Global food inequality is driving type 2 diabetes in the large numbers of people who are malnourished on the one hand and obese on the other
“Epidemic” is an over-used word. But when the the International Diabetes Federation (IDF) uses it, it’s worth listening. Rapidly increasing instances of a disease is afterall the very definition of the word. And that is exactly what’s happening, says Ann Keeling, IDF’s chief executive and chair of the NCD Alliance – comprising the IDF, the World Heart Federation, International Union For Cancer Control, and voluntary scientific organisation The Union (TB and lung disease).
“Type 2 diabetes is driven by both over nutrition and malnutrition”, says Keeling. “These are global risks and global threats. We’re seeing, particularly in middle income countries, type 2 diabetes related to maternal malnutrition. The dysfunctional food system is very much connected to what’s happening in global agriculture changes and … it is leading to both huge numbers of people who are malnourished and huge numbers of people that are obese.”
The numbers are overwhelming: 366 million people have diabetes worldwide, expected to rise to half a billion – one in 10 adults – by 2030. The reason for the rise, along with a growing population, is climate change.
Given that diabetes already causes 4.6m deaths and costs more than £300bn ($465bn) globally every year in direct health care costs, the situation is not sustainable. The vast majority – 80% – of people with diabetes live in low-to-middle-income countries, which are due to be the worst effected by extreme weather and crop failures caused by climate change. At the same time urbanisation is leading to increasingly sedentary lifestyles, with obesity and diabetes as a result.
The link between diabetes and climate change is highlighted in a new report from the IDF and supported by Bupa, which aims to put non-communicable diseases (NCDs) high on the international agenda.
Climate change is expected to cause people to migrate, increase slum growth, and makes resources scarce. Rapid migration and urban slums also lead to food shortages and malnutrition which increase the risk of diabetes. In a cruel irony, the world’s poorest one billion people account for just 3% of greenhouse gas (GHG) emissions but experience the most devastating impacts of climate change. Small island states are at especially high risk and are disproportionately affected by diabetes, with rates of more than 20% in the adult populations of Pacific islands such as Kiribati, Samoa and Tuvalu.
It is a self-perpetuating problem. Where diabetes is caused by sedentary lifestyles, argues the report, there is a rise in GHG emissions from food production and car travel: “A population in which 40% of people are obese requires 19% more food energy than a population with a normal BMI distribution.”
Andrew Smith, head of sustainability at Bupa, also cites a study that found outcomes could change significantly when geographic location did too. “When Mexicans and Hispanics move to the US, a [negative] transformation in diets occurs within 12 months. The environment around them, the food and transport available – changes health outcomes really quickly.”
The potential solutions, according to both Bupa and the IDF, are evident in the causes. If it is how we live that is causes diabetes, then – in simple terms – we need to start changing how we live. “On a small scale there are a number of cities around the world where there are proven solutions to get populations both large and small to move more, eat better,” says Smith. “But they have not been scaled – they tend to be delivered in one city, in one country, in one campaign.
“In many places it is still in silos – food policy might be looked at as something solely about generating income and export revenue for that country, which is great, but food policy must also be about health. In the same way a transport policy isn’t simply about moving people from A to B, it should also be about health.”
Keeling points to New York as a positive example of how small changes can make a difference. “Mayor Bloomberg has achieved some really quite spectacular changes through policies to encourage a more active lifestyle, and planning transport so that it’s more accessible to people. Also food labelling – in New York you will see that sandwiches, everything, are labelled with calories on them … there’s a lot more information for people to really be empowered and look after their own health.”