Issue: December 2017 - IDF Congress 2017
Section: The global campaign
The impact of rural-to-urban migration upon diabetes in Bolivia
The United Nations reported that half of the world populations live in cities and expected that this will rise to 60% by 2030. In Bolivia, in the year of 1992, 58% of the national population lived in urban areas. Today, that figure is 75%. The mathematical projection with adjustments, indicates that in 2032, 90% of the Bolivian 15 million, will live in cities. This is principally due to rural to urban migration. The consequences of this migration in developing countries where urban planning and development is prioritized result in the rural underprivileged and the urban gifted access to better facilities and economic opportunities in urban centers than rural areas.
From the 339 Bolivian municipalities, 256 have a population of less than 20,000 inhabitants and in none of them is there a second level hospital, nor will there be any for reasons of economy of scale.
A peasant who moves to live in a city ceases to be a peasant because his productive, social and cultural relationship is with the land factor. An indigenous native who moves to live in a city, does not cease to be one, but does not take with him his mode of production; in the city there is no hunting, fishing or gathering, and both must compete at a disadvantage because they do not possess the instruments required by urban life.
Migrants in general tend to suffer from worse health and display disadvantaged risk factor profiles. While the trends of increased risk of diabetes among migrants are well documented, much less is known about the effects of rural-to-urban migration in Bolivia.
There is an important impact of the rural-to-urban transition upon diabetes in Bolivia. Being exposed to unhealthy lifestyles in an urban environment will increase the risk for developing diabetes. Migrants acquire the high risk of the urban population because their traditional ways of living are lost. They adopt modes of life that put them at similar risk to the urban population.
In Bolivia, a high percentage of the population declares themselves as indigenous (62%), presenting large disparities in health indicators that could be attributed to living in rural areas with a lack of healthcare. Despite there being minimal data on the prevalence of diabetes in the indigenous population of Bolivia, there are barriers to healthcare such as cost, education and also mistrust in healthcare services.
The migration from rural to urban areas is due largely for economic reasons. But, theres is another reason that may not be so obvious: climate change.
Santa Cruz de la Sierra, situated in eastern Bolivia, is one of the fastest-growing cities in the world: in the year 1900 the city had 18,335 inhabitants, by 1960 the population rose to 70,000. In 1976, the population skyrocketed to 254,682 inhabitants and in 2012, the population of Santa Cruz de la Sierra was nearly two million. It is expected that by 2020 there will be four million.
Santa Cruz will be, by far, the most populated city in Bolivia not only because of the historical tendency of growth, but also due to other events in the rest of the country related to climate change, such as desertification (process of ecological degradation of fertile land) of the Altiplano (Andean Plateau) and the Chaco zone (southwestern semi-arid lowland); the salinization (accumulation of salts) in other rural areas or the floods in Pando (northwestern jungle) and Beni (northeastern lowlands). People are moving, because of climate change, from one part of the country with less prevalence in diabetes to another with a higher prevalence.
Therefore regardless of the location, action needs to be taken to improve the health status of the population. Potentially, as the country’s economy grows, the disparity between rural and urban centres will be reduced. Therefore interventions specifically promoting healthy lifestyles will need to be undertaken to reduce the effect of the westernised lifestyles that have been imposed as desirable in Bolivia.
Douglas Villarroel is an endocrinologist, educator and Bolivian author. Currently, Dr. Villarroel is Editor-in-Chief of Diabetes Voice.