NEED TO STOP THE TIDE OF CHRONIC DISEASES
In a report “Diabetes: a defining disease of the 21st century” published on 24 June 2023 by The Lancet, it is estimated that more than 1·31 billion people could be living with diabetes by 2050 worldwide, more than double the 529 million in 2021. Type 2 diabetes, usually an adult disease, is now occurring in childhood and, in fact, its incidence in US children had increased by 95% between 2001 and 2017.
Not only diabetes, but in the US, for those above 50 years-old, the number with at least one chronic disease is estimated to increase by 99.5% from 71.522 million in 2020 to 142.66 million by 2050. For example, fatty liver disease which used to occur only in alcoholics, now affects 100 million non-alcoholics in the US and has become the most common liver disease in children there, having more than doubled in the last 20 years. Now, there is even an unexplained increase in cancer in millennials in developed countries.
Chronic illnesses will cause about 70% of all deaths and account for at least 75% of healthcare spending in most developed countries.
Doctors can diagnose, treat, prescribe pills and give advice to control these conditions, but since their work do not address the underlying causes of these metabolic disorders, they cannot cure them. Management of these chronic diseases and their complications by clinics and hospitals will have to be long-term or for life, while the burgeoning number of new cases will add increasing stress to the system and costs to our economy.
Most of these worldwide trends are driven by demographic shifts causing national populations to age rapidly, the high stress of modern living, higher rates of obesity, widespread sleep deprivation, environmental pollution and occupational risks, tobacco use, alcohol use, and low physical activity. Yet, objective evidence seems to indicate that the most important factor is dietary in nature; especially the specific increase in consumption of high-sugar and high-carbohydrate ultra-processed foods since the 1980s. It is so prevalent that today, such foods make up 73% of US food supply.
To stop the tide, we need to empower our population to change their diet and lifestyle and political action to transform our food and social culture.
If the 3-year Covid-19 pandemic which resulted in 1,722 deaths necessitated a special national task force, this chronic disease tsunami would necessitate an even greater and wider effort to overcome it. The recently-launched Healthier-SG initiative is well-intended, but in its present form is ill-suited for the task as it is conceptually and operationally too narrow and misdirected. It is too tediously pre-occupied with data collection, selective age-group enrolments and individually-prescribed physical activities when it should be launching a free society-wide programme of culture change in our health landscape. Needfully, everyone of us will have to do our part urgently, starting from our children, our young and healthy all the way to our seniors, our doctors, scientists, researchers and politicians, to tackle the underlying causes of the crisis.
Though the challenge is great, much of what needs to be done is already known. First, we ought to start an honest and authentic conversation about the facts and the science. Then, we should believe that we are capable of changing our lifestyles. And finally, we must have the will and courage to do it!
