The Journal of the American Medical Association recently published some astounding findings about the spread of diabetes in China. As reported in Bloomberg, a nationwide survey found a rapid increase (what an expert quoted in the story called an “epidemic”) in the prevalence of diabetes. The spread of this disease is stark: since a similar survey in 2007, China has added 22 million diabetes patients, roughly equivalent to the population of Australia, meaning that 11.6 percent of Chinese adults have the disease. This morbidity rate only just edges out the United States (where the figure is 11.3 percent). By contrast, the regional average for Europe, based on 2011 figures cited by the International Diabetes Federation, is 6.6 percent.
The new findings put the origins of this health risk squarely on China’s growing affluence: “Chinese are developing the metabolic disease at a lower body mass index than Americans, the researchers found, meaning that changes in diet and physical activity stoked by rapid economic development are resulting in an earlier onset of the obesity-linked disease.” China, whose economic awakening is one of the most important stories of the new millennium, is not alone. India, whose economic growth has also boomed in the last two decades, is experiencing a similar sobering trend: by 2030, according to Time, India could see 100 million diabetics.
This trend is the tragic flipside to the effort at eliminating poverty in the developing world. Rising incomes, urbanization, and global trade makes for a more sedentary population (more office workers, fewer farmers) with the financial resources to consume calories beyond a subsistence level. In addition to diabetes, many of these countries are also seeing rising rates of cardiovascular disease and cancer, according to the Congressional Research Service.
Solving this issue is of crucial importance to the United States. It is in America’s self-interest that both China and India find a way for lifting their populations out of poverty in a sustainable way. That goal becomes incredibly difficult to reach if public and individual resources are being diverted to the maintenance of myriad costly chronic diseases.
In the cases of both China and India, lack of trained medical personnel is a contributing factor. Another important consideration is the availability of inexpensive drugs in places where millions of people still live on incomes below $2.00 a day. Unfortunately, in recent years, both countries have been battlegrounds for fights between their respective governments and international pharmaceutical companies over patent rights and generic drugs.
The recent case of Novartis in India is instructive: Novartis claimed that India’s licensing of a generic equivalent to one of their cancer drugs was a violation of their intellectual property rights and would slow future development of drugs. The Indians countered that they had a responsibility to their population to make life-saving drugs affordable, and that the new drug was not as much a quantum leap from previous iterations as initially advertised. (For its part, the Bloomberg story references a recent corruption probe the Chinese are conducting into British drug manufacturer GlaxoSmithKline, related to alleged bribery of doctors and government officials.)
The U.S. government certainly can play a role in solving this problem without necessarily getting mired in patent law. A first step would be restoring U.S. overseas global health funding. Most of current funding is aimed at combatting critical infectious diseases, such as HIV/AIDS, and U.S. programs, such as the President’s Emergency Plan for Aids Relief (PEPFAR), should be celebrated for the positive impact they have had. Sequestration has taken its toll on these global health programs, however: though funding increased during the 2000s, programs in the Foreign Operations budget were targeted for a 5 percent cut in Fiscal Year 2013.
While restoring funding would be a boon to America’s diplomatic prestige, it is as important to consider where the money should be directed. PEPFAR is already moving toward a model of capacity-building (as opposed to direct provision of medicine) in countries hardest hit by AIDS. When it was re-authorized in 2008, PEPFAR included partnership frameworks designed to help recipient countries designed operational plans to increase accountability in how aid money was spent. The frameworks include five-year strategies which included input from the U.S. and recipient countries to more clearly outline effective strategies. Organizations focused on global health policy, such as the Kaiser Family Foundation, have called for increasing the focus on such capacity-building.
The U.S.’s global health programs should adopt a similar approach for non-communicable diseases, increasing its focus on these diseases as a proportion of its total programming (currently, for example, only 1.2 percent of funding is explicitly earmarked for nutrition), and using methods and case studies built from how the world’s most advanced industrialized nation has faced and continues to face its own affluence diseases. With the “pivot” or “rebalancing” of U.S. foreign policy to the Asia-Pacific region a stated goal of the Obama administration, it would be one area in which U.S. actions could transcend a hitherto narrow security lens.