Diabetes: Global Health Epidemic Of The 21st Century
The Global Diabetes Epidemic Symposium will take place this Thursday, April 29 starting at 1:30 p.m. at SDSU's Parma Payne Goodall Alumni Center.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh. You're listening to These Days on KPBS. Diabetes has been known in the United States as the ‘silent killer’ because it often presents only vague symptoms all the while it's seriously damaging your cardiovascular system. But now diabetes has a new nickname; it's being called the global epidemic of the 21st century. The World Health Organization predicts that in the next 15 years, diabetes will affect more than 300 million people worldwide, mostly in developing countries, and may even lower expected life spans in some areas of the world. A symposium about the global health threat posed by diabetes is taking place this week at San Diego State University and here to tell us about it is my guest, Dr. Thomas Novotny, professor of Epidemiology, and Associate Director for Border and Global Health at the SDSU Graduate School of Public Health. Dr. Novotny, welcome to These Days.
DR. THOMAS NOVOTNY (Professor of Epidemiology, San Diego State University Graduate School of Public Health): Thanks. It’s a pleasure to be here.
CAVANAUGH: Did the rate of increase in diabetes worldwide kind of sneak up on us? Or has this been going on and predicted for a long time?
DR. NOVOTNY: Well, epidemiologists have been tracking this for some time and realized that there’s a lot of transitions that are in place. One is that people are growing older and so it makes sense that diseases such as diabetes that affect older populations are going to be more prevalent. And, in fact, we’ve already reduced childhood illness and deaths due to those illnesses due to immunizations, etcetera, that have allowed people to age and, hopefully, age more healthily but on the other hand there have been a number of influences that have been recognized in terms of globalization, things like changes in the way we work, our physical output, in terms of calories used. Our diets have become globalized so that we’ve changed from a lot of complex carbohydrates to more fatty and sugar-laden foods. And so we’ve seen these trends in terms of behavior, urbanization, globalization, and so it’s not surprising that a disease such as diabetes has become more prominent, and I think we’ve been seeing this come for at least a decade.
CAVANAUGH: So what you’re saying is, in a way this is a symptom of the fact that the World Health Organization, world health efforts have succeeded in a way, people are living longer and fewer children are dying of communicable diseases but this was sort of an unintended consequence of those triumphs.
DR. NOVOTNY: Well, I don’t know if I’d call it that. I think what has happened is that we’ve focused appropriately on a lot of infectious diseases, childhood illnesses and done a good job with those. What we have not focused on, though, is the noncommunicable diseases, things that are just as potent in terms of impact on disease, death, and economic impacts as well. And I think it’s more a balance that has not been achieved in focusing on these noncommunicable diseases. Global health has gained in importance with all of the donations and investments from World Health Organization, World Bank, the Gates Foundation, Bloomberg and others, and now we have this additional challenge of noncommunicable diseases to engage in terms of this global health international effort.
CAVANAUGH: How many people is it estimated are suffering from diabetes right now around the world?
DR. NOVOTNY: Well, it’s about 150 million. I believe that the, you know, the projections are going to go up as high as 370 million by 2030. And this, you know, this represents a high prevalence in some fairly high population countries such as the United States, where the prevalence is about 7.8%, and it’s growing in countries such as India and China, where the burden is actually quite remarkable already. And so it varies, you know, in terms of the impact around the world but what we see is that the burden is going to be borne disproportionately in lower-middle income countries, developing countries, as we used to say, so that the impact on economic development is going to be quite significant in those.
CAVANAUGH: So, Dr. Novotny, tell us how eating habits have changed, especially in the developing world that contributes to the spread of diabetes.
DR. NOVOTNY: Well, there’s been a lot of changes. I think, again, some of this is the globalization of information, advertising, even the globalization of fast food. The movement of peoples from rural areas to urban areas has changed the way they work, has increased their demand on sort of prepared foods and less homegrown kind of calorie supplies. And so I think the issue is that, you know, the world has changed to the worse in terms of the way we eat and how we eat, and I think it now has caused at least considerable attention so that we look at things like food policies, like agricultural policies, and like the availability of foods in urban environments to rectify this situation.
CAVANAUGH: I think that maybe it’s hard for many people to understand—I know it’s hard for me to understand—don’t many cultures around the world traditionally have rich, sweet foods in their diets? What is it about this kind of processed food that is triggering an epidemic of diabetes?
DR. NOVOTNY: Well, yeah, everybody has deserts and rich, sweet foods.
DR. NOVOTNY: I think it’s the accessibility for these cross populations at lower economic levels that may be some of the problem. But the concentration of animal fats and as people transition from low economic potential to higher economic potential, they tend to increase their consumption of these prepared and highly concentrated sugary and fatty foods.
CAVANAUGH: I see. Okay, and so what are the implications then for countries that are having a large number of people develop diabetes? They’re still trying to develop in other areas and yet now they have this sickness that they have to deal with.
DR. NOVOTNY: Yeah, we call that the double burden, epidemiologic burden. There’s still significant infectious diseases, unfinished agendas in maternal and child health but also now this increasing demand on health systems caused by diabetes and the complications thereof. These are expensive illnesses, as we know. Cardiovascular disease, blindness, complications from neuropathies, and these things cost a lot of money. And health systems are not prepared to take care of them both in terms of the manpower and facilities needed but mainly the financing. And that’s going to be a tremendous impediment for many countries including China and India, in fact, because of the demands placed on the healthcare system by an increased diabetes.
CAVANAUGH: And I know that you are a part of the Border and Global Health Direct for the SDSU Graduate School of Public Health. Does that also include Mexico? Is there a threat there for Mexico?
DR. NOVOTNY: Well, yes, you know, they’re suffering from the same kinds of things that countries emerging into more developed economic situations are. Also our focus is on populations that cross over the border and on the Hispanic populations here in San Diego. The symposium that you mentioned that’s coming up this Thursday from 1:30 to 5:00 will focus some of the research of our faculty on border populations and the interventions that may be possible in the unique Hispanic community that we have here in San Diego.
CAVANAUGH: I’ll be speaking more with Dr. Thomas Novotny about the Global Diabetes Epidemic Symposium that’s taking place at SDSU this weekend. You’re listening to These Days on KPBS.
CAVANAUGH: I'm Maureen Cavanaugh. You're listening to These Days on KPBS. My guest is Dr. Thomas Novotny and we’re talking about the global diabetes epidemic. A symposium on that subject will take place this Thursday, not this weekend as I said before, but this Thursday at SDSU. Dr. Novotny, what are some of the things that the public health community is doing to try to prevent the spread of diabetes?
DR. NOVOTNY: Well, the first thing is to raise public awareness about the issue, and this requires public information campaigns and reinforcing the things that people basically know but to really put a pointed edge on them. It’s primary prevention. Public health is all about prevention. It’s not the discipline that provides people with medications necessarily but really emphasizes primary prevention in particular, and that means basically reducing inappropriate diet intake and increasing exercise. And it’s a rather simple formula that’s been recommended by the WHO and other organizations and that’s a half an hour of physical activity per day, a reduced calorie intake, certainly reduced concentrated sugars and fatty foods. That alone is going to make a big difference in the diabetic futures that we anticipate. And there’s also the issue of secondary prevention, which means basically making sure people are screened, appropriately counseled, appropriately referred for treatment and make sure – and making sure that they have access to the medical care that’s necessary once the condition has been identified.
CAVANAUGH: Now as you embark on public health education campaigns in other countries, do we have any idea how successful our own public health education campaign has been here in this country?
DR. NOVOTNY: Well, I would like to say that it’s been successful. We do have evidence from clinical trials and community interventions that there are things that work at the community level. There are a lot of unmet needs, however, and these include things such as policies, food policies, labeling policies. We’ve learned a lot from things like the tobacco control efforts where if we raise the level of public information where we can institute policies that help people change their behavior and we put some economics into this mix, that we can make a difference in the way seemingly intractable behavioral risk factors create this illness. And so I think we’ve learned a lot from other arenas but also have enough evidence to go forward with rather basic, cost effective interventions at the public community level.
CAVANAUGH: As we see diabetes becoming this global epidemic, as the symposium says, it’s not just about diet, though, is it? There are other issues that are contributing to the spread of this disease, the way people are living their lives, their lifestyles. Tell us a little bit about that.
DR. NOVOTNY: Yeah, I think one of the more important ones is the built environment. And, you know, this is something that I think we have a long way to go here in San Diego. The built environment could discourage us from doing even modest exercise, walking. If we don’t have safe streets to walk on, if we don’t have bike paths to use, if we have encouraged the use of elevators instead of stairs, if we build our buildings so that they’re in the wrong place and don’t have access to physical, you know, exertional opportunities, we’re compounding the problem. I think there’s room for works sites, schools, and, you know, certainly with the school exercise programs to increase, to change the environment in which we conduct our physical activity. And the built environment is a critical issue that requires policy as well as a lot of partnerships across the private sector and government.
CAVANAUGH: As you look at diabetes as a global problem, what are some of the challenges you face in making it a global issue? Are other countries resistant to this kind of public health campaign or are they all on board?
DR. NOVOTNY: Well, I wouldn’t say that there’s resistance. There certainly is a lot more emphasis placed on noncommunicable diseases now. But it was in 2004 that the WHO came out with a multinational strategy relating to diabetes, obesity, physical activity. It hasn’t been a very heavily invested strategy, that is, you know, we’ve got an enormous amount of global health funding now coming into, as I mentioned before, infectious diseases and there’s been some amazing improvements and extension of services in that realm but that funding hasn’t happened in the noncommunicable disease realm. It’s everything from the way our U.S. Agency for International Development might invest in foreign assistance to the way the multinational community and organizations put money into this. One suggestion has been that there is – should be a established global fund to support diabetes interventions just as there has been a global fund for AIDS, TB and malaria. There’s been a lot of success with that and maybe some of that success can be patterned in diabetes as well.
CAVANAUGH: What are the – what’s the goal of the symposium that’s taking place at SDSU Thursday?
DR. NOVOTNY: The main goal is to raise the level of awareness among students, researchers, the community as to the importance of this global epidemic and to highlight some of the important research that’s going on so we can see what works and what can work. And then finally, to think about new ways of approaching this through partnerships. Global health is something that requires people to think outside the box, to think across disciplines and to bind together those who have interests in medicine and medications to those who do public health, to those who do community outreach in a way that – in ways that are new and appreciate new thinking and partnerships. So what we’re trying to do is raise awareness, emphasize what we know and build towards some future investments in diabetes as a global health problem.
CAVANAUGH: Suppose diabetes does become as huge as projections are projected to become. I wonder, what are the risks associated with allowing this disease to spread?
DR. NOVOTNY: Well, they extend from a macro level down to certainly a human level. The macro level is suggested by the fact that global development, that is just economic progress can be impeded by the demands that chronic diseases such as diabetes can make on health systems and on society. And, in fact, it’s not just the medical care costs. Probably as much as five times the medical care costs are lost in terms of lost productivity, disability, loss of employment, etcetera. So these indirect costs really do impact development, and so that’s something to look forward to. And then the other issues is that, you know, as families have to deal with these chronic diseases, it really changes our dynamic. We’re not able to do things that are productive outside of medical care. In fact, in India, it’s been shown that about – a diabetic family spends about 25% of its income on the care of the diabetic patient. That’s a huge hit. And it, in large part, is preventable.
CAVANAUGH: I want to let everyone know the Global Diabetes Epidemic Symposium will take place this Thursday. It starts at 1:30 at SDSU's Parma Payne Goodall Alumni Center. For more information about how to sign up, you can go to the These Days page at KPBS.org. And Dr. Thomas Novotny, thanks so much.
DR. NOVOTNY: Thanks for allowing me to be here. Thank you.
CAVANAUGH: You’ve been listening to These Days on KPBS.