As my semester in D.C. is coming to a close, I am finding myself finally loosening up inside the beltway, and it has allowed me to take a step back and reflect on my lifestyle here in the past semester.  I wanted to share some of these reflections because it pertains to lifestyle choices related to health.

I am a rural, nature kind of girl.  I went to high school in a rural part of Connecticut right next to Lake Wononscopomuc, and one of the most exciting things to do was go swimming in the lake with your peers or go sit on the golf course to watch the sun set after a laborious day at school.  I loved it.  Even for college, I ended up at Cornell University, known to be a college in the middle of nowhere with nothing to do.  As you can see, coming to D.C. was a complete change for me, but thankfully D.C.’s beautiful Potomac river really saved me.  If it wasn’t for the Potomac river and the trails and paths around it, I am not sure if I would have gotten any physical exercise in this expensive city.  Having been in a rural area for the past seven years, it was easy to go out for a run outside whenever I wanted to.  Here, in the city, it seemed a lot harder – I didn’t want to pay for an expensive gym membership; and it was too difficult to run around my neighborhood, which is full of traffic lights and crowds of people.

However, one thing I realized about this city was the high ‘popularity’ of exercising.  Many people are always wearing workout clothes, walking their dogs, or just strolling alongside the river.  This motivated me to exercise more and stay healthy. And I would have to say that the aesthetically pleasing, safe, and easily accessible river trails definitely motivated me to engage in more physical activities outside as well.  I did some research on D.C., and not surprisingly, in 2011, D.C. had one of the lowest obesity rates in the U.S. after Colorado, Hawaii, and Massachusetts.  Though researchers are not able to exactly explain the relatively low prevalence of obesity in D.C., they speculate that it may be due to the use of subways, which requires more walking.

Unfortunately, when I reflect on my D.C. diet, I cannot say the same.  For someone whose diet always consisted of fresh fruit (especially apples!) and fresh vegetables, I have had a hard time committing to that kind of diet here.  Grocery shopping has been almost non-existent in my life this semester.  The closest grocery store is only a block away, but because it’s a small, privately owned downtown market, prices are high and selection is limited. The closest big-brand grocery store is about a 20-minute walk, and it’s a daunting task to lug around groceries on foot in one of the busiest areas of the city.  Consequently, I have been eating out for almost every meal.  Not only has this resulted in dire consequences for my bank account, but also for my health.  I find myself constantly having to compromise healthy food for cheap meals, and this has inevitably led to unhealthy choices.  Though my daily exercise has helped to balance my poor diet, I cannot deny that I have felt the physical consequences.  Eating out has decreased my overall energy level, and I’ve found myself needing more sleep than usual.  After this semester, I can no longer easily dismiss or deny the hackneyed phrase:  You are what you eat.  It really is true.

From analyzing my life here in DC, it’s clear that it takes more to build a healthy community than simply educating and advertising healthy food and physical exercise. We must also cultivate an environment that helps people make healthy choices.  The government and the public have placed this issue on the table, and there’s no doubt that there is work going on at the policy level to tackle these questions. I’ve seen banning of sodas, removing junk food from vending machines, and requiring restaurants to provide calorie counts on their menus. I have also seen the farmer’s market in the heart of the city at Dupont Circle on Sunday mornings.  Many grocery stores also provide delivery services that allow shopping for items online and deliver groceries right to your door.  However, personally, these programs did not help me; I had other commitments Sunday mornings, and delivery services were inconvenient because that required me to stay home for a block of time for delivery, not to mention the extra delivery fee.  But what I am realizing as I am reflecting on this post is that maybe this is precisely what changing lifestyle means to live a healthy life.  It’s not just about changing lifestyles to get more physical exercise or make better choices in our diet, but also about making sacrifices to make healthy living a priority.

Reaching one million people with text messages about diabetes, Arogya World is creating a new model for health education and disease prevention

Arogya World’s mDiabetes concept is as simple as its implications are vast. One million consumers from all over India have been enrolled by key partner Nokia to receive a series of 56 text messages on diabetes education and prevention, twice a week, in 12 languages, over the course of six months.

Developed with Emory University to ensure they are based on sound science and behaviour change principles, the messages were reviewed for cultural relevancy and accuracy by Arogya World’s Behavior Change Task Force and pre-tested with consumers. Arogya World is currently evaluating the effectiveness of the programme in bringing about behaviour change known to prevent diabetes.

At the time of writing:

• All one million consumers have been enrolled in the programme.
• 185,691 consumers have already completed the six month mDiabetes programme.
• Over 45m text messages have been sent.

About the Programme

mDiabetes is the flagship project of Arogya World, a US-based nonprofit organisation working to prevent non-communicable diseases such as diabetes and heart disease through proactive health education and lifestyle change. Arogya World is implementing this programme in partnership with several like-minded organizations – Nokia, Emory University, Biocon, Johnson & Johnson, Aetna and Ipsos. The mDiabetes project was formally announced as a Commitment by Arogya World at the 2011 Clinton Global Initiative Meeting.

Why India?

As the home of 60 million people with diabetes, India is at the front line in the fight against the disease. The World Health Organization says that diabetes, heart disease and stroke will cost India $237bn in lost national income between 2005 and 2015. India is a rapidly developing nation, and lifestyle changes including diet and level of physical activity are negatively impacting the health of a growing portion of the population.

“As we look forward, India is going to be a nation of 101 million diabetics in 2030 and has more than 900 million mobile phone users,” says Dr. Sandhya Ramalingam, Arogya World’s head of programme evaluation. “There is compelling clinical evidence that diet and exercise can help prevent diabetes. It is imperative that we motivate consumers to a lead a healthier life and do our bit in disseminating vital information on diabetes prevention to as many people as possible to bring about behavior change.”

Initial results are promising

Initial consumer feedback has been positive – more than 90% said they found the information valuable, and 85% said they would share the messages with friends. A study of the programme’s effectiveness is currently underway and a final report will be delivered at the Clinton Global Initiative conference in September 2013.

A scalable model for disease prevention

“The most exciting thing about our mDiabetes project is not the current initiative but how we are planning to learn and build upon this initial programme,” says Raj Davé, key advisor to Arogya World. “Diabetes prevention through mHealth has the potential to be one of the most cost-effective health interventions available to heath authorities. This potential will only be enhanced in future years as interactive technology becomes more affordable to developing populations and we are better able to target and engage individuals regarding their specific chronic disease risk factors.”

Thanks to the prevalence of mobile phones even in resource-poor settings throughout the world, the mDiabetes model can be easily adapted to different cultures, diseases and goals, putting valuable health and wellness information literally into the hands of the people who can directly benefit. mDiabetes is just a first step to a comprehensive chronic disease prevention model for the developing world, and a high-impact solution in the fight against non-communicable diseases.

Through family deaths from cancer and heart disease, I became personally aware of how Non-Communicable Diseases (NCDs) touch peoples’ lives regardless of gender, age, race or religion. Later on when I started a Masters in Public Health, I was struck by the enormity of the global NCDs problem which I learned killed 36 million people every year from diseases such as heart disease, diabetes, respiratory disease and cancers.  For example, the problem of diabetes and obesity has reached epidemic proportions and like NCDs in general, requires drastic, collective action and commitment from all stakeholders, to tackle the problem. The most shocking part in all of this is that many of these diseases are preventable since their development is linked to diet and lifestyle choices. So by changing what we do, we can help reduce the risk of getting these debilitating diseases.

The seeds for this article were sown through a chance discussion during the Geneva Health Forum in April 2012 about why drinking too much soda was bad for our health, and during which I realised that I wasn’t able to answer this question fully, despite being aware of the growing evidence of sodas’ potential negative impact on health.  Several months later, I was able to learn more about obesity and diabetes and how this is related to diet and lifestyle choices, including the role of sugary drinks, during a course on prevention strategies for NCDs at Oxford University.

From a public health perspective, I am convinced that NCDs will continue to feature higher on both the health and political agendas in both developed and developing countries because it is a vast and complex multi-factorial global problem requiring all stakeholders to take some very difficult decisions and action which may be met with resistance from the food and drinks sector.  Despite the complexity underlying NCDs and their risk factors, it is nevertheless possible to bring about positive changes provided the political will is there and all stakeholders are committed to reducing NCDS. The role of individuals is vital in the fight against NCDS because in your everyday roles as consumers of food and drink, as parents or teachers of school children, as employees or employers, you can help bring about the necessary changes to reduce NCDs. Key to this is understanding the issues and using your collective and powerful voice to apply pressure to bring about the changes urgently needed to protect the health of current and future generations.

See the full article here.

Stop the presses….

Just as we were putting the finishing touches on this article, a large scale study involving 27,058 men and women across 8 European countries has been published by the InterAct consortium led by Dr. Dora Romaguera at the Imperial College School of Public Health, London, showing a 22% increase in the risk of developing type 2 diabetes from drinking just one 12 oz can of soda a day. When people’s weight, height and what they ate were taken into account, this risk decreased slightly to 18% but it is still an important finding. Whilst these results do not conclusively prove that drinking sugary drinks daily causes type 2 diabetes, they do help strengthen existing scientific evidence, including the points we’ve discussed throughout the article.

Writing about the harmful effects of soda and working with Arogya World has been a rewarding experience. In particular I am indebted to Thea Joselow, Head of Arogya World’s social and digital media, for her valuable editorial assistance and for improving the formatting and readability.. I hope readers will find this article informative and thought provoking.

Mohinder Watson

In my recent work as an intern at Arogya World, I’ve been studying the alarming numbers and facts about NCDs worldwide and more specifically for India. Now I want to bring it closer to home and explore the issue in South Korea, my home country.

Diabetes is not as prevalent in South Korea as it is in India. In fact, I don’t think anyone who has visited South Korea would think that diabetes exists. TraditionalKorean meals are very well-balanced, and social norms and the media promote a healthy weight. On the streets, I haven’t noticed an obesity problem, and a study from the Organization for Economic Co-operation and Development agrees that the obesity rate in South Korea is one of the lowest in the world at 3.8 percent.

Yet according to the Korea Diabetes Association, 1 out of 10 adults over age 30 and about 22.7% adults over age 65 have diabetes, and recent data from 2010 show that there are a total of 3.2 million Koreans living with diabetes. A study published in The Korean Diabetes Journal says that the main causes of diabetes are smoking and genetics, and claims that smoking increases the risk for diabetes by 14%, a figure I find alarming. Over the years, I’ve seen the increasing popularity of smoking among teens and college students just from personal encounters and observation. However, a study also showed that in general, the smoking rate among South Korean men increased from 40.9 percent in 2008 to 43.1 percent in 2009. And not only is smoking increasing, but what’s more distressing is that smoking has become much more accepted among both students and parents. It’s important to note that not only is smoking a risk factor for diabetes, but smokers who already have diabetes experience far worse consequences: smokers with diabetes are three times more likely to die of cardiovascular complications than diabetic non-smokers.

We know that genetics and diet are two of the main causes for the rising number of people with diabetes in India. Because of their diet and genetic make-up, Indians are more susceptible to developing type II diabetes, especially at a younger age. Despite the differences in the main causes for diabetes in these two countries, the key to disease prevention is the same for both: helping people adopt healthier lifestyles. For example, in Korea, people need to be educated that smoking increases their risk of acquiring diabetes. People often associate smoking with only cancer, and thus, it’s important that the public is more informed of the many dangers of smoking, including diabetes. I believe that education and awareness can go a long way to improving health outcomes.

As an undergraduate following the medical track, I had always believed that a doctor is the only effective way to reduce illness, but I now realize that public health interventions can have incredible outcomes. Arogya World has proven to me just that. We recently announced how we enrolled one million people in a diabetes prevention mHealth initiative in India. Arogya World accomplished this by collaborating with Nokia to send out alerts through mobile phones about diabetes and its prevention through lifestyle changes. We are now awaiting effectiveness results. During my internship, I’ve also been able to attend many panels on global health and disease prevention this semester, and I’ve realized the power of education to make life-changing differences in vulnerable communities.

One attendee at the event shared with us the following message:

“As a woman whose family has been impacted by non-communicable diseases, I thank your organization for actively fighting against cardiovascular disease, diabetes, cancers and chronic lung disease. My friends and I were happy to donate to your cause through an Indian cooking class taught by my dear friend Prameela. I have the power to effect change in my family’s health one meal at a time!”

The attendees, who are all new to Indian cooking, also received a bag of Indian spices at the cooking class. This made it easier for them to cook an Indian meal for their families. Which they did! Many of them went home and cooked the items for their families.

We thank Prameela for her hospitality and generosity, as well as for her commitment to educating people about healthy eating and cooking practices.

If you would like to view some of Prameela’s recipes, please click here.

I am Ebele Mogo, the president of Engage Africa Foundation. I have quite an interesting story as I moved from the thriving metropolis of Lagos, Nigeria, to a much smaller city – Waterloo, Canada, to start university at the age of 14. Between then and now, I have earned a BSc in the Sciences from the University of Waterloo, an MSc in Global Health and Public policy from the University of Edinburgh, and have done work in research, community development, and exploring and acting on global and local emerging issues especially in the area of health.

Recently I and my team have embarked on the most fulfilling and challenging experience – doing something about the issue of non-communicable diseases (NCDs) in Africa. Growing up in Nigeria, I came face to face with the severity of the issue; from losing several loved ones and acquaintances to NCDs, to seeing women and their children pushed into dire poverty after their husbands died from NCDs, to seeing my classmate drop out of school because her father had died of cardiovascular disease.

During the course of my higher education, I had often felt very frustrated about how the growing problem of chronic diseases in Africa was largely understated in the academic and development spheres. It seemed there was no frame of reference for a conversation about chronic diseases in Africa, as the conversation had so far been dominated by infectious diseases which seemed to have become the ‘comfort zone’ where issues of health and development in Africa were concerned. This was quite frustrating for me until I realized my generation could do something about it.

At Engage Africa Foundation, our team consists of young people with diverse backgrounds ranging from human rights, to the sciences, to public health and information technology, all converging on our common desire to creatively and sustainably use the resources at our disposal to make non-communicable diseases a thing of the past.

It is our desire to do this through leveraging the power of social media, health promotion, and knowledge sharing and with an ever strong emphasis on prevention.

Recently we started a petition that aims to draw attention to the underestimation of chronic diseases globally. See the petition:

• The Bill and Melinda Gates Foundation: Take a lead role to curb the rising epidemic of non-communicable diseases

As you may know, chronic diseases are projected to overtake infectious diseases as the main cause of death even in developing countries. In the African continent where the family is usually the only ‘social insurance,’ once chronic diseases strike the breadwinners in their economically productive years as they tend to do, their dependents are pushed into poverty.

Non-communicable diseases not only cost the developing world trillions in dollars every year but also undermine all the great strides that have been made in fighting diseases, strengthening the health system and alleviating poverty. With the increasing impact of non-communicable diseases on health and economic growth, inadequate focus on reducing non-communicable diseases raises warranted questions about sustainability and equity in global health.

The Bill and Melinda Gates foundation are the largest funders of global health and we believe that if their priorities adequately represent the urgency of non-communicable diseases, then a more action-oriented conversation on the issue can be catalysed.

Our vision for this petition is to see the big players in global health specifically the Bill and Melinda Gates foundation, being the largest funders of global health initiatives make a prominent paradigm shift toward leadership in combatting chronic diseases as a global health priority.

I hope you will collaborate with us through proactively spreading the word about this petition among your network:

• The Bill and Melinda Gates Foundation: Take a lead role to curb the rising epidemic of non-communicable diseases

Thank you for making this happen.

Recently, my TweetDeck has been flooded with more news articles on adolescent health and the childhood obesity epidemic.  As I’ve been reading and researching more in-depth about childhood obesity, it was alarming to read that cases for type II diabetes in adolescents increased by 21% from 2001-2009 (SEARCH for Diabetes in Youth study).  A little over a month ago, Pediatrics published the first guidelines for children with type II diabetes.  A couple of weeks ago, First Lady Michelle Obama joined her first ever Google+ hangout for the three-year anniversary celebration of the “Let’s Move” health initiative—an initiative with a mission to reduce childhood obesity.

Obesity and related diseases have been rapidly increasing in the US and around the world, mostly among adults 40 years of age and older.  Adults living with diabetes can definitely testify to the challenges of living with diabetes—checking blood glucose daily, taking appropriate medicine, and making lifestyle changes including following a rigid diet and exercise plan.  Diabetes is also a leading cause of kidney failure, lower-limb amputations and blindness, heart disease and stroke.  Now imagine taking all of that on as a child.

According to SEARCH findings, there were 3,600 youths newly diagnosed with type II diabetes annually between 2002-2005, a rate of new type II diabetes cases of 8.5 per 100,000 adolescents.  Behind this increasing rate of new type II diabetes cases is the rising epidemic of childhood obesity, a major risk factor in developing type II diabetes, and statistics now tells us that about 17% of children and adolescents aged 2-19 years are obese.  Reducing childhood obesity must be our primary goal if we want to prevent the rise of new type II diabetes cases. It is crucial to keep in mind that once a child is diagnosed with type II diabetes, there are serious long-term health complications, even though diabetes is controllable with diet and exercise.  As a child, adopting a new lifestyle with a new diet and exercise plan proves much more difficult than as an adult.  Dr. Francine Kaufman, former president of American Diabetes Association, stated in an NBC news article that “over 90 percent [of children] need medication and only under 10 percent can actually be treated with what we call lifestyle mainly because so few can actually invigorate such a difficult lifestyle change.”

As mentioned in my last blog post, the adolescent period is critical for future health outcomes.  And I think it’s important to see that having type II diabetes as a child doesn’t only mean adverse health outcomes related to diabetes in the future; but that other major social and emotional health implications come with having a serious illness at such an early age. In promoting a healthier lifestyle for children, Mrs. Obama emphasized in the recent Google+ hangout that it’s important to not make this an issue about appearance, but that we must talk to children about how they feel inside.  Adolescence can be a very carefree period in one’s life, and most children just want to play.  But with diabetes, a child will be limited in many ways that a child without diabetes will not be.  As health always affects other aspects of our lives, it will inevitably affect a child’s learning, social interactions, and everyday activities.

Another way to look at this is to see that treating diabetes cost the nation $245 billion in 2012.  As cases of diabetes in children are rising, so surely will these costs rise as well.  And if it’s impacting the nation in such a significant way, it must also be impacting individuals at the micro level, and this all ultimately affects the development of a child.

Parents who adopt a healthy lifestyle at an early stage in a child’s life can play a critical role in ending this growing trend.  Many studies in the past have shown over and over again that parents have a huge influence during a child’s development. Parents play a vital role in reducing childhood obesity, and thus, preventing rising cases of diabetes.  And again, I quote Mrs. Obama: “we as adults have to make sure we are taking ownership as well and doing everything we can to make the journey easier for [our children]”.  For more information, you can visit the Let’s Move! initiative online.  Anyone who is involved in a child’s life must take action now, however small or big, to address the growing problem of type II diabetes in children

Bangalore, 20 March 2013. Arogya World and Nokia India today reported that they have enrolled one million people into mDiabetes, the groundbreaking diabetes prevention mHealth initiative in India.  As part of mDiabetes, an ongoing Clinton Global Initiative (CGI) Commitment and one of the first and largest programs of its kind in the world, alerts have been sent in 12 regional languages, informing Nokia mobile phone users in India about diabetes and its prevention with lifestyle changes. It is also estimated that more than 70,000 consumers have completed the six-month program, having received free-of-charge mDiabetes alerts twice a week.

mDiabetes runs on the Nokia Life platform, which delivers life-enhancing information and advice co-developed with more than 90 knowledge partners, and works on a wide range of Nokia mobile phones. To-date, Nokia Life services covering topics such as health, education and agriculture have been experienced by more than 95 million people across India, China, Indonesia and Nigeria. The mDiabetes program in India started in January 2012. People enrolled for this service span residents of rural and urban India.

“mDiabetes is of special significance in India, a country with an enormous diabetes burden. We are encouraged by the positive consumer feedback we have received for our alerts to date. If effective, mDiabetes will add to the evidence base for mHealth and become the cornerstone of a chronic disease prevention model for the developing world. We are pleased with the progress we have made and are well on our way to honoring our CGI Commitment,” said Dr Sandhya Ramalingam, Head, Program Evaluation, Arogya World.

Commenting on the development, B.V. Natesh, Director – Emerging Market Services at Nokia said, “Nokia Life was designed to address livelihood and life improvement needs of consumers in emerging markets such as India. Since launch, the service has been experienced by more than 50 million people across India. With the rapid growth of mobile penetration, campaigns such as mDiabetes have the potential to reach millions of people, helping build awareness and associated behavior change.”

Karthik, a 29 year old working professional from Tamilnadu in South India, uses a Nokia Asha 311 with Nokia Life. He enrolled in the mDiabetes program because his father has had diabetes for the last 3 years.  “Earlier my father did not go for his walk regularly and was not careful about his diet and weight. I now make him go for a walk everyday, have added more healthy food items to his diet and made him aware of the problems of diabetes. This program helped me gain a better understanding of diabetes, which I use to help my father have a better life.”

Positive reactions have been obtained from other consumers as well. In 2012, Arogya World asked 750 consumers what they thought of individual mDiabetes alerts. The results obtained were promising – 70% of the consumers said they remembered receiving the alerts, of which more than 90% said the alerts were clear and easy to understand, and importantly, more than 80% were willing to share the alerts with friends and family.

Effectiveness evaluation of the mDiabetes program is in progress.

About mDiabetes: mDiabetes is Arogya World’s flagship program.  On 20 September 2011, at the CGI Annual Meeting, Arogya World  committed  (http://www.arogyaworld.org/media/press-release-announcement/arogya-world-launches-new-diabetes-prevention-mhealth-program-in-india-with-nokia-life-tools-2/) to providing alerts on diabetes and its prevention in 12 languages to 1 million Indian consumers, and to measuring program effectiveness.  The non-profit was joined in this two-year Commitment by multiple partners: Nokia, Emory University (Rollins School of Public Health), Aetna, Johnson & Johnson (Lifescan Inc.), Biocon and Ipsos (formerly Synovate).

Noteworthy program accomplishments include i. developing 56 text message alerts with Rollins School of Public Health of Emory University with emphasis on science and behavior change theory, ii. getting them reviewed for technical accuracy and cultural relevancy by Arogya World’s Behavior Change Task Force, made up of medical, health promotion and consumer communications experts iii. consumer testing of alerts, both before and after transmission iv. refining mDiabetes content based on consumer feedback v. finalizing Effectiveness Evaluation research design, with the input of academic experts from around the world vi. getting ethics approval for the research plans from an independent expert committee in India vii. completing the Pre-phase of Effectiveness Evaluation and viii. establishing a thriving public private partnership in which each partner has a unique role but all are driven by a common purpose – using technology to improve health outcomes.

Background: At the core of this program is the compelling clinical proof that diabetes and other NCDs, non-communicable diseases, can be prevented with lifestyle changes.  According to the WHO, 80% heart disease, 80% diabetes and 40% cancers can be prevented by avoiding tobacco, eating healthy foods, and increasing physical activity.

India’s diabetes burden is alarming. See http://www.arogyaworld.org/our-work-in-india/.

About Arogya World

Arogya World (www.arogyaworld.org) is a US based non-profit changing the course of chronic disease, one community at a time.  In India, the organization implements programs for preventing diabetes through lifestyle changes in schools, workplaces and the community. To further advance the organization’s work, it has set up a Trust in India.

mDiabetes is a registered trademark of Arogya World.

About Nokia

Nokia is a global leader in mobile communications whose products have become an integral part of the lives of people around the world. Every day, more than 1.3 billion people use their Nokia to capture and share experiences, access information, find their way or simply to speak to one another. Nokia’s technological and design innovations have made its brand one of the most recognized in the world. For more information, visit http://www.nokia.com/about-nokia.

Media Contacts – Arogya World – info@arogyaworld.org

As Indian Americans, we have a lot to be proud of in our communities and in the changes underway in India. Today, to protect our families and this remarkable progress, we must address one of the greatest health and development challenges of the century, the rise of non-communicable diseases (NCDs). NCDs, including diabetes, heart disease, cancer, and chronic lung diseases, have thus far escaped our attention and collective action.

The Rising Threat of NCDs

NCDs kill 2 out of 3 people today – six times as many as from HIV, TB and Malaria combined, making them the greatest threat to health and development that you’ve never heard of. It’s a mistake to consider these diseases of affluence – 80% of the deaths are in developing countries, and NCDs hit the poorest of the poor the hardest. It’s true that India and other developing countries have raised standards of living and made great strides against many infectious diseases, but there is little time to celebrate: the recent Global Burden of Disease report from the World Health Organization established that while infectious disease is decreasing, the prevalence of NCDs is increasing rapidly around the world.

It is to address this epidemic that I started a non-profit, Arogya World, a couple of years ago. We take a proactive approach to preventing NCDs and engage with individuals and health policy leaders alike on the issue. Our name is aligned with our mission – the word Arogya in Sanskrit means to live a life without disease.

NCDs Matter to all Indian Americans

In India, the country of our origin, 20% of the population has at least 1 chronic disease, and 10% suffer from 2 or more.

• Some 60 million Indians live with diabetes and 1 million die from it each year.
• Indians get diabetes at least 10 years earlier than Americans, often in their 30s and 40s rather than in their 50s or 60s. We likely have a greater pre-disposition to diabetes than other Americans.
• In the US, where we live, the diabetes figures are no less alarming. Some 26 million Americans have diabetes – nearly 1 in 10. More than one-third of Americans are obese and by 2030 half of us will be.

The combination of our genetic profile and Western lifestyle means that the risk for diabetes is alarmingly high for Indian Americans – it is for us a double whammy.

Why are Indians more prone to diabetes?

• Combine the presumed genetic predisposition with today’s sedentary lifestyles and love of fast food and you have big risk factors.
• New research also suggests that low birth weight can lead to diabetes later in life. Malnourished mothers in India often have low birth weight babies, which in turn may increase the risk of diabetes and heart disease when the child grows up.
• And indeed even something as seemingly innocuous as mealtimes can have an influence. A recent study showed that eating dinner late in the evening can increase the risk of diabetes. And we know that among Indians serving dinner at 10 pm is not considered late!

There is Hope in Prevention

Diabetes is preventable. We don’t need to wait for a new technology or vaccine. There is compelling proof from landmark clinical studies that moderate exercise and a healthy diet can prevent diabetes and keep it at bay for at least 10 years. According to the World Health Organization 80% diabetes, 80% heart disease and 40% cancers can be prevented by avoiding tobacco, increasing physical activity and eating healthy foods.

Unfortunately, diabetes is so commonplace we are lulled into inaction. The hard truth is that diabetes is the leading cause of preventable blindness, and leads to heart disease, kidney disease, nerve damage and even amputations. The healthcare costs are staggering. The World Economic Forum (WEF) ranked NCDs as one of the greatest risks to global well-being – similar in magnitude to the fiscal crises we read so much about. WEF projects a cumulative loss of $47 trillion to global GDP by the year 2030 from NCDs. Staggering, to say the least. Poor families in India, for example, may spend 25% of their total income on diabetes care for one adult.

Prevention through lifestyle changes is at the core of Arogya World’s work. In India, we are educating and empowering housewives and farmers, working adults and school children to take small steps towards preventing diabetes by leading healthier lives. Our flagship program, called mDiabetes, is a Clinton Global Initiative commitment. In partnership with Nokia, we have reached over 1 million people in India with diabetes prevention text messages. See www.arogyaworld.org, follow us on Twitter and join us on Facebook. This is a big year for us, and we invite you to watch how our small but “mighty” organization is reaching more people and having a greater impact than ever before.

I started off my internship experience with Arogya World by attending a breakfast panel titled Milestones in Adolescent and Youth Health and Development, hosted by the International Center for Research on Women along with the United Nations Foundation.

Maybe it was the delicious pastries, the amazing speakers, or the gripping numbers and stats, but I found it fascinating. Sure, I’ve taken undergraduate courses relevant to human development and global health, but it had never really attracted my attention in the way that this panel did.

This panel shed light on the positive implications of actively including the youth when tackling the rising problem of NCDs.  A well-known statistic about non-communicable diseases (NCDs) is that they kill more than 36 million people each year and 80% of NCD deaths occur in low- and middle-income countries.  And of the 7 billion people in the world today, 45% of the population is under 25 years old.

From these numbers alone, it’s safe to conclude that in any country, the adolescent period is critical to set the tone for future health outcomes.  Nearly one in five of the world’s adolescents aged 13-15 years use tobacco, the leading cause for cancer.   70% of overweight adolescents have one or more risk factor for cardiovascular disease, and in the United States alone, approximately 12.5 million of those aged 2-19 years old are obese.  Clearly, there is an urgent need to invest in the world’s youth to alleviate the global burden of NCDs.  If children are now being affected with NCDs and adopting behaviors that contribute to future development of NCDs, the future looks bleak.

The Lancet published a series on adolescent health in 2012 and Dr. Susan Sawyer, one of the authors of the series and a speaker at the panel, introduced the conceptual framework for adolescent health.  The framework shows how different factors such as social context including home and school environment, risk and protective factors, and even social media exposure affect future health-related behaviors.  In an interview with ABC on this series, Dr. Sawyer comments on the impact of the changing global social environments on the health of young people:

We are seeing some remarkable global change because in terms of the drivers of health behaviours in young people, it is no longer simply restricted to one’s narrow village or even at a national level but the impact of social media, globalisation, the change from predominantly rural to highly urbanised communities has throughout the globe, including countries like India, particularly in the African countries, has really changed the nature of community in these countries and has in a sense reduced the extent of social scaffolding that has previously been of major support of protecting young people as they move towards a path into adult life and many of those structures have broken down.

So what does this mean?  Coming up with appropriate policies that address healthier social environments and monitoring social media for healthier marketing of products and lifestyle for adolescence will be critical.  For example, a past study has shown that schools that have strong relationships between students and teachers result in reduced social behaviors that have negative health consequences.  However, what does this mean for us ordinary people who are not directly involved with policy-making?

For the rest of us there are still many things we can do at the micro level that will have lasting implications.  If you are a mom, you play a critical role in your child’s adolescent period.  It is during the adolescent period, especially during puberty that we are biologically evolving.  Make sure you are presenting a healthy diet to your children.  In 2009, Dr. Reimer discovered that our diets during childhood directly influence the expression of genes related to our body’s metabolic pathways later on.   As for school environments, get involved in your child’s school system and make sure that your child’s school is prioritizing a healthy social environment.  Also with the rising number of children engaged in social media, increasing concerns include lack of physical exercise and more sleep disturbances which both have negative health consequences.  Make sure your child is getting enough physical exercise during the week.

It’s important that we do not neglect adolescents as we work to reduce the incidence of NCDs and improve health globally.  We are discovering that the adolescent period is a critical time period for future health outcomes.  It’s a hackneyed phrase, but children are our future, and if we do not take action now, our future health statistics will be increasingly alarming.