P Pushpam, a resident of Chennai, India, was denied her job appointment with the Indian Railways on the grounds that she was a chronic diabetic. The court ruled in her favor and pointed out the impracticality of discriminating against people suffering from diabetes in a country that has over 40 million diabetics.
As India makes its demographic transition toward lower birth rates and higher life expectancy, the prevalence of non-communicable diseases is on the rise. India is the “Diabetes Capital of the World” with over 60 million diabetics in the country, that is projected to at least double by 2030. The country ranks second, between China with 90 million and USA with 24 million diabetics. About 17% of the country has diabetes and about 77 million are considered to be pre-diabetic, which refers to those individuals who have higher than normal blood glucose levels, but not high enough to categorize them as diabetic.
Disability-adjusted life years (DALYs) is a measure of the burden of a specific disease in a population. A study shows that the DALYs attributed to communicable diseases in India such as malaria and TB will decrease. However, the DALYs associated with diabetes and other non-communicable diseases will increase. When compared to China, another country with a large and rapidly aging population, one sees a decrease in the DALYs for both communicable and non-communicable diseases.
Smoking, poor physical activity and alcohol use are some pertinent risk factors of diabetes in India. A survey revealed that close to 40% of Indian men are daily smokers and approximately 18% of the study respondents had poor physical activity levels. The survey also suggested that in addition to these individual level risk factors, environmental factors, specifically indoor air pollution contributes to the increasing prevalence of diabetes. The incidence of solid fuel use, contributing to air pollution in India is 83.5%. An urban lifestyle, and increasing strength of the food, fertilizer, pharmaceutical and beverage industries in the past decades, also contributes to a higher prevalence of diabetes.
A major obstacle to diabetes in elderly health is the lack of awareness of one’s status. A study in the urban slum of New Delhi reported that only 36% of their respondents were aware of their diabetic status. Low awareness among the elderly is linked with difficulties in screening, diagnosis and treatment abilities. Elderly patients tend to have lower mobility and are more likely to be dependent on their family members, delaying their ability to seek care.
The increasing prevalence of diabetes management among the elderly places a huge burden on the Indian health care system. While lifestyle modification is the most cost-effective solution to this growing epidemic, a more intense plan of management and care for elderly diabetics is needed.
Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.