In a field where war, communicable and vector-borne diseases, and access to clean water and sanitation are everyday crises, chronic diseases are often minimized or simply overlooked by global health advocates. Billions of dollars are poured into HIV prevention and treatment efforts and malaria vaccines with the idea that once we deal with these “acute issues,” we can begin to focus on chronic diseases that receive so much more attention in developed nations. However, we overlook chronic disease at our own peril, or perhaps the peril of those that are suffering from it while it is unaddressed. These diseases are becoming a major problem in poorer countries where they are not being dealt with: 80% of chronic disease deaths now occur in low and middle income countries.1
Diabetes in particular is a growing burden on the developing world. This chronic condition, caused by the body’s inability to produce enough insulin (the hormone that regulates blood sugar) or to use the insulin it produces, can lead to heart disease and stroke, kidney failure, nerve damage, and blindness.2 Reduced blood flow and nerve damage often leads to foot ulcers and eventual limb amputation. The WHO tells the story of Zahida, a Pakistani woman whose diabetes went undiagnosed for eight years. She is now receiving insulin and proper care, but an infected foot ulcer eventually led to her losing her right leg below the knee.
The International Diabetes Federation estimates that diabetes may cause nearly four million deaths in 20103 – more deaths than either malaria,4 AIDS,5 or tuberculosis6 cause each year. Like many other diseases that weigh heavily on the public health of developing nations, it is relatively easy to prevent and to treat. Good diet and regular physical activity have been shown to be effective in preventing or delaying onset of type 2 diabetes.7 Early diagnosis with simple blood tests and moderate blood sugar control with insulin are cost-effective interventions for patients with type 1 and 2 diabetes in low and middle income countries. However, as with other diseases that receive more attention, reaching people with these interventions remains a challenge – it is as difficult to provide people with insulin as it is to bring them mosquito nets, antiretroviral medications, antibiotics, or clean water. Still, it is a condition that we can no longer afford to ignore: the WHO estimates that diabetes deaths will double by the year 2030. It is a condition that deserves at least as much attention as the other “everyday crises” of global health.