And we wonder at the growing obesity epidemic…

Global health advocates are becoming increasingly vocal about the growing international obesity epidemic, and all of the complications that come with it (e.g. cancer, diabetes, etc.). I have been traveling all across the state during the last few weeks for my day job (I coordinate a surveillance program at the  state health department), so I have been spending a lot of time in airports. Here is a shot of a drink vending machine at one of them.

Yep, that’s right: rows and rows of sodas and sugar-sweetened beverages, and no water. Next to this machine is a snack machine (naturally full of candy and salty snacks) and next to that was a coffee machine. There was no place in this tiny airport to buy a bottle of water.

And that, ladies and gentlemen, is why over a third (35.7%) of Americans are obese.

Cancer: the Next Challenge for Global Health

Guest blogger: Dr. Isobel Hoskins

We think of cancer as a disease of affluent countries. That may have been true in the 1970s, but since then, cancer levels in developing countries have risen alarmingly. This massive rise in cancer is one reason why a UN summit in June is addressing chronic diseases, including cancer, with the aim of kickstarting the fight against these illnesses.

Some figures: 5.5 million of the nearly 8 million deaths from cancer in 2008 happened in the developing world. Back in 1970 only 15% of cancers were found in the developing world. However, by 2008, according to the World Cancer Report, more than half of cases were in developing countries. These numbers hide a burden of misery – cancers in developing countries are often detected at a late stage – too late for many treatments. These patients often don’t even have access to pain medications.

What drove this increase? The WHO Director General, in a recent address to the IAEA, cited ageing, urbanization and the globalisation of unhealthy lifestyles. Population growth has also driven the numbers up. Isn’t it ironic that improved life expectancy leads to increased cancer burdens?

Many papers can be found indicating the enormous problem that cancer is for developing countries. Given the expense of treatment is there anything that can be done to reduce the cancer burden? Fortunately there is – I read a paper in the Lancet that gives a ray of hope…

Farmer et al. say that we shouldn’t accept that cancers in developing countries will remain untreated. Instead, we should make cancer prevention and treatment broadly available as rapidly as possible. We should consider the example of HIV and TB a decade ago: critics asserted that HIV and TB treatments were too complex and long term for weak health systems. These arguments proved unfounded. Farmer et al. point out examples of successful treatment and prevention of cancer in low resource settings that we can build on.

The approach should concentrate on curable and preventable cancers. Farmer et al. have come up with a list. These cancers can be prevented by reducing risk factors such as tobacco use or infection, or they can be cured by early detection and surgery methods or specific low cost systemic drugs. It includes some very common cancers: lung cancer, breast cancer, cervical cancer and liver cancer.

Many problems posed by cancer care, including cost of drugs and lack of infrastructure and specialists, was a big obstacle for HIV, too. The solutions could be similar: Farmer et al. suggest reducing drug cost by drug purchasing and production negotiations, as well as the use of primary and secondary caregivers to deliver services. The paper cites an example of cancer care in Malawi that uses such workers with remote support from specialists.

And if there is no suitable treatment, pain control is low cost, and the paper asserts that all should have access to that as a human right.

Farmer and co-authors have formed the Global Taskforce on Expanded Access to Cancer Care and Control in Developing Countries to address cancer care worldwide. I for one hope this taskforce prospers!

Dr Isobel Hoskins is Co-Editor of the bibliographic database Global Health which covers public health research worldwide. Global Health is produced by CABI, an international not-for-profit information provider. She’s usually found blogging on the Global Health Knowledge Base and on Twitter here: @CABI_Health.

Diabetes in the developing world: Overlooked and underestimated

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

Zahida Bibi, a Pakistani woman with diabetes, wearing a white shawl and surrounded by her family.
Zahida Bibi (image courtesy of WHO/Chris de Bode)

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.