Diabetes in the developing world
Background
Scientific progress and technological innovations in the 20th century have brought about major improvements in global health and markedly improved the quality of life. However, the progress has not been evenly distributed all over the world, and there is an inverse relationship between the distribution of need and the distribution of resources.
The developing world carries 90% of the disease burden, yet poor countries benefit from only 10% of the resources that go to healthcare. Furthermore, while there is continued progress in developed countries, the situation in developing countries is deteriorating, and the gap between rich and poor is increasing. The situation is aggravated by the current AIDS epidemic, as most of the people with HIV/AIDS live in developing countries.
The WHO estimates that one-third of the world population still lacks regular access to essential drugs. This figure rises to over 50% in the least developed parts of Africa and Asia. Many factors become barriers to healthcare access in developing countries:
- Lack of healthcare infrastructure
- Social and political factors such as civil conflicts
- Lack of education
- Shortage of financial resources
Mechanisms for public financing of healthcare are non-existent in most developing countries, thus health costs typically represent out-of-pocket expenditure for people with severely limited means. (According to WHO, 80% of people in developing countries pay directly for some or all of their own medicines). In many instances, the choice is between healthcare and food or clothing. Such financial constraints inevitably result in under-consumption of healthcare services.
Diabetes is a huge problem in the developing world
Although infectious diseases still constitute the leading cause of mortality and morbidity in developing countries, the WHO predicts that non-communicable diseases such as diabetes, cardiovascular disease, cancer, and chronic respiratory diseases will become the world’s main disablers and killers within the next quarter-century.
Diabetes can be found in almost every population in the world, and its prevalence has reached epidemic proportions. Using epidemiological data, the WHO estimated the global burden of diabetes at 135 millions in 1995, with the number reaching 300 millions by the year 2025.
Most of this increase will occur in developing countries, which will therefore bear the brunt of the diabetes epidemic in the 21st century. The diabetes pandemic — which consists primarily of type 2 diabetes — has evolved in association with rapid cultural changes, aging populations, increasing urbanisation, dietary changes, decreased physical activity, and other unhealthy lifestyles and behavioural patterns. Without effective prevention and control programmes, diabetes will most likely continue to increase globally.
Recent research shows that diabetes is the leading cause of blindness in people aged 20-74 years, and it is also the leading cause of end-stage renal disease. The risk of leg amputation, heart disease, and stroke is much higher for people with diabetes compared to those without.
In developing countries, the prevailing poverty, ignorance, illiteracy, and poor health consciousness further add to the problem. Studies have shown that for uneducated, unemployed people, especially those living in semi-urban or rural areas with no access to even the bare minimum of healthcare facilities, there are likely to be delays in diagnosis, and serious diabetes-related complications. Furthermore, many people with type 1 (i.e. insulin dependent) diabetes die before they are diagnosed or soon after diagnosis due to inadequate access to treatment.
In addition to personal suffering, diabetes accounts for a significant amount of national healthcare spending; in the U.S., more than one out of ten USD for healthcare is spent on diabetes, and one out of four Medicare dollars pays for healthcare for people with diabetes. With the present trend, diabetes is likely to take more than a third of the health budgets in 15 to 20 years. A 1997 WHO report concluded that due to its frequency and the cost and suffering imposed by its complications, diabetes is one of the most daunting challenges posed today by chronic diseases.
Thus, it is clear from the available information that in the future, diabetes will constitute a severe burden on the already fragile and under-resourced healthcare systems in the developing world.
Most of current health-related initiatives in developing countries are aimed at high-profile communicable diseases, such as HIV/AIDS, tuberculosis, and malaria. In fact, developing countries face a double burden of disease. They suffer a considerable backlog of common infections and malnutrition. At the same time and without having addressed these challenges, they have to cope with the emerging problem of non-communicable diseases, of which diabetes is one of the most common.
