Expert gives wake-up call for action against diabetes

Islamabad: The health sector in Pakistan needs to move beyond its existing national priorities, and take on greater challenges already within its mandate, to truly improve the health status of its population. Having a Prime Minister with a proven track record of commitment to cancer control inspires hope for affirmative action being taken for the prevention and control of Non-Communicable Diseases (NCDs).

Talking exclusively to ‘The News’ here on Wednesday, Dr. Ghulam Nabi Kazi, the World Health Organization’s former Communicable Diseases, Epidemiology and Health Systems Specialist currently associated with the University of Missouri-Kansas City School of Medicine, pointed out that “the health sector’s existing priorities are dictated by considerations ranging from good intentions, scientific evidence and international priorities and commitments, to donor funding.”

He believes there is a major and justifiable focus on maternal and child health and/or communicable diseases, with chronic conditions like diabetes, cancer, cardiovascular diseases and chronic respiratory diseases taking a back seat despite the existence of a long-approved National Action Plan for Prevention and Control of NCDs.

“Even though NCDs are also part of every health policy drafted or approved in the last two decades, there appears to be a major unexplained gap between policy and implementation in this regard,” he stated.

Focusing specifically on diabetes— a chronic, metabolic disease characterized by elevated levels of blood glucose, which leads to serious damage to the heart, blood vessels, eyes, kidneys, and nerves—Dr. Kazi reminded that with less than seven years left for Pakistan to fulfil its international obligations vis-à-vis diabetes control, appropriate programmes are required on a war footing at the provincial and district levels. “What kind of programmes,” he was asked. “At an operational level, such programmes may include capacity building of primary care physicians, paramedics and outreach workers; surveillance of diabetes trends; behaviour modification; early detection through screening to identify diabetics and high risk pre-diabetics; access to effective therapies to prevent life threatening complications; and nutritional surveillance focusing on overweight children. And all this has to be done urgently; the more we procrastinate, the more unattainable we will make our targets!”

Dr. Kazi also pointed out that while Pakistan is still a few steps away from imposing taxation on breast milk substitutes, sweetened sodas, and the most ‘notorious’ fast foods, it can still check unbridled advertisements of unhealthy foods and drinks along the style of tobacco control to somewhat mitigate their unwanted consequences. “It can also be proactive in promoting environmental action like increasing playgrounds while enhancing access to the right foods such as fruits and vegetables with a meaningful collaboration with the food and beverage industries,” he proposed.

Diabetes is a major public health problem that is fast emerging as a pandemic; it doubles a person’s risk of early death and contributes to a higher risk for ischemic heart disease, strokes, blindness, kidney failure, extremity amputations, and other chronic conditions. “Its role in exacerbating infectious diseases has been well documented. In terms of numbers, the situation is no less disparaging. As of 2015, an estimated 415 million people or 8.3% of the adult population had diabetes worldwide,” he shared.

Responding to a question on Pakistan-specific data, Dr. Kazi was reminded of the alarming results of the National Diabetes Survey 2016-17. “Over 35 million people above the age of 20 years in Pakistan suffer from diabetes; this should serve as a wake-up call.

The risk factors in our population include malnutrition, rapid urbanization with unhealthy lifestyle changes, genetic factors, and a singular lack of awareness leading to erroneous lifestyles,” he stated.

Dr. Kazi identified substandard diabetes care, heavy burden of undiagnosed diabetes, virtual lack of screening for pre-diabetics, and insufficient clinical monitoring of the complications of diabetes in Pakistan as the key factors contributing to rising cost of care, both in human and financial terms.

Despite this alarming estimated disease prevalence, Dr. Kazi believes that the provincial and district governments appear “ill-prepared to either cope with this major epidemic through systematic efforts or measure the economic and social impact of diabetes and other major NCDs in Pakistan. ” Seen from the purview of competing health priorities, such data could provide incontrovertible evidence for mainstreaming of the prevention and control of diabetes, cardiovascular diseases and cancers in public health planning.

Pakistan has participated in a globally agreed commitment to halt the rise in diabetes and obesity by 2025. “Suffice it to say, however, that the prevention and control of diabetes in neither simplistic nor easy, yet it is an absolute imperative both in the national and international perspectives for good reasons,” Dr. Kazi concluded, hoping that swift interventions succeed in turning the tide against NCDs.