The solution to this crisis is not to tell people to be more careful but rather to combine education and policy to create an environment in which a healthy lifestyle becomes the default rather than a defiant act of will.
By Ryan McGreal
Published April 07, 2016
The myriad and often devastating effects and complications of this chronic disease include nausea, seizures, coma, cardiovascular disease, poor circulation, foot ulcers, nerve damage, blindness, kidney disease, cognitive decline, and mortality.
Type 1 diabetes - sometimes called "juvenile diabetes" because it manifests in children - is an inability of the pancreas to produce insulin, the hormone that regulates blood sugar by helping cells absorb sugar for energy. Treatment for type 1 diabetes generally involves administering insulin, since the body cannot produce it.
Type 2 diabetes, in contrast, is an acquired disease in which the body's cells become insulin-resistant: they become progressively less responsive to the presence of insulin by absorbing blood sugar for energy. As a result, cells become starved for energy and blood sugar levels do not drop.
The pancreas responds by producing more insulin, but as the condition worsens it can no longer produce enough insulin to counteract the insulin resistance.
The underlying cause of type 1 diabetes is not yet clear and it is not known how to prevent it.
Type 2, on the other hand, is very much a lifestyle-related disease. While there are some genetic predispositions, the onset of type 2 diabetes can be prevented or delayed by a lifestyle that incorporates a healthy diet and regular physical activity.
Unfortunately, the standard Western lifestyle of highly processed food and low physical activity have created a perfect storm of chronic disease pathogenesis - a perfect storm that is spreading around the planet.
As a result, the incidence of type 2 diabetes has been rising rapidly in developed countries but also increasingly in developing middle-income countries.
According to the WHO report, approximately 422 million people worldwide had diabetes in 2014. The incidence of diabetes among adults rose from 4.7 percent in 1980 to 8.5 percent in 2014, and continues to rise.
In fact, type 2 diabetes - formerly called "adult-onset" to contrast with juvenile diabetes - is increasingly showing up in children.
The report argues forcefully that the solution to this crisis is not to tell people to be more careful but rather to combine education and policy to create an environment in which a healthy lifestyle becomes the default rather than a defiant act of will.
Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids.
Taking a life-course perspective is essential for preventing type 2 diabetes, as it is for many health conditions. Early in life, when eating and physical activity habits are formed and when the long-term regulation of energy balance may be programmed, there is a critical window for intervention to mitigate the risk of obesity and type 2 diabetes later in life.
No single policy or intervention can ensure this happens. It calls for a whole-of-government and whole-of-society approach, in which all sectors systematically consider the health impact of policies in trade, agriculture, finance, transport, education and urban planning – recognizing that health is enhanced or obstructed as a result of policies in these and other areas.
It's not enough to say that people can make up their own minds and the state should not be trying to shape behaviour. The state is already shaping behaviour through policy decisions on how our streets and buildings are designed, decisions that make it difficult or impossible for people to choose active transportation.
The report is abundantly clear on the vital role of municipalities in creating a disease-resistant built environment that designs regular physical activity back into our lives:
The physical or built environment plays an important role in facilitating physical activity for many people. Urban planning and active transport policies can ensure that walking, cycling and other forms of non-motorized transport are accessible and safe for all.
The physical environment can also provide sports, recreation and leisure facilities, and ensure there are adequate safe spaces for active living for both children and adults.
The poorest groups in society, especially women, may have less time and fewer resources to participate in leisure-time activity, making policy interventions that target active transport and incidental physical activity throughout the day much more important.
This was borne out a few years ago in Toronto in a cohort study which found that the incidence of new cases of type 2 diabetes was signifciantly higher in less walkable neighbourhoods than in more walkable neighbourhoods, even after controlling for other contributing factors.
Another study, published in 2014, came to the same conclusion with respect to neighbourhood walkability and rates of obesity, which is an independent risk factor for diabetes.
Now, in a city that aspires to be "the best place in Canada to raise a child," this message has special significance.
Does Hamilton's urban planning policy support disease-preventing lifestyles with healthy eating and regular physical activity? Are individual projects and designs evaluated against this standard?
The conclusions of the report including the following recommendation:
Prioritize actions to prevent people becoming overweight and obese, beginning before birth and in early childhood. Implement policies and programmes to promote breastfeeding and the consumption of healthy foods and to discourage the consumption of unhealthy foods, such as sugary sodas. Create supportive built and social environments for physical activity. A combination of fiscal policies, legislation, changes to the environment and raising awareness of health risks works best for promoting healthier diets and physical activity at the necessary scale.
Will Hamilton be the best place to raise a child or the best place to raise blood sugar levels?
(h/t to Carlton Reid at Bike Biz for picking up on the WHO report.)
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