Fatal consequences: India counts the cost of its economic boom

By Julie Ji

7 July 2006
Chronic diseases such as diabetes are becoming an epidemic in India and are likely to trim approximately 1 per cent from the country's gross domestic product, according to new research from the University's George Institute for International Health.

A study on the prevalence and management of diabetes in rural India, led by Associate Professor Bruce Neal and his team, found 13 per cent of adults aged 30 or older have the disease, with a further 16 per cent exhibiting features of pre-diabetes. The study sampled more than 4,500 people in rural areas of Andhra Pradesh.

The findings reflect the rapidly changing nature of health problems across India, even in remote rural areas, said Professor Neal. He said that as countries like India undergo economic and social development, rising health care standards mean that most of the population can live past childhood into middle and old age. As a result, chronic diseases like diabetes start to replace infectious diseases and malnutrition as the main cause of health problems.

Cardiovascular diseases are the leading cause of death worldwide, accounting for 16 million deaths a year - the majority in developing countries. Professor Neal warned: "The growth of conditions like diabetes is going to drive a huge increase in heart disease and stroke in regions that are not well equipped to deal with them." Moreover, the onset of these diseases occurs 10 to 15 years earlier than in Western nations, at a time when people are still active and working, so the economic impact can be enormous.

Researchers have already identified simple low-cost ways of identifying those at risk of diabetes: for example, looking for signs of obesity and focusing on older people can help make diagnosis more cost effective. The George Institute is now focusing on developing low-cost strategies to improve detection and treatment rates, which will be crucial in managing the disease.

Although India has one of the largest generic drug industries in the world and the capacity for low-cost production, drugs are not readily available in remote rural villages. New national policies on drug pricing and distribution might achieve some of the gains seen with systems like the PBS in Australia, said Professor Neal.

He said it is crucial that India does not seek to adopt doctor-driven Western approaches to diabetes treatment - doctors are expensive and not widely available, especially in rural areas. Instead, the Institute is developing a model in which primary health carers and nurses in villages could be trained to identify symptoms and deliver care, at a much lower cost.

The current study is the second phase of the Andhra Pradesh Rural Health Initiative, a large-scale collaboration between the George Institute and the University of Queensland in Australia and the Byrraju Foundation, the Centre for Chronic Disease Control and the CARE Foundation in India. After meeting India's Health Minister earlier this year, Professor Neal and his team aim to generate more evidence about detection and management strategies for resource-poor areas, and incorporate them into India's public health policy.

Pictured: Researchers sampled more than 4,500 people in rural areas of Andhra Pradesh.

Contact: Richard North
Phone: 02 9351 3720
Email: rnorth@media.usyd.edu.au