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The coming tide

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I left Ghana earlier today Rabat, Morocco where I will be for the next three days attending an international forum on “Promoting Maternal Survival : sharing experience and sustaining progress”. I am really looking forward to the discussion among countries about what has worked for them and what the big challenges are ahead.

I’ve been to Morocco before, but never to Rabat, and so I figured I might as well go out and get lost in the souks here as well. Eventually I ended up at this great cafe in the Kasbah overlooking where the Bou Regreg meets the Atlantic Ocean. Not one to turn down a local speciality, I had what everyone else was having: a glass of Moroccan tea (read: a bit of green tea mixed with 1/2 c white sugar, some fantastic mint, and hot water) and a snack (read: three almond and honey drenched cookies) and topped if off with a glass of freshly squeezed orange juice from a street vendor. By the time I got home, I was nearly in a diabetic coma.

Which is why it is not particularly surprising to me that rates of diabetes have been rising rapidly around the world, including in much of the developing world. Prevalence is increasing, but it is not just because people are getting older, age-specific rates of the disease also appear to be rising. Nearly 10% of the world’s adult population is now estimated to have diabetes.

While I was in Ghana, my collaborator Kim Yi Dionne and I were doing some prep work for a research survey we plan to launch later this year. We had the chance to talk to regular people about what health issues were important to them. But in at least one of these discussions, people seemed to be confused when we mentioned diabetes. On guy asked what it was while another asked “is that the sugar disease?”.

My waiter tonight at the cafe – who was probably about my age – barely had any teeth left…presumably rotted away from his regular tea drinking, which is a huge part of the culture here. I personally don’t love it when people describe the rising rates of non-communicable diseases as spreading at “epidemic proportions” because to me that term tends to describe something unexpected or something that is just passing through a population, as opposed to the problem that confronts us today. Decades of bad habits, many of which we have known for a long time are bad for us, are starting to catch up on us and we are woefully ill prepared to battle this opponent. It is going to be a long and drawn out fight.

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