advancements have been used in poorer communities in African countries, where the epidemic is the greatest in severity. Thankfully, the prevention and treatment methods have been so effective that HIV/AIDS is no longer the leading cause of death in Africa. This advancement not only impacts health but restores communities’ economic success with more resources available for infrastructure and households.
  2. Vaccines are more varied and accessible. Over the last century, vaccines have not only become more varied, as well as more accessible, but their usage has risen. While vaccines have prevented diseases such as measles, polio and smallpox, a vaccine recently came out in 2011 that protects against the shingles virus. The shingles virus is a painful, blistery skin rash that originates from certain strains of the chickenpox virus, which is most common among children. However, unlike the chickenpox virus, the shingles virus is a higher risk for contraction in elders. The shingles vaccine greatly improves quality of life and has already made a huge impact. While vaccines are less standard in more disadvantaged areas, improvements are being made to include more vaccinations for more people, oftentimes cost-covered by charity organizations such as UNICEF.
  3. Mortality associated with childbirth has decreased significantly. Both infant mortality and maternal mortality rates were historically high compared to modern day rates. These statistics are an outstanding improvement from 25 years ago when infant mortality rates were as high as six and a half percent of all births and maternal mortality rates were around four-tenths of a percent. In 2017, a mere one-third of a percent of all children born did not survive past one year and an even lower percentage of mothers died during childbirth (two-hundredths of a percent). However, due to an increased overall implementation of sanitary health practices globally, these percentages continue to drop. In developed countries, where per capita income is higher, sanitary practices are at their most prevalent. Meanwhile, the opposite is true for countries with lower per capita income where there is lessened sanitary practice adherence. This, in turn, allows for a higher survival rate of both infants and mothers, leading to more families to have fewer children as they know infants have a greater chance of survival.
  4. Diabetes is no longer a “life sentence.” As recent as one hundred years ago, by the time diabetes was detectable, a person had mere months or years to live. Among the amazing improvements in global health, specifically thanks to the discovery of insulin in 1920 and all the advancements made in treatment as a result, diabetes will now have little to no impact on a person’s life expectancy. While people living in impoverished nations may have a harder time accessing treatment, great strides have still been made and are being made to provide treatment to people in disadvantaged regions such as sub-Saharan Africa, the Middle East and South Asia, including the provision of diabetes education.
  5. Water-related illnesses are reduced by better access to clean water. Clean water, once a scarcity, has been augmented by greater attention, funding and resources for water sanitation. There is a connection between poverty, health and reduced access to clean water, where poverty exacerbates the situation and makes clean water harder to access, adding an extra layer to both poverty and decreased health. Over the last 18 years, world access to clean water jumped from 76 percent to 91 percent. This improvement has prevented illnesses such as malaria, diarrhea and dehydration.

The above list merely scratches the surface of recent improvements in global health. There is much more left in the healthcare conversation and many more advancements that are being enhanced, discovered and yet to be discovered. Improvements in global health afford people the opportunity to dissolve their poverty, allowing them to live a longer and better life.

– Alexandra C Ferrigno
Photo: Flickr

Curbing Diabetes in the Marshall Islands

In 2017, diabetes in the Marshall Islands had the highest prevalence worldwide, with nearly one-third of Marshallese adults suffering from the disease. The Marshall Islands is a country consisting of two archipelago island chains in the western Pacific with a population of about 75,000 people, two-thirds of whom live on the atolls of Majuro and Ebeye.

The majority of people with diabetes in the Marshall Islands, as with most other countries, have type two, which results from the body’s inefficient use of insulin. Common causes of type two diabetes include obesity and a lack of physical activity. According to a 2016 estimate, 53 percent of adults in the Marshall Islands are obese, the fourth highest percentage of in the world. Type two diabetes has reached epidemic levels in the Marshall Islands, and its increase is primarily attributed to poor dietary habits and low levels of physical activity.

Majuro has become increasingly dependent on imported food due to overpopulation. Domestic production supplies only 10 to 20 percent of all food calories consumed since local foods tend to be more expensive than imported foods and the quantity is insufficient to sustain the whole population. Of the food imported, fruits, vegetables and other healthy perishables are the most expensive.

The Marshallese diet is comprised primarily of imported, processed foods that are high in sugar. For example, typical breakfast foods include pancakes, fried doughnuts, ramen, coffeebread, rice and spam. Lunch and dinner usually feature white rice and fresh or canned meat.

Perhaps the greatest change to dietary practices required is a change in attitude. When it comes to food purchase and consumption, the Marshallese tend to value quantity and price over quality. However, results from a recent child development study confirming the link between poor nutrition and growth stunting in the Marshall Islands led the government to consider this issue in setting priorities for development programs and interventions. The study identified poor nutrition as the cause of growth stunting in 35 percent of children surveyed.

In the National Strategic Plan 2015 – 2017, the government addressed the need for both increased access to nutritious foods and the implementation of nutrition education programs in Marshallese schools. Also, in November of 2017, President of the Marshall Islands Hilda Heine met with the World Bank to discuss a long-term early childhood health project to improve childhood health status.

“We received a very enthusiastic response from the World Bank,” President Heine said.

Still, several challenges lie ahead for effective health reform in the Marshall Islands. But the current steps being taken to achieve better health outcomes have the potential to prevent and reduce the prevalence of diabetes in the Marshall Islands.

– Gabrielle Doran

Photo: Flickr