[Mb-civic] Diabetes, free trade and death

[ean at sbcglobal.net]

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Today's commentary:
http://www.zmag.org/sustainers/content/2006-01/25shah.cfm

==================================

ZNet Commentary
Diabetes Is Not Just An American Problem January 31, 2006
By Sonia Shah 

This week's New York Times series on diabetes in New York City throws 
much
needed light on the silent epidemic of chronic disease brought on by our
sedentary, fast-food culture. But diabetes is not just an American
problem. It is spreading fast to the rest of the world, too.

We think of McDonald's as an American restaurant, but of the five new
McDonald's that open around the world every day, four are located beyond
our borders. Coca-Cola is the quintessential American drink but that
company has been buying up water licenses in poor countries-many still
bereft of safe drinking water-where they sell soda for less than the price
of a glass of clean water. In Africa, the number one employer is not a
mining company or an agricultural firm, but Coca-Cola.

As the Times series has amply shown, our health suffers when we rely on
fast foods and sugary drinks to sustain ourselves. But in places where
malnourishment and poverty are rampant, the ramifications are even more
profound. 

In Western countries the transition from hardscrabble malnourishment to
today's drive-through, fast-food cornucopia occurred over centuries, with
the happy result that our societies were able to control infectious
diseases spread by hunger and poverty before facing the maladies of richly
calorific diets, including diabetes, obesity and heart disease. As anyone
who has seen the KFCs and Pizza Huts sprouting along the alleys of Mumbai
and Cape Town knows, in developing countries, no such time lag exists.
What experts call the "nutrition transition" is taking place within a
single generation.

According to recent research, malnourished mothers tend to bear babies
predisposed to storing excess energy as fat. This is a useful adaptive
advantage in communities where calories are often scarce, enabling babies
to survive nutritional deficits. But when such babies grow up to consume
Western-style diets chock-full of fatty, sugary foods, that benefit turns
into a deadly curse, leading them to gain disease-causing extra fat much
more rapidly than they would have otherwise. 

And so, hot on the heels of the multinational soft drink and fast food
companies in poor countries has been an epidemic of chronic disease.

Today, four of out five people who die of chronic, noncommunicable
diseases such as diabetes and heart disease perish not in New York or
California but in developing countries, according to the World Health
Organization. More Indians and Chinese suffer cardiovascular disease than
Americans, Japanese, and Europeans put together.

Diabetes and coronary heart disease are epidemic in India, which is home
to the greatest concentration of Type II diabetes sufferers in the world.
In some areas of Africa, as many as one in five has diabetes. Nearly 20
million Africans suffer from hypertension. Worse, while diabetes in rich
countries is primarily a condition of the elderly, in developing countries
the disease strikes those in the prime of life, aged forty-five to
sixty-five, slashing their average life expectancy by ten to fifteen
years. 


For developing countries barely treading water amid the flood of
malnutrition, HIV infection, malaria, and tuberculosis, "the public health
implications of this phenomenon are staggering," the WHO has noted, "and
are already becoming apparent."

The era of strings-attached IMF and World Bank loans, which forced the
dismantling of many indebted countries' public-health infrastructures, is
partly to blame. In Zaire, for example, World Bank and IMF "economic
recovery" measures required the government to slash its spending on social
services--in a single year, the government fired more than 80,000 teachers
and clinicians. In Zambia, within just two years of such programs, the
nutritional and health status of children had plummeted, canaries in a
coal mine. Infant mortality rose by 25 percent while life expectancy
dropped from 54 to 40 years. In Argentina, polio and DPT immunizations
fell by nearly 25 percent between 1992 and 1998, and throughout Latin
America, previously controlled diseases such as cholera and dengue fever
re-emerged at epidemic levels. The flow of patients into clinics and
hospitals in Nigeria, Kenya, and Ghana slowed to a trickle, dropping by
half within days of the imposition of new fees. "Before, everyone could
get health care," one developing-country patient noted. "Now everyone just
prays to God that they don't get sick because everywhere they ask for
money."

Global trade agreements forged throughout the 1990s eased the entry of
soda makers and fast-food companies into the emerging markets of the
developing world. And western officials have willingly undermined public
health protections in developing countries when they appear obstructive to
U.S. business interests. In the mid-1990s, for example, U.S. State
Department officials forced Guatemala to scrap a widely praised law that
saved the lives of scores of infants. The law banned the use of images of
chubby babies on infant-formula packaging, which tended to encourage
illiterate mothers to forego breastfeeding their babies in favor of
formula feeding, which in areas of sporadic access to clean water often
ended up killing their babies. But when baby food manufacturer Gerber
objected to the law, state department officials threatened Guatemala with
trade sanctions. Guatemala later gutted the law.

Access to cheap medicines to address these ills is scarce. Multinational
drug companies eager to access the growing markets of countries like
Brazil and India pressure these governments to crack down on cheap local
producers of medicines that undercut their sales. The problem is
especially acute in India, where 1970s-era patent laws once protected only
how products were made, not the products themselves. The rule had allowed
local drugmakers who could reverse engineer drugs to manufacture
knock-offs of the latest brand-name drugs at a fraction of the cost. 

The biggest Indian drugmakers, such as Cipla and Ranbaxy, have reverse
engineered some of the most important medicines of modern times, slashing
the cost of treating AIDS from $15,000 a year on patented, brand-name
drugs to just a few hundred dollars. What's more, bypassing the turf wars
of brand-name companies who would as readily add a competitor's drug to
their own as Coke would add some Pepsi to its six-pack, the Indian
drugmakers combined several different HIV medicines into combination pills
that could be administered in simple, once-daily doses. But when
non-profit health organizations and activist groups across the developing
world started importing the cheap, Indian-made generic drugs, the Western
drug giants who had patented the compounds unleashed a firestorm of
protest. In 1998, 39 multinational drug companies sued the South African
government for allowing the cheap drugs into the country. By 2005, India,
along with other developing countries roped into WTO agreements, was
forced to strike down its relaxed patent laws, instituting instead 20-year
patent protection for drugs and other products. The vibrant generic drug
industry-and the cheap meds it made available--is now crippled.

For these reasons and more, as we start to address the deadly legacy of
hyper-marketed fast foods and sodas here at home, we should remember that
the problem does not end at the corner Burger King. We've spread the
problem beyond our borders, where its effect is likely to be much worse. 



Sonia Shah's new book The Body Hunters: Testing New Drugs on the World's
Poorest Patients is forthcoming from The New Press in July 2006. A fully
updated paperback edition of her 2004 book, Crude: the story of oil is
forthcoming in April 2006.



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