In 2018, Nam Han Cho, then president of the International Diabetes Federation (IDF), referred to the epidemic of this disease as “the third world war,” comparing the 1.5 million annual deaths that the disease causes to the casualties of war. Such hyperbole shows some experts’ desperation amid the disease’s relentless advance and the difficulty of raising society’s awareness of the extent of the problem. This week, the medical journal The Lancet published a series of articles that once again draw attention to the threat of a disease that, they argue, is not being confronted with the right tools.
According to the estimates published in the journal, by 2050 around 1.3 billion people will be living with diabetes worldwide, an increase that more than doubles the 529 million people affected today. Ninety percent of those people will have type 2 diabetes, a disease associated with obesity, diet, alcohol or tobacco consumption and lack of physical activity, and there’s a close association with poverty. In the United States, diabetes is 1.5 times more common among minorities such as blacks and Native Americans, a problem that the authors of The Lancet articles attribute to structural racism, among other things.
In an editorial that was also published this Friday, the journal warns against a common but erroneous approach to diabetes. Despite the success of new drugs against the disease — which also help to tackle obesity — ”the solution to unhealthy and unfair societies is not more pills but to re-evaluate and re-imagine our lives to provide opportunities to tackle racism and injustice, and to prevent the major social drivers of disease,” they say, citing physician Rupa Marya and economist Raj Patel. According to some estimates, the market for diabetes drugs will reach $100 billion in the next decade and could increase by tenfold by 2045. However, as with many other ailments that are more treatable by adopting healthy habits early than with drugs when it is almost too late, preemptive efforts for diabetes are not receiving the necessary attention. In 2018, European Union countries spent, on average, 2.8% of their healthcare expenditure on prevention.
Experts have long stressed the need to include poverty as a key factor that must be addressed in order to improve health. The Lancet’s wake-up call estimates that as many as three out of four adults with diabetes worldwide will live in low- or middle-income countries by 2045. Today, about 10% of people who have the disease in these places receive adequate treatment. However, the increased burden of diabetes is not only occurring in countries with fewer resources. In the U.S., the disease’s prevalence has nearly doubled among young people, who are increasingly exposed to all kinds of foods that increase the risk of obesity and a more sedentary lifestyle. As with all diseases everywhere in the world, those who are most affected by the increase in diabetes in the United States are the poor, especially Black individuals and Native Americans.
At present, no country is expected to reduce its percentage of diabetics, and rates will reach 20% in regions like North Africa and the Middle East. “Diabetes remains one of the greatest public health threats of our time and will grow rapidly over the next three decades in all countries, regardless of age or gender, posing a major challenge to healthcare systems worldwide,” says Shivani Agarwal of Albert Einstein College of Medicine in New York. Agarwal, who led this series of articles, says that “focusing on understanding inequality in diabetes is vital to achieving the UN Sustainable Development Goals,” which seek to decrease noncommunicable diseases, such as cancer and diabetes, by 30% in less than seven years and reduce the increasingly negative effects on the health of marginalized populations and on the strength of national economies in the decades to come, she adds.
The series mentions success stories about supporting under-resourced communities, such as the ones in some sub-Saharan African countries, where the cooperation of governments, industry and patient associations has facilitated access to insulin and other medical devices, leading to measurable reductions in the disease’s impact.
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