Zack Gross
Zack Gross

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Poor Face Double Burden of Disease 

Brandon Sun “Small World” Column, Monday,  Monday, February 27 / 12

Zack Gross

It used to be that developing countries faced high mortality and morbidity (illness) rates due to the communicable diseases they were vulnerable to because poverty and deprivation.  These diseases included malaria, tuberculosis, measles and HIV/AIDS.  Now, as modernization – but not wealth – catches up with the poor, they face a “double burden” of disease, the non-communicable kind, including heart and respiratory illnesses, cancer, diabetes and even greatly increased road accidents.

In 2008, two-thirds of deaths globally were of the non-communicable variety.  You might say, glibly, that we are now “doing it to ourselves” by our habits and appetites – but it is not that easy!  In part, the cause of illness in developing countries is the same as here in Canada.  We have become fast food junkies, moving away from our more natural diets toward convenience foods that are high in sugar, salt, preservative and processing chemicals, and fat.  This trend began in my teen years in the Sixties, and has come to Africa, Asia and Latin America more recently.

Says a medical student on a tour of duty in Ecuador, when writing in her on-line Global Health blog: she met many people who were both malnourished and obese.  Many suffered from hypertension, vitamin deficiencies, parasites and tooth decay.  Many of the children she treated had stunted growth.  These people faced the “usual” problems of poor sanitation and lack of food, but also what they did eat was “not good for them
” The cause might be lack of education and lack of money to buy good quality food.  In Mexico, I saw on a visit to poor communities there, the Coke truck reaches the least accessible village where buying milk for your children is much harder to do.

A disturbing story about immigrants to our Western world hit the airwaves recently, on The Nature of Things, about the instance of autism in the “new Canadian” population.  Evidence points to the very negative impact of processed foods on the abilities of many children who have come from a natural diet.  The increasing instance of autism in the more traditional Canadian population and the concern about obesity in children is an indication of the impact of processed foods and lack of fitness activities in our population.

The President of Tanzania, Jakaya Kikwete, recently spoke on this subject at the United Nations.  Due to poor diet and lifestyle habits, he said, smoking is up to 10%, obesity is at 22%, raised cholesterol also sits at 22%, and high blood pressure stands at 30%.  In a poor country with little money to cover health care services, the treatment of diabetes or heart disease can cost a household 25 to 40% of its income.  It’s a double burden because the country also still faces those other communicable diseases – they have not gone away and also take huge resources to deal with, or are just not dealt with.

A Sri Lankan researcher reports that even a more modern Asian country like hers suffers from modern diseases on top of traditional ones.  Addictions to alcohol and drugs, sexually transmitted diseases and suicide are now prevalent issues in her island nation, along with the effects of a long civil war (which make it a triple burden).  Prevention and community health tend to receive the dregs of the health care budget after 85% of funds have been used in direct care.

The ultimate in modern health challenges is the motor vehicle.  It is now the leading cause of death by injury, with over a million killed and fifty million injured every year, occupying half the orthopedic beds in developing countries.  85% of world road deaths occur in poor countries and three-quarters of the deaths are to males in their productive years, causing great economic as well as emotional hardship.  Poor roads, lack of regulation, impairment and speed mean that vehicles and their drivers not only mow down one another but also pedestrians and cyclists. 

These serious conditions of the double burden of disease are not just caused by individual choice – by drinking, smoking, speeding, poor eating habits or lazing about.  That is the small picture of what is happening.  The big picture is that rural people in developing countries are moving to the city and away from traditional sources of food and exercise.  Land on which they have grown their food is being given over to export agriculture which means less employment, less income, indeed less food for all. 

Meanwhile, social programs that offer nutritional education and health care are being cut back in the name of smaller government and debt reduction, policies promoted by international financial institutions.  The city ultimately doesn’t offer a positive alternative – it often means living in a slum, dealing with daily poverty and violence.  Jobs often mean under-employment, under-payment and poor working conditions that also contribute to the burden.

The double burden that the poor deal with today is not just a “Third World” phenomenon.  It is the reality for poor Canadians and Manitobans with rates of high blood pressure, diabetes, crime and suicide much higher than the average, and life expectancy a decade shorter. 

As the 2015 deadline to reach the United Nations’ Millennium Development Goals draws nearer, signaling that we are tackling these urgent issues and making progress, we can see that we will fall short and have much to do at the global, community and family levels.


Zack Gross works for the 
Manitoba Council for International Co-operation (MCIC), a coalition of more than 40 international development organizations.

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