[A-List] Diabetes Is Not Just An American Problem

[Bill Totten <shimogamo@xxxxxxxxxxxxx>]

by Sonia Shah

ZNet Commentary (January 31 2006)

This week's New York Times series on diabetes in New York City throws much
needed light on the silent epidemic of chronic disease brought on by our
sedentary, fast-food culture. But diabetes is not just an American problem.
It is spreading fast to the rest of the world, too.

We think of McDonald's as an American restaurant, but of the five new McDonald's
that open around the world every day, four are located beyond our borders.
Coca-Cola is the quintessential American drink but that company has been buying
up water licenses in poor countries - many still bereft of safe drinking water -
where they sell soda for less than the price of a glass of clean water. In
Africa, the number one employer is not a mining company or an agricultural firm,
but Coca-Cola.

As the Times series has amply shown, our health suffers when we rely on fast
foods and sugary drinks to sustain ourselves. But in places where malnourishment
and poverty are rampant, the ramifications are even more profound.

In Western countries the transition from hardscrabble malnourishment to today's
drive-through, fast-food cornucopia occurred over centuries, with the happy
result that our societies were able to control infectious diseases spread by
hunger and poverty before facing the maladies of richly calorific diets,
including diabetes, obesity and heart disease. As anyone who has seen the KFCs
and Pizza Huts sprouting along the alleys of Mumbai and Cape Town knows, in
developing countries, no such time lag exists. What experts call the "nutrition
transition" is taking place within a single generation.

According to recent research, malnourished mothers tend to bear babies
predisposed to storing excess energy as fat. This is a useful adaptive advantage
in communities where calories are often scarce, enabling babies to survive
nutritional deficits. But when such babies grow up to consume Western-style
diets chock-full of fatty, sugary foods, that benefit turns into a deadly curse,
leading them to gain disease-causing extra fat much more rapidly than they would
have otherwise.

And so, hot on the heels of the multinational soft drink and fast food companies
in poor countries has been an epidemic of chronic disease.

Today, four of out five people who die of chronic, noncommunicable diseases
such as diabetes and heart disease perish not in New York or California but in
developing countries, according to the World Health Organization. More Indians
and Chinese suffer cardiovascular disease than Americans, Japanese, and
Europeans put together.

Diabetes and coronary heart disease are epidemic in India, which is home to the
greatest concentration of Type II diabetes sufferers in the world. In some areas
of Africa, as many as one in five has diabetes. Nearly twenty million Africans
suffer from hypertension. Worse, while diabetes in rich countries is primarily a
condition of the elderly, in developing countries the disease strikes those in
the prime of life, aged forty-five to sixty-five, slashing their average life
expectancy by ten to fifteen years.

For developing countries barely treading water amid the flood of malnutrition,
HIV infection, malaria, and tuberculosis, "the public health implications of
this phenomenon are staggering", the WHO has noted, "and are already becoming
apparent".

The era of strings-attached IMF and World Bank loans, which forced the
dismantling of many indebted countries' public-health infrastructures, is partly
to blame. In Zaire, for example, World Bank and IMF "economic recovery" measures
required the government to slash its spending on social services - in a single
year, the government fired more than 80,000 teachers and clinicians.

In Zambia, within just two years of such programs, the nutritional and health
status of children had plummeted, canaries in a coal mine. Infant mortality rose
by 25 percent while life expectancy dropped from 54 to 40 years. In Argentina,
polio and DPT immunizations fell by nearly 25 percent between 1992 and 1998,
and throughout Latin America, previously controlled diseases such as cholera and
dengue fever re-emerged at epidemic levels. The flow of patients into clinics
and hospitals in Nigeria, Kenya, and Ghana slowed to a trickle, dropping by half
within days of the imposition of new fees.

"Before, everyone could get health care", one developing-country patient noted.
"Now everyone just prays to God that they don't get sick because everywhere they
ask for money".

Global trade agreements forged throughout the 1990s eased the entry of soda
makers and fast-food companies into the emerging markets of the developing world.
And western officials have willingly undermined public health protections in
developing countries when they appear obstructive to US business interests.
In the mid-1990s, for example, US State Department officials forced Guatemala
to scrap a widely praised law that saved the lives of scores of infants.

The law banned the use of images of chubby babies on infant-formula packaging,
which tended to encourage illiterate mothers to forego breastfeeding their
babies in favor of formula feeding, which in areas of sporadic access to clean
water often ended up killing their babies. But when baby food manufacturer
Gerber objected to the law, state department officials threatened Guatemala
with trade sanctions. Guatemala later gutted the law.

Access to cheap medicines to address these ills is scarce. Multinational drug
companies eager to access the growing markets of countries like Brazil and India
pressure these governments to crack down on cheap local producers of medicines
that undercut their sales. The problem is especially acute in India, where
1970s-era patent laws once protected only how products were made, not the
products themselves. The rule had allowed local drugmakers who could reverse
engineer drugs to manufacture knock-offs of the latest brand-name drugs at a
fraction of the cost.

The biggest Indian drugmakers, such as Cipla and Ranbaxy, have reverse
engineered some of the most important medicines of modern times, slashing
the cost of treating AIDS from $15,000 a year on patented, brand-name drugs to
just a few hundred dollars. What's more, bypassing the turf wars of brand-name
companies who would as readily add a competitor's drug to their own as Coke
would add some Pepsi to its six-pack, the Indian drugmakers combined several
different HIV medicines into combination pills that could be administered in
simple, once-daily doses. But when non-profit health organizations and activist
groups across the developing world started importing the cheap, Indian-made
generic drugs, the Western drug giants who had patented the compounds unleashed
a firestorm of protest.

In 1998, 39 multinational drug companies sued the South African government for
allowing the cheap drugs into the country. By 2005, India, along with other
developing countries roped into WTO agreements, was forced to strike down its
relaxed patent laws, instituting instead twenty-year patent protection for drugs
and other products. The vibrant generic drug industry - and the cheap meds it
made available - is now crippled.

For these reasons and more, as we start to address the deadly legacy of
hyper-marketed fast foods and sodas here at home, we should remember that the
problem does not end at the corner Burger King. We've spread the problem beyond
our borders, where its effect is likely to be much worse.

_____

Sonia Shah's new book The Body Hunters: Testing New Drugs on the World's Poorest
Patients is forthcoming from The New Press in July 2006. A fully updated
paperback edition of her 2004 book, Crude: The Story of Oil is forthcoming in
April 2006.

http://www.zmag.org/sustainers/content/2006-01/25shah.cfm


Bill Totten     http://billtotten.blogspot.com/