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FFifty years ago, a diabetes study conducted in the Republic of Nauru concluded that a third of Nauruans had type 2 diabetes. This is the first time this relatively rare disease has been found to be widespread in the population, and researchers have sounded the alarm about the potential.global diabetes epidemic”.
At the time, there were few other studies on population-wide diabetes, so the researchers made several assumptions to explain the data and suggest future solutions. First, they said that diabetes on Nauru was probably caused by a genetic predisposition to diabetes in the islanders (this hypothesis was later criticized by the original authors and is still not supported by data) archaeology, anthropology or genetic); the modernization of the islanders’ lifestyle has led to a high-calorie diet (a theory held by my colleagues and colleagues) I’ve been trying ever since); and decreased physical activity and obesity. Second, they suggested that these causes may be most effectively addressed through nutrition and lifestyle education.
Subsequent research has built on these claims, and for 50 years researchers have focused primarily on diet and physical activity as causes and treatments for type 2 diabetes on Nauru.
Despite decades of interventions based on these studies, type 2 diabetes remains a leading cause of death and disability, along with heart disease and stroke, in Pacific island nations. ing. There are also serious disabilities associated with diabetes, from gangrene and amputation of limbs to blindness due to kidney disease, and many people experience the debilitating side effects of diabetes medications. Life expectancy remains low, around 60 years for men and 66 years for women.
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The human cost of non-communicable diseases (NCDs) is enormous and increasing. These diseases claim about 41 million of the 56 million people who die each year, three-quarters of whom live in developing countries.
NCDs are just that. Unlike, for example, a virus, it cannot be transmitted. Rather, they are caused by a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancer, chronic respiratory diseases, diabetes, and cardiovascular diseases (heart attacks and strokes). About 80% are preventable, and all are on the rise as economic growth and urbanization drive aging populations and lifestyles, making poor health a global phenomenon. It is spreading all over the world.
NCDs were once considered a disease of the wealthy, but now they also affect the poor. Illness, disability, and death are perfectly designed to create and widen inequalities, and the poorer they are, the less likely they are to receive accurate diagnosis and treatment.
Investments in tackling these common and chronic diseases that kill 71% of us are incredibly low, while the costs to families, economies, and communities are staggeringly high.
In low-income countries, some of the needed funds are invested or donated to fight NCDs, which are usually progressive and debilitating diseases. Although the threat of infectious diseases continues to receive attention, cancer mortality rates far exceed those caused by malaria, tuberculosis, and HIV/AIDS combined.
‘Common Symptoms’ is a Guardian series that reports on the prevalence, solutions, causes and consequences of NCDs in the developing world and tells the stories of people living with these diseases.
Tracy McVeigh, Editor
How is it possible that 50 years later, we are still making similar assumptions and reaching similar conclusions about type 2 diabetes, even though the evidence shows little improvement?
What if the assumptions are wrong?
In the early 2010s, I began researching obesity in Nauru. Building on previous research, I aimed to track how people’s diet and physical activity changed throughout the 20th century. But after a year on the island, it became clear that the biggest changes the people of Nauru had experienced were not their diet and activities.
I pivoted my research to focus on their voices. I documented the history of low socio-economic status, social stress, and family rifts associated with colonialism, wealth, poverty, and land loss on the island. I learned about changes related to globalization, healthcare, mining, technology, immigration, and he two world wars. I avoided drinking from national desalination plants, which often have high levels of bacteria. I breathed in the fine white dust mist from the phosphate mines, leaving a dusty film of “Nauru snow” on my houses and glasses.
All of these aspects of life on Nauru are consistent with the rise of type 2 diabetes as a population-wide phenomenon on the island. However, they do not fit neatly into the 50-year-old framework of diabetes as simply the result of an individual’s diet and physical activity behavior.
I initially thought that the medical facts that had echoed through decades of diabetes research on the island must be correct and that my social research was somehow flawed. I don’t really understand it now. Creeping doubt made me pause and question the claims made in the original diabetes study.
Debunking the idea of an isolated nation
In 1974, just six years after Nauru gained political independence from the colonial powers, Austin Bernicke, Nauru’s Minister of Health and Education, gave the green light to the world’s first national diabetes survey.
The Australian research team tested 100 people on the first day. The results were so unexpected that one of the researchers thought the blood sugar measurement method was flawed and immediately returned to Melbourne.
However, the methodology was solid. The study concluded: 34% Two-thirds of Nauruans and those over 40 had diabetes.
The final report’s suggestion that Western diets and activity levels caused diabetes among the islanders, but not among Westerners, was not until after World War II, when islands such as Nauru were said to have ” It depends on the third assumption that the person was isolated from “contact”. Rapid modernization occurred.
The evidence paints a different picture. Since the late 1800s, the people of Nauru have had various aspects of their lives controlled by various colonial authorities (including Germany, Britain, New Zealand, and Australia). They had experienced racism, Japanese occupation, and a fight for political independence. They received educational programs at missions and colonial schools that exposed them to the culture of whalers, traders, and Chinese miners. Nauru’s commercial and strategic importance as a radio and telegraph station, and its high-grade phosphates used as crop fertilizer in many countries, made it more than a century later than the report had assumed. We have been connected to the world for a long time.
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The research team did not examine this medical history, likely because they had already narrowed the scope of the study to focus on factors previously associated with the individual’s diabetes. They recommended that the Nauruan government change the country’s diet and physical activity levels by appointing overseas-trained nutritionists and importing Western dietary and exercise education.
Consider factors other than diet and exercise
Our continued focus on dietary and physical activity interventions to address diabetes on Nauru is important, given that several studies over the past 50 years point to another possibility. That’s interesting. for example, low socio-economic status, chronic stress, social isolation and loneliness and systemic inflammation All of these are thought to be associated with exposure to poor air quality, as well as diabetes. change the intestinal flora.
You can find it in Nauru if you look for it. However, such potential never seems to be harnessed in shaping interventions, medical education, and government decision-making. This is much more than diabetes on Nauru. Global beliefs about type 2 diabetes continue to center around diet and exercise, and in some cases genetics, with little consideration of other factors. For example, the World Health Organization’s fact sheet on diabetes states: “Factors that contribute to the development of type 2 diabetes include being overweight, not getting enough exercise, and genetics.”
We don’t talk about this often, but a major barrier to improving public health outcomes is knowing when beliefs that are assumed to be “facts” are not serving us. It’s about identifying. belief Cholera was caused by bad air. It can take decades for such beliefs to become established as “fact” among medical professionals, decision-makers, and the public, and decades more to chip away at them again. Probably diabetes as well.
find a new path forward
If initial assumptions about health are flawed, new interventions, no matter how innovative, will at best fail and at worst make the problem worse. Questioning historical claims about diabetes and reconsidering what we believe to be “facts” and why, creates space for new questions, perspectives, and potential interventions. For example, what are the connections between colonialism, land loss, socio-economic inequality, chronic stress and diabetes on islands? What is the microbiome of islanders? mycobiome What has changed over time, but what are the effects on people’s health? Think of diabetes as a product of population exposure to inflammatory factors, from ultra-processed foods to poor air quality, and Can we intervene and hold those responsible accountable?
This does not necessarily exclude that diet and physical activity are contributing factors, but it does explain why these factors have come to dominate the type 2 diabetes landscape and where they fit into the future. More questions need to be asked, such as what are the unintended consequences of this? And how to de-center what is held firmly as a universal truth.
If we let go of the mindsets of 50 years ago, places like Nauru could help other parts of the world find a new way forward.
