India, with a population of 1.1 billion, has more than 35 million people with diabetes—nearly 15 percent of the global diabetes burden—and projections show that this will increase to 70 million by 2025.
Diabetes disproportionately affects people of working ages and accounts for $2.2 billion in annual health care costs in India alone. Because 40 percent of Indians are under age 18, investment in the health of India's future workforce is crucial. Poorly controlled diabetes leads to complications, amplifying disability and mortality rates and leading to high direct, indirect and intangible costs.
A comprehensive approach that addresses diabetes risk factors is needed. Harnessing positive aspects of globalization—increased information flow, improved technology and innovation—via international collaboration is crucial. In India, a country with limited health resources, an approach that draws on many sectors—including the private sector—can ensure successful implementation.
Diabetes as a National Health Priority
If immediate action is not taken, diabetes threatens India's emerging economy. Projections show that in the next decade, India will lose more than $230 billion in national income due to diabetes, stroke and heart disease, yet Indian policy makers do not yet perceive the epidemic as a priority.
The Planning Commission of India, a governmental institution that determines the country's developmental priorities and resource allocation, should set up a group to guide development and implementation of diabetes prevention and control policies; bring together relevant stakeholders; and ensure accountability, cohesion and collaboration. Such a body is essential for increasing political will for diabetes action, ensuring that the voices of all stakeholders are heard, and could serve as an effective platform for business and the involvement of non-governmental organizations.
The Ministry of Health and Family Welfare of India currently provides Healthy-India.org, a website which advocates for healthy living and prevention of diabetes and other non-communicable diseases.
Improving India’s Health System to Combat Diabetes
Progress with addressing diabetes is impeded by a health system that places a higher priority on communicable diseases and maternal and child health services and by a private health system driven by curative medicine. However, change is possible, as demonstrated by successful tobacco-control efforts over the past twenty years, despite negative economic impacts to India's tobacco industry.
Health care facilities are concentrated in large urban centers, are focused on tertiary care and cater to the urban affluent. Government-run facilities are often crowded and under-resourced, so even low- and middle-income patients prefer private care or alternative medicine. For these populations, as much as 25 percent of income can be spent on diabetes care.
Initiatives such as National Rural Health Mission (which aims to improve rural health services), the National Program on Diabetes, CVD and Stroke (launched in 2008), the Public Health Foundation of India's new public health schools and the National Diabetes Control Program (which focuses on capacity building and rural health care delivery) are expected to increase capacity and resources.
Additional resources allocated to diabetes care should go toward stronger prevention efforts, diagnostic infrastructure (especially in rural areas), accessibility and affordability of treatment, and skilled health care workers.
Revamping Food and Nutrition Policies
India has the worst stunting and iron deficiency in the world and also the largest number of people with diabetes, representing a failure in the nutrition governance system. Many nutritional surveys are conducted throughout India, but they focus on under-nutrition; these should be expanded to include over-nutrition. Food consumption patterns and trade and agricultural policies have changed, encouraging over-consumption of unhealthy foods and under-consumption of healthy foods.
To prevent diabetes through healthier diets, India's dietary guidelines should be revised to reflect principles of chronic disease prevention and health promotion; food availability and affordability should reflect these guidelines through agricultural policies.
The food industry should work with the health ministry to implement a national nutrition policy by developing foods that comply with dietary and labeling guidelines and are thus more marketable as healthy options.
Promoting Physical Activity to Address Diabetes
The Indian government should implement urban design policies to facilitate physical activity as a component of daily life. India's urban design and transportation policies contribute to physical inactivity by encouraging the use of private cars and by making walking and cycling less feasible. Growth in the technology industry has encouraged the development of suburbs without adequate public transportation. More people are migrating to urban areas, straining urban infrastructure, but no national transportation survey has been conducted to identify needs.
International Organizations Can Strengthen National Action
The World Health Organization and the International Diabetes Federation are well positioned to provide technical assistance, and the World Bank can provide financial support for public policy interventions against non-communicable diseases.
The private sector can collaborate to implement many of the prevention-oriented governmental policies proposed above, through funding, expertise in distribution systems for provision of healthier foods (and low-cost medicines for treatment) and market innovation encouraging healthy eating and physical activity.
Non-governmental organizations can assist with the formation of international networks and alliances to advocate for policy change, knowledge generation and translation of research findings for policymakers.
(Learn about the use of Public Participation in the Formation of Public Health Policies.)
Reference:
- Siegel K, Narayan KMV, Kinra S. Finding a policy solution to India’s diabetes epidemic. Health Affairs 2008; 27(4): 1077-1090.
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Juan Ramos - Juan Ramos is a health communication specialist based in Boston, Massachusetts, USA. He has worked in the non-profit sector for more than ...
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