Politics of Diabetes
Politics of Diabetes
Issue 116 - 11 Oct 2022 (8-min read)
"What is it like living there?" I get this question every time someone finds out I live in Tahiti. I also get this question every time someone in Tahiti finds out I am from Karachi. And I understand why. Those places couldn’t be further apart.
Tahiti is small, sparsely populated and so green. Karachi is huge, dense and so brown (although climate change is making it greener than before). And we don’t live the same way either. Life in Tahiti is slower while Karachi seems to be racing against time itself. And if that doesn’t convince you how far apart these two places are, you should know that Tahiti and Karachi are almost each other’s antipodes: two places on Earth located exactly opposite each other.
But enough about differences. I learned this week that Tahiti and Pakistan share more than I thought. The two countries top the charts for having the world’s highest prevalence of diabetes among adults, according to the International Diabetes Federation. In Pakistan, 30.8% of adults have diabetes while, in French Polynesia, it’s 25.2%. This are the highest in the world, followed by Kuwait (24.9%), New Caledonia, Nauru and Northern Mariana Islands (23.4% each).
You don’t have to dig too far down to find out why this is the case. It’s colonialism. The series of European, Japanese and American colonisers who have passed through Asia, Africa and the Pacific Islands have left behind a legacy of disease and suffering.
According to Dr Mubin Syed, colonialism physically altered South Asians through the 31 famines caused by the British Empire in the 18th and 19th centuries. South Asian bodies changed to adapt to starvation and, as a result, are able to generate and store more fat than usual and find it harder to burn it off. It also increases the likelihood of cardiovascular diseases among grandchildren by 2.7 times.
The story from the Pacific is no different. The World Health Organization has alarmingly revealed that on average half of the population in 10 Pacific Island countries is overweight, with some countries even reaching up to 90%. In American Samoa, an unprecedented 80% of women are obese.
Ethnicity plays a big role in giving Pacific islanders a "thrifty gene" that historically predisposes them to have slower metabolisms, perfect for enduring long sea voyages. However, the rapid societal changes brought by colonialism replaced traditional diets of fish and vegetables with processed foods imported from abroad, causing widespread obesity and diabetes.
What makes diabetes an even more worrying crisis is the fact that, while there is a general acknowledgement of the atrocities and health impact of nuclear testing by world powers in the Pacific Islands (which we covered in detail before), there is little to no attention paid to the diabetes epidemic. In fact, it is common to hear Polynesians being body shamed for their 'big size' as if obesity is their personal failure.
However, blaming the entire diabetes epidemic on colonialism would be simplistic. There are a range of factors and policies adopted by post-colonial governments that have ensured poor health and living standards for their populations, and it is important to know what those are to tackle the issue long term.
Researchers who study Type 2 diabetes have found that better treatments have done little to stem the rise of the disease. They have reached the conclusion that, "there is no device, no drug powerful enough to counter the effects of poverty, pollution, stress, a broken food system, cities that are hard to navigate on foot and inequitable access to health care, particularly in minority communities. Our entire society is perfectly designed to create Type 2 diabetes."
Diabetes is political. And if we want to control its epidemic, we would have to treat it as such. A group of American experts have prepared a roadmap for the US Congress to tackle diabetes and they are calling for a reframing of the epidemic as a social, economic and environmental problem. Solving the issue won’t just need better treatment or more access to healthcare, but also improving access to healthy food and clean water to rethinking the designs of communities, housing and transportation networks.
As we look into our own communities, how can we adapt this roadmap for our people? How can cities be pushed to become walkable not just for the sake of urban planning but for the very lives of its residents, to have a health agenda and not only a financial one? How can we decolonise our bodies from centuries of trauma we inherited from our ancestors? How can we dismantle oppressive structures that continue to malnourish certain sections of the population?
Until next time, take care and stay safe!
Hira - Editor - The Global Tiller
Dig Deeper
As upsetting as the politics of diabetes has been, the business of diabetes is even more alarming. With turnover of $46 billion, diabetes is a massive and extremely lucrative market. Constantly promised miracle cures have not led to satisfactory treatment, with patients either taking too many drugs or no longer being able to afford them. It’s a desperate situation, and the only ones benefiting seem to be pharmaceutical companies.
…and now what?
Hira asks us questions to help us look forward and to develop new systems to avoid the (many) mistakes of the past and shows just how important is to look back to make sure we don’t repeat those mistakes.
Let’s take a look at what happened in Tahiti. From the late 50s to the early 70s, Tahiti underwent huge systemic changes. The colonisation of its islands may have started in the mid-19th century but life here didn’t change that much in the following hundred years. The colonial systems may have been imposed but the economy and the local livelihood was not that impacted.
Tahiti was a colony, but one of least importance to France, a far away land without much strategic interest. But in the 1960s, as France was looking for a new place to pursue its nuclear testing (following the independence of Algeria), Tahiti became a hotspot, strategically speaking. Within a decade, modernity poured on the islands and a traditional lifestyle of centuries was flipped upside down. Change came fast, perhaps too fast. Depending on which side of the political spectrum you fall, in terms of being pro or against independence, your interpretation of this period of history will vary.
But after living, studying and working here, I have come to realise that it’s not the pace of change that was problematic, it was the fact that it was imposed on the population with the one-sided view that this modern-European lifestyle will be naturally digested by the local society. That there was no need for support, training or conversations on what should or should not implemented, or the adaptation needed. But perhaps, that was the point, to not give any choice to the local population to be able to resist any change.
And that’s a major flaw of the process of change. We consider it so obvious or, worse, so necessary that we tell people: this is where you should go, this is what you should do now. We always forget to look at the perspective of those who go through the change to make sure: they understand it, they accept it and, eventually, they manage it in a way that fits their interest as they see it.
Yes it may slow down the pace of change and, on the short term, it may seem like a waste of time but, on the long run, it’s highly beneficial.
Had modernity been proposed or adapted, maybe Polynesians would have found a way to use local crops in new ways, inspired by other influences. Maybe they would have found new systems to adjust with their traditional social organisation, adapted new tools improved from their traditional ones. Or not… maybe they would have kept what they had and that would have been fine too.
If you look at this even more deeply, you realise how much of imposed change is not only impacting people’s life, all the way down to their health, their life opportunities, their life span, but it also deprives us from other views, other ideas, other ways of doing things.
When change is imposed by one side, when its pace, its expected outcome serves the interest of some and not of all in the community, we are harming everyone for decades, if not centuries.
In Tahiti, it’s an impact that runs deep within people’s bodies: from diabetes to nuclear-induced cancers. It's an impact that has wiped out centuries of technologies and social systems that have been as efficient as the ability to develop communities throughout the biggest ocean of the world.
As we’re looking at the need to change quickly in the face of existential challenges, at the need to adapt new tools that are still imposed from the top, we may end up repeating the same mistakes and depriving our world of ideas and impacting people in their own flesh. So, as Hira asked: how can we do it in a way that will help everyone grow and thrive and not just allow some to earn and all the rest to be deprived?
Philippe - Founder & CEO - Pacific Ventury