Our diabetes epidemic

World Diabetes Day, marked annually on November 14, is an opportunity for us to reflect on Pakistan’s ignominious and contradictory position as both a very poor country and a nation with one of the highest diabetes burdens anywhere in the world. With the country home to an estimated 36 million diabetes patients, including around a quarter of all adults, only China and India have more people living with diabetes than Pakistan. This is also a sharp increase from the previously reported 33 million diabetics, particularly for vulnerable groups like women, among whom the diabetes rate has risen to an alarming 30.9 per cent. Given the large gaps in the nation’s healthcare network and the fact that even these most current estimates are based on data for 2022, it may well be that 36 million is a conservative estimate when it comes to diabetes prevalence. The situation has gotten so bad that diabetes has led to a surge in severe health complications in Pakistan with nearly three million patients suffering from foot ulcers that can lead to amputations, 16 to 20 per cent facing eye problems, and 28 per cent developing kidney failure, as per health experts. The situation is complicated by the fact that many diabetics in Pakistan do not get the treatment they need, due to a combination of financial pressures and a lack of adequate monitoring. Aside from physical ailments, 78 per cent of of Pakistanis with diabetes have experienced anxiety, depression, or other mental health conditions as a result of their condition, according to a survey by the International Diabetes Federation (IDF).

That a country both struggling to feed all of its people and with a disease that is usually a consequence of having a diet high in sugar speaks to the evolving nature of global food systems and where Pakistan finds itself in them. Countries across the Global South are becoming large markets for all kinds of unhealthy junk food. As a result, the global diabetes rate has doubled since 1990, rising from 7.0 per cent to 14 per cent, primarily driven by rising cases in low- and middle-income countries. This is also compounded by the fact that food inflation is increasingly putting healthier eating options out of the reach of not just poor but many middle-class Pakistanis too.

Overcoming the diabetes crisis will require expanding access to healthier foods by making them more affordable for the majority of citizens and encouraging people to lead healthier lifestyles. This must go beyond simply encouraging people to eat healthier and run around a bit more. The state actually has to get behind making sure the facilities for people of all ages to exercise are widely available and that serious efforts are made into improving availability and affordability of healthier eating options. The young are a particularly key demographic when it comes to tackling this problem given the widespread availability of unhealthy snacks and drinks targeted towards young people and how unhealthy habits tend to stick if developed at an early age. Our schools will need to pursue good physical health and fitness among their students just as intently as they focus on good grades and test scores. These priorities must reflect in the attitudes of parents as well. This does not mean that we can tackle diabetes without a more robust healthcare system, only that this will need to be complemented by equally robust changes to our lifestyles.