Deadline: April 10th, Transforming Health Systems

Deadline: April 10th, Transforming Health Systems
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Debilitating ailments on rise in South Asia




(10-05) 04:00 PDT Chennai, India -- T. Selvaraj, 29, lay writhing in pain on a hospital bed in an overcrowded ward, a plaster cast draping his left leg where a neuropathic ulcer had broken down the tissue.
"It is excruciatingly painful," he said, while injecting himself with insulin above his belly button.
Every 30 seconds, a person loses a leg to diabetes, a disease of high blood sugar that can result in amputations, blindness and heart failure. The malady is estimated to cause 3.2 million deaths worldwide every year, according to the World Health Organization. That's nearly 1 1/2 times the number of deaths from AIDS.
Once believed to be a disease associated with industrial nations, diabetes is slowly engulfing the developing world as well. Eighty percent of sufferers now live in developing countries, where, WHO predicts, the number of diabetics will increase 1 1/2 times in the next 25 years.
Currently, 1 of every 3 diabetics lives in India and China, with India having the dubious distinction of being the global leader - about 35 million diabetics, or nearly 15 percent of the world's total. WHO says India is now "the diabetes capital of the world."
Indian health experts warn that the brisk spread of diabetes could have a devastating effect on the economy. Diabetes already accounts for $2.2 billion in annual health care costs, according to government estimates. And a recent report by the Indian Council for Research on International Economic Relations estimates India lost $9 billion in national income as a result of heart disease, stroke and diabetes in 2005 and projects that figure will exceed $237 billion over the next 10 years.
Once known for horrific famines, India in recent years has experienced a torrid economic boom that has lifted millions out of poverty. But this newfound prosperity has also sparked numerous health problems, including diabetes, health officials say. Amid rising income from plush call centers and software companies, Western food habits and sedentary lifestyles are taking root among India's burgeoning middle class. According to WHO, nearly 18 percent of Indians say they do no physical exercise.
Fast food chains have tapped into a vast market in cities where the burgeoning middle class is shying away from traditional foods. And for some, a huge belly has become a symbol of success.
"In a land where famines once made people starve, a bulging paunch is mistaken for affluence," said Dr. V. Mohan, director of Dr. Mohan's Diabetes Specialities Center in Chennai. "Indians today suffer from what I call ... too much consumption."
Selvaraj's leg - which doctors say might require amputation - is a consequence of Type 2 diabetes, the most common kind.
"How will I ever work without a leg?" said Selvaraj.
Seven years ago, Selvaraj left his father's arid farm in rural Tamil Nadu state and migrated to the state capital, Chennai, to open a grocery store. As his business grew, he says he ate richer foods and drank excessively.
Selvaraj's condition is indicative of how diabetes is increasingly afflicting the young, and with India urbanizing at blinding speed, how diabetes - believed largely to be an urban malady - is also spreading to vast swaths of rural India. Since many rural migrants send money home to their families, they are causing a marked shift in eating habits, health officials say.
Studies conducted by Mohan's hospital in Chennai - a manufacturing and software hub in southern India, where nearly 20 percent of adults are said to have diabetes - found that awareness of diabetes is poor, especially in rural areas.
Progress is also impeded, experts say, by a health system that places a high priority on communicable diseases such as malaria, while allocating sparse funds for noncommunicable diseases such as diabetes.
Nevertheless, the Ministry of Health in January launched a pilot program in seven states to increase awareness of diabetes, cardiovascular diseases and stroke.
The program couldn't come at a better time, said Mohan, who travels around Tamil Nadu educating residents about diabetes and preventive health care.
"The message I give out is that 'fatness is not wellness,' " he said. "It'll take a while before that mind-set changes."
Key facts about diabetes
-- Diabetes is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
-- There are two basic forms of diabetes.
-- In Type 1, sufferers produce very little or no insulin and require daily injections of insulin. In Type 2, sufferers cannot use insulin effectively. They sometimes manage their condition with lifestyle changes. Oral drugs, however, are often required - and less frequently insulin - to achieve metabolic control. Most people with diabetes have Type 2.
-- At least 171 million people worldwide have diabetes, and the figure is likely to double by 2030.
-- Around 3.2 million deaths every year are attributed to complications of diabetes; that's six deaths every minute.
-- Cardiovascular disease is responsible for between 50 and 80 percent of deaths in people with diabetes.
-- Diabetes is the most common cause of nontraumatic amputation of the lower limb.
-- Direct health care costs of diabetes range from 2.5 to 15 percent of annual health care budgets.
-- The top 10 countries, in numbers of sufferers, are India, China, the United States, Indonesia, Japan, Pakistan, Russia, Brazil, Italy and Bangladesh.
-- In developed countries, most sufferers are above retirement age. In developing countries, most sufferers are between 35 and 64.
Source: World Health Organization