Two wide-ranging pieces of medical research issued in the last week have changed the way we see poverty around the world. In a previous generation the poor were typically perceived as starvelings, deprived of enough food to thrive. But research published in The Lancet, a medical journal, has found that for the first time the world has more obese people than malnourished.
A separate report by the World Health Organisation shows that the scourge of diabetes, once thought of a disease of the wealthy, is galloping across the world. Cases have quadrupled in the past 35 years and now one in 11 people worldwide suffers from it. Most significantly, two thirds of all new cases of diabetes are now in low and middle income countries such as China, India, Mexico and Egypt.
At one level the notion that the world is getting fatter is not surprising. The proportion of people in absolute poverty is declining. So it is natural that people should feed themselves better. And in countries where hunger is a haunting memory, it is understandable that grandma wants to see some spare flesh on her brood.
This is not to say that malnutrition has gone – it is still a serious problem in parts of India and Ethiopia and the African Sahel region which needs to be addressed. The issue is that a fuller diet has potentially catastrophic implications for health care budgets. Nor is it a surprise that diabetes, a disease in which the body cannot control levels of blood sugar, is growing. An over-rich diet combined with lack of exercise is a key risk factor for the disease. It is expensive to treat and has many complications, including heart attack, stroke, blindness, kidney failure and lower limb amputation.
There may be genetic and cultural reasons for the growth of diabetes but one clear factor is the “diet transition”: food that used to be caught or farmed and then transported and prepared with great expenditure of effort can now be consumed with no effort at all.
The outstanding case is American Samoa, a United States territory in the South Pacific where one in three people now has diabetes. The traditional diet has been replaced by rice, sugar, flour, canned meats, canned fruits and vegetables, soft drinks and beer. In a word, a swift transition from fish to deep-fried chicken.
There is a cultural reason here: being well fleshed was a sign of aristocracy in the South Pacific, notably in Tonga where the late King Taufa’ahau Tupou IV weighed 209kg in the 1970s before losing a third of his weight in a fitness campaign.
The situation in the Middle East region is no less dramatic. It has seen the highest rise of any region, with the prevalence of diabetes soaring from 5.9 per cent of adults in 1980 to 13.7 per cent in 2014. Egypt stands out: 16 per cent of the population has diabetes (compared with 8 per cent for the UAE), almost double the global average of 8.5 per cent.
This is not just a story of individual tragedies. The burden of the diabetes explosion threatens to wipe out the benefits of rising incomes in poorer countries. Professor Majid Ezzati of Imperial College London says that diabetes has now reached levels that can bankrupt some countries’ health systems: “The enormous cost of this disease – to both governments and individuals – could otherwise go towards life essentials such as food and education.”
Last year, research funded by a pharmaceutical company concluded that the cost of treating diabetes in Britain – believed to be the fattest country in Europe with a diabetes rate of 7.7 per cent – would rise from 10 per cent of the health budget to 17 per cent by 2025. The National Health Service rejected the idea that that this would “bankrupt” its budget, arguing that no one could predict how the cost of managing the disease might change over a decade. But there is no doubt of the seriousness of the challenge, even for the wealthiest countries.
And what of the poorer ones? Two things are clear. First, the concept of inequality – now largely seen in terms of money – will increasingly be understood in broader terms, including access to health care.
The end of abject poverty will mean little if the diseases that go with higher spending power cannot be managed or the government is unable to promote the necessary changes in lifestyle and diet.
All middle income countries are working on ways to improve the health care of their populations. After an experiment with the “user pays” model – under which those who need treatment beyond the most basic level must pay for it – the preferred goal is now for health care to be funded by taxes or national insurance schemes. But the sums do not add up if a health service has to cover the complex long-term needs of diabetes sufferers.
The second conclusion is that diet is going to be an increasing focus of public policy. The contribution of the meat and dairy industries to climate change has until recently been neglected. Putting meat and milk products on the table accounts for 15 per cent of global emissions, equivalent to exhaust emissions from all the vehicles in the world. With global population expected to rise from 7.3 billion to 9.7 billion by 2050, it is clear that many products of the livestock industry are going to be luxuries, not every day fare.
This has not been highlighted for the simple reason that telling people they cannot eat as much meat and cream as they like is unlikely to convert them to the cause of fighting climate change. This is especially true for those who have for generations lived off rice and vegetables and yearn to share in the delights enjoyed by others. But that does not change the simple truth: Diet is no longer a subject of individual choice. It is a challenge for all governments.
Alan Philps is a commentator on global affairs
On Twitter: @aphilps