Nepal: Paying the Price of Urbanisation

Jul 19, 2011
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A health crisis is brewing as diseases such as diabetes, stroke and heart disease spread with urbanisation.

1071 Increased urbanization has increased access to processed foods. (Photo: Dana MacLean )

Rapid urbanisationand the extension of the road network in some parts of Nepal are bringing chronic, non-communicable diseases such as diabetes and cardiovascular disease to formerly isolated rural communities, health experts say.

“Villagers are in a double whammy situation – they are already struggling with communicable diseases and are now burdened with chronic disease on top of it,” Jyoti Bhattarai, a leading endocrinologist at Nepal’s Diabetes Thyroid and Endocrine Centre (NDTE), told IRIN from Kathmandu.

“Non-communicable diseases like cardiovascular disease, diabetes, stroke and high blood pressure in Nepal are mostly due to rapid urbanisation in rural areas,” he said. “In villages where they only ate vegetables, people are now eating all sorts of processed food."

Up to 42% of deaths in Nepal are due to chronic diseases such as heart disease, stroke, diabetes, and cancer, and by 2030 rates are expected to climb to 66.3%, according to the Nepal Public Health Foundation, a multi-sector health network for NGOs and the medical community.

In villages where they only ate vegetables, people are now eating all sorts of processed food.

Type 2 diabetes has been a pervasive problem nationally since 2008 when a recorded 15% of people over 20, and 19% over 40, had the disease, according to the International Diabetes Federation (IDF), an umbrella organisation of more than 200 diabetes organisations worldwide.

Child malnutrition, which affects 1.7 million children in Nepal, according to the UN Children's Fund, makes people more prone to chronic disease later in life when they eat foods higher in sugar and fat, according to Rebecca Firestone, a social epidemiologist at the U.S.-based China Medical Board.

"Individuals exposed to undernutrition in pregnancy and early childhood may be more susceptible to health risks later in life when in more calorie-rich environments," Firestone explained.


Lack of awareness

Ritta Chettri, aged 40, from the rapidly urbanising Jhapa District, roughly 300km southeast of Kathmandu, has dealt with diabetes for the past four years. “[When I was diagnosed] my doctor told me I should have taken precautions but I was not aware of how to do it,” Chettri said. She said many of her friends and relatives also have diabetes. “We don't have enough awareness of how to avoid it."

While people of Asian descent are more genetically susceptible to high percentages of body fat (a precursor to chronic diseases such as diabetes) than their European counterparts, city lifestyles still remain the most pernicious culprit of chronic disease, according to NDTE.

"Increased consumption of processed and sugary foods as well as reduced physical activity, are causing increased rates of obesity, which is an important determinant of diabetes," Renu Garg, the World Health Organization’s adviser for Southeast Asia, told IRIN from New Delhi.

As city lifestyles gradually spread to rural areas, where 80% of Nepal’s population still lives, so the risk of non-communicable diseases in these areas rises. “Our observation is that diabetes in Nepal has increased significantly wherever there is road access,” NDTE's Bhattarai said. About 7,000km of roads have been built in Nepal in the past decade, according to the World Bank.

Garg blamed “irresponsible marketing of unhealthy food, especially sugary drinks and other unhealthy products like processed and packaged foods”, for some of the increases in diabetes.


Few treatment facilities

Though lifestyle-related chronic diseases are spreading to new areas, no hospitals outside the capital are trained to deal with them, Bhattarai said.

“I had to sell my farmland and my buffaloes to pay for the treatment. Now because of my disease, the whole family suffers," said Chettri, who has to travel 12-14 hours by road to Kathmandu to see a doctor.

More doctors should be trained in the chronic care model, according to Bhattarai. “Immediate steps [in prevention and awareness] are needed to control the health burden,” he said.

Nepal is only one of the countries in the region where lack of investment to battle an "uncontrolled non-communicable disease epidemic" has led to enormous health costs for vulnerable populations, according to a recent report by The Lancet medical journal. "A health crisis is transpiring right before our eyes," the study said.


This article was first published in IRIN.