Diabetes Prevention in a Challenging Environment

Abstract

Pakistan is a developing country with diverse economic, educational, and social patterns. It has a population of 161.66 million, of whom 68% live in rural areas. Challenges faced by Pakistan are multifactorial: 30% (42 million) of the population live below the poverty line; 45% (61 million) of the population have no access to safe drinking water; and 40% (54 million) of the population have no access to even basic health services. Nine million children under the age of 5 years are malnourished and 8 million children do not go to school. Pakistan's education indicators are the worst in South Asia [1].The health facilities available for the people of Pakistan are very poor. There are 149 201 registered doctors, with 1206 population per doctor. There are 10 958 registered dentists and 76 244 nurses [2]. There has been little increase in public sector spending in the health sector for the last 40 years. Since 1970, public expenditure on health and health infrastructure represented 0.7-0.8% of GDP and 3.5% of total government expenditure. Pakistan spends less than 30% of the health budget on the development of health infrastructure while private expenditure forms the bulk (75%) of total expenditure on health [3].The International Diabetes Federation (IDF) estimates that there are approximately 7.1 million people with diabetes in Pakistan, ranking it seventh worldwide, and with the highest number of adults with diabetes [4]. This number is predicted to increase to 13.8 million by the year 2030, making it fourth in this list. These predictions are based upon populationbased studies conducted in urban and rural areas of the four provinces of Pakistan at different periods, which show a prevalence of diabetes ranging Prevention of Diabetes, First Edition. Edited by Peter Schwarz and Prasuna Reddy.

Current management strategies to target the increasing incidence of diabetes within Pakistan

“…The main contributors are sedentary lifestyle, including Internet and TV usage, and calorie-rich diets leading to increasing obesity 9,10. The prevalence of obesity among young adult is now 15%, and it is one of the main causative factors for the epidemic of diabetes in both urban and rural population of Pakistan 11…”