The Canberra Times

By Lesley Russell

In the past 30 years the world has seen the number of adults suffering from Type 2 diabetes - a preventable disease directly linked to obesity - more than double. Globally, one in 10 adults (347 million people) now has diabetes. Obesity and diabetes are diseases of poverty in affluent environments and these shocking statistics are a direct reflection of what happens when development fails to include everyone.

In the developed world this is exemplified in the United States, where obesity and diabetes rates continue to rise. Overall, 25.8 million Americans have diabetes and 79 million have pre-diabetes. The rates are highest among those who are poor, less educated and minorities.

Currently nearly 70 percent of adults and 44 percent of children in Mississippi, the nation's poorest state with an average annual household income of $US35,693 ($A33,660) are obese or overweight, and 12 percent of adults have diabetes. Fifteen years ago, Mississippi's obesity rate was 19.4 percent. That was the highest in the nation then, but lower than the lowest-ranking state today, Colorado at 19.8 percent.

Australia has the same disastrous trends. Last year the Organisation for Economic Co-operation and Development found Australia has the fastest growing obesity rate among developed nations. One million Australians have diabetes and another two million are at risk for the disease, with indigenous Australians at greatest risk. The rate of diabetes has increased by up to 40 percent over the past five years in the poorer areas of NSW.

The impact on health-care budgets and productivity is crushing for Australia and the US. So consider the consequences of the escalating diabetes epidemic in developing countries where it could erase economic gains made in recent years and pose a severe threat to national and global economies.

The countries most at risk are those in the Australian-American geopolitical sphere. So even as Australia and the US struggle to tackle obesity, health-care reforms and budget crises at home, they must also look to being key leaders in the fight to prevent obesity and its consequences in the Pacific Islands, Asia, and the Indian subcontinent.

In China, soaring economic growth has taken a toll on public health and there are now more people with diabetes than any other country in the world; 92 million people have the disease and another 150 million have pre-diabetes. In India, an estimated 50 million people have diabetes. In Malaysia, diabetes prevalence has increased 250 percent in the past 20 years, and one in seven adults is diabetic. An estimated 12 percent of Jakarta residents have diabetes.

The poverty-stricken Pacific Island countries, the recipients of large amounts of aid from Australia and the US, have seen the most dramatic rise in diabetes. On some islands one-third of the population has the disease. And further afield, five of the Gulf States are among the top 10 countries affected.

While obesity rates are much lower in Asian countries, the rapid pace of economic development, changing diets with more dairy and meat, and increasingly sedentary lifestyles have led to expanding waistlines. It is fat stored around the abdomen that affects metabolism and the body's use of insulin. So while people in Asia generally have lower body mass indexes, they have an increased and earlier prevalence of diabetes compared with Western countries. This is aggravated by higher rates of gestational diabetes in women and metabolic syndrome (a precursor to diabetes) in children.

Caring for people with diabetes was estimated to cost the world economy $A355 billion in 2010, or 11.6 percent of total world expenditure on health care. More than 80 percent of this was spent in the world's richest countries, despite the fact that 70 percent of people with diabetes live in poorer countries. India alone spent $A2.64 billion.

In China it is estimated that diabetes accounts for more than 14 percent of the health-care budget and productivity losses of the order of 1.5 percent of GDP.

The prohibitive cost of treatment in developing countries means that prevention and early interventions are the only effective options for action. This may mean redirecting funds from industrial development and defence to agriculture and health. Neither Australia nor the US can serve as great examples here, with both countries spending less than 3 percent of their total health budgets on prevention.

However doing nothing at home and abroad is not an option. The World Economic Forum recently highlighted non-communicable diseases such as diabetes as one of the three most likely and severe risks to the global economy, and therefore to global stability.

Dr Lesley Russell works in health policy in Washington DC. She is a research associate at both the Menzies Centre for Health Policy and the US Studies Centre at the University of Sydney.