By Savanna Henderson, Humanitas Global
As the growing population concentrates itself in urban areas, governments find themselves unable to keep up with the pace, failing to provide necessary infrastructure. As a result, one in three urban inhabitants lives in slums or informal settlements. The United Nations Human Settlements Program (UN-Habitat) defines a slum household as “a group of individuals living under the same roof lacking one of more of the following conditions:
- Access to improved water
- Access to improved sanitation facilities
- Sufficient living area – not overcrowded
- Structural quality/durability of dwellings
- Security of tenure
In addition, urban residents, especially those in slums, are faced with issues related to food insecurity, provision of health care services, infectious and non-infectious diseases and poverty. Urban slums often suffer from a lack of health care services. As noted above, governments find themselves unable to match population boosts with an equitable distribution of health facilities and supportive infrastructure. This is especially daunting in countries, often the low- and middle-income ones, where healthcare infrastructure is already weak. In addition to the struggle for governments to provide accessible health facilities is the global shortage of health care workers. A report by the World Health Organization (WHO) revealed that the world will be missing 12.9 million health care workers by 2035. As the world loses health care workers, its’ urban populations are mushrooming and facing even more health risks that will go undiagnosed and untreated.
Urban areas are more reliant on imported food than rural areas and therefore are more susceptible to shocks in international food prices. High food prices greatly impact dietary diversity and studies (Download Afsun-1-pdf) in urban Zimbabwe have seen the proportion of urban households with adequate dietary diversity shrink from 87% to 59%. Those studies have also discovered increases in consumption of energy-dense, nutrient-poor foods, like potato chips and other fried foods. This change in diet, combined with loss in physical activity as rural residents adjust to the more sedentary lifestyle of urban living, can impact the health of urban slum dwellers.
It is important to keep these urban populations in mind as we approach World Diabetes Day this November 14. Of the 387 million people living with diabetes, 77% live in low- and middle-income countries; the same countries where explosive urban growth is most pronounced. Cities Changing Diabetes writes that nearly two thirds of those living with diabetes reside in cities.
Type 1 Diabetes
Type 1 diabetes is the most severe form of the disease. Individuals suffering from type 1 rely entirely upon insulin injections to prevent severe damage to their eyes, kidneys, nerves and the heart. Untreated type 1 diabetes can also lead to coma and death. In type 1, the body’s immune system attacks its own pancreas, specifically targeting and destroying the insulin-producing cells found there. These cells are responsible for sensing glucose in the blood. They then release insulin to help convert glucose into energy and normalize blood sugar levels. Without these cells producing insulin, glucose builds up in the blood and isn’t converted to energy. The resulting build-up of glucose in the blood stream, called “Hyperglycemia”, can lead to the potentially severe physical damages that are mentioned above.
Type 2 Diabetes
Type 1 diabetes, though the more severe form of the disease, is less prevalent than type 2. Type 2 diabetes accounts for 90% of all diabetes cases. In type 2, the body is unable to produce or use insulin efficiently. As in type 1 diabetes, the exact cause is unknown. However, risk factors known to correlate with type 2 diabetes include:
- Obesity
- Poor diet
- Physical inactivity
- Older age
- Family history of diabetes
- Ethnicity
- Gestational diabetes
Unlike type 1 diabetes, type 2 sufferers can manage their diabetes with diet and exercise or through taking an oral medication. However, if those methods fail, they will have to use insulin injections to control blood glucose levels.
Gestational Diabetes
Gestational diabetes appears during pregnancy and can lead to health risks for both mother and child. The cause of this form of diabetes is thought to be related to the pregnancy; hormones produced by the placenta can cause insulin resistance. If blood glucose levels aren’t adequately managed, it can lead to macrosomia or, a bigger than normal baby. Built up glucose travels through the placenta to the baby where the baby’s pancreas produces insulin to convert the glucose into energy, causing extreme weight gain. In many cases, the baby is large enough that it is necessary to perform a caesarean. Like type 1, gestational diabetes can be controlled with diet and exercise. Oral medication and insulin injections could be needed if diet and exercise fails though.
Challenges
The materials needed to control and treat diabetes can be prohibitively priced in any context, but are often so in developing countries. Blood glucose test strips, meters, oral medication, syringes and insulin can be too expensive for many individuals and families to take on. Novo Nordisk found that the life expectancy for a child just diagnosed with type 1 diabetes can be reduced to less than a year in parts of the developing world. Apply diagnosis of the disease and these costs to an urban slum and it’s hard to imagine a picturesque outcome.
All types of diabetes pose an enhanced risk to urban slum dwellers. Pregnant women with gestational diabetes face increased risk during birth, which is elevated if they cannot give birth with a skilled health worker or in a health facility. Many cases of type 2 diabetes go undiagnosed, with some victims living for years unaware they have the disease. Because the effects of diabetes are insidious and can be misinterpreted or hidden, individuals could potentially never know of their diagnosis if they have no access to health care services. Those who are living with diabetes could face more difficulty in receiving health care, education and treatment. Trying to control type 2 and gestational diabetes in a slum could prove impossible, with little to no access to a variety of healthy foods and safe places to exercise.
This World Diabetes Day, be sure to get involved and advocate for diabetes to be made a priority on health and development agendas. Diabetes is no longer confined to the borders of wealthy and developed nations. Attention needs to be paid to those most vulnerable populations who lack access to health services, struggle with food security and live in poverty. Learn more about diabetes from the International Diabetes Federation.
