Developing countries

Editor-in-chief's editorial

While we may believe we understand the connection, Nauruans know first-hand, and perhaps better than anyone else, the bitter link between negative lifestyle change and one of its devastating consequences – type 2 diabetes. Located in the Central Pacific, 60 km south of the equator, Nauru is the smallest independent republic in the world. Its 10,000 inhabitants occupy a single coral island only 6 km long and 4 km wide. Approximately 80% of the population are indigenous Nauruans of Micronesian origin.

Despite a fall in diabetes prevalence from around 35% in 1975 to 16% in 2004, obesity and non-communicable diseases, including type 2 diabetes, remain the primary threat to health and well-being confronting Nauru in the 21st century. Nauru has few natural resources and, with a population of only 10,000, does not have the critical mass to support manufacturing. Nor, with a tiny land mass of 21 km² and unfavourable topography and soil conditions, can it support farming.

Diabetes in young people is a heavy burden all over the world but it is particularly severe in developing countries. Although the condition is the same, the context can be very different. Young people with diabetes in the Democratic Republic of Congo have to face a number of major challenges. They are perceived as having a ‘mysterious disease’ which requires a lot of attention on a daily basis throughout a lifetime. Belief in spells is quite common in Africa, and many families feel it is their responsibility to find the person responsible for causing the diabetes.

In South Africa, managing diabetes in children and adolescents can be especially challenging. South Africa is a country of great socio-economic and ethnic diversity, where healthcare, like culture, languages and customs, varies significantly from one area to another. Furthermore, access to healthcare depends on affordability and availability, ranging in quality between developed- and developing-world standards. With these challenges in mind, the DAWN Youth South Africa survey was undertaken to evaluate the effects of diabetes on young people with the condition and their  family.

India is undergoing an economic transformation – a financial boom according to many. Among India’s strong points contributing to this positive economic climate is its enormous young population. The potential for productivity, savings and investments by this generation will increase in the future, and is driving up levels of investments and confidence in the Indian economy. However, such gains are cancelled out to a large degree by excessive healthcare spending.

An article in this magazine in March 2004 described the Rapid Assessment Protocol for Insulin Access in Mozambique, and some of the results from its implementation. Since it was carried out in 2003, much has changed in Mozambique with regards to access to insulin and diabetes care. The Protocol provided vital information on the areas that the healthcare system needed to focus upon in order to improve care.

Like many other developing countries, Algeria is undergoing a transition in its disease  profile. The emergence of non-communicable diseases, including obesity-driven type 2

President's editorial

Chronic diseases are increasing in global prevalence and seriously threaten developing nations’ ability to improve the health of their populations. Indeed, chronic disease has become the dominant health burden in many developing countries. It is estimated that in 2005, chronic diseases were responsible for 50% of deaths and illness in 23 selected developing countries. Surveys from countries in all corners of the world reveal significant health and economic consequences from chronic diseases, with the greatest impact likely to occur in the poor countries that are least able to respond.