World Health Day - avoiding diabetes is harder than you think

Professor Brian Oldenburg has dedicated his career to understanding how human behaviour can influence the way we manage chronic disease.

I’m interested in trying to understand more about the rapid development of lifestyle-related chronic diseases in rapidly developing countries, particularly in the Asian region. Once we understand more about the causes and the “causes of the causes” of chronic conditions like diabetes, heart disease, and some cancers, we can then develop much better ways to address their prevention and management.

My original background is in psychology and sociology and I then went on to study clinical psychology. I then undertook my PhD in medicine and psychiatry to understand the challenges that people on dialysis for end stage renal disease face with the very demanding treatment regimen. My doctoral research really made me understand how human behaviour is so inextricably linked to every aspect of our health and wellbeing and that this has such a profound influence on not only the causes of lifestyle-related chronic conditions, but also, their progression and outcomes.

People’s living and working environments make a huge difference to their health and wellbeing. We’re seeing rapid changes in people’s lifestyles around the world. Increases in the use of tobacco and the move away from traditional diets towards the consumption of more processed food, sugar and fat have been very important contributors to the rapid increase of chronic conditions in both high income and developing countries.

 Sedentary lifestyle and heavy reliance on driving instead of walking or cycling is an underestimated risk factor for chronic diseases. Picture: iStock
Sedentary lifestyle and heavy reliance on driving instead of walking or cycling is an underestimated risk factor for chronic diseases. Picture: iStock

People have also become much more sedentary as work has become much less physically demanding over the last 50 years. We also rely much more on motor vehicles. These changes, combined with the rapid urbanisation in most developing countries, are the reasons we are seeing such big epidemics in hypertension, diabetes, heart disease, many cancers and so on. The downstream impact of these epidemics on families, health systems and the economies of many countries can be catastrophic.

Something that is often said is that lifestyle is an individual choice. It should be the responsibility of governments and civil society to help make the healthy choices also the easy choices for its citizens, particularly for those population subgroups who are most disadvantaged. In fact, it is very difficult to make healthy choices about not smoking, physical activity and eating healthy food if these choices are difficult and constrained because of your living and working environment and your level of socioeconomic and social disadvantage.

Epidemiologists have known for more than 30 years that people who are more socio-economically disadvantaged are more likely to use tobacco and this very strong socio-economic gradient also exists for other lifestyle behaviours as well. So it’s not just individual choices, it’s living environments and social circumstances that really determine lifelong health prospects.

To manage a chronic condition is a 24/7 challenge. For people who already have a chronic condition like diabetes, the majority of such individuals will generally just see their GP a few times a year. However, people have to manage the condition for all of the rest of the time by themselves. They have to worry about weight control, their diet, being physically active, taking medication and blood glucose testing. How to integrate all of these tasks into one’s daily life for the rest of your life is a very big challenge for everybody with such a condition! Moreover, it is becoming more and more common that people have multiple health conditions to contend with and to manage.

At the Melbourne School of Population and Global Health, we have developed a new digital health program called My Diabetes Coach (MDC). We want to see how people with diabetes and other chronic conditions can access and use programs delivered by their smart phones, computer tablets or PCs to self-manage these kinds of chronic conditions. Increasingly, we are using these kinds of devices to shop, manage our finances, travel and even for our social lives, so why isn’t our health system better at helping people to manage their health and to interact more effectively with their health practitioners? We call this new field “digital public health”.

Using technology can enable people with diabetes better self-manage their condition. Picture: iStock
Using technology can enable people with diabetes better self-manage their condition. Picture: iStock

In Australia, we’ve been conducting prevention and screening programs for many different conditions for 50 years. Most people understand why these kinds of initiatives are important, even if they do not always adopt the messages or change some aspect of their lives in response to these programs. But if you go to a developing country that doesn’t have a tradition of prevention, notions of health and sickness are much more traditional: I’m either healthy or I’m sick. And indeed, until a doctor tells me that I have a diagnosis of diabetes, hypertension or a cancer, then I continue to see myself as healthy and well, even though in fact, I might already have a very high risk of one or more of these conditions.

Until very recently, the idea that we could reduce the risk of a chronic disease and maybe even prevent it occurring is quite a Western concept. We are now starting to conduct such programs in developing countries with some success. There is also a close link between prevention and helping people with a chronic condition like diabetes. From our research in Kerala, in India’s south, over the last 10 years, we have found that just about every household has people with diabetes or with a high risk of diabetes. The people in these households have said to us, “if you teach us more about how to reduce the risk of diabetes, you are also teaching us things that will benefit the other people in our household as well as our friends and neighbours who also want to reduce their risk, including the risk of diabetes complications that can ultimately lead to blindness, amputations and renal failure”. This is an example of how a very important new learning from a different culture can then be used to inform the development of more culturally appropriate and relevant programs for that culture.

As I have spent more time working in other countries in recent years, I’ve come to realise that we often take for granted here in Australia that we‘ve got this wonderfully diverse health workforce and researchers from laboratory sciences right through to clinical research to public health research and the social and behavioural sciences. We’ve got this very rich mix of people who can look at a problem and analyse it through so many different lenses and that doesn’t exist in a lot of other countries. In developing countries the research systems and the expertise of different disciplines and backgrounds are often very under-developed, particularly in the social behavioural sciences; hence, the importance of human behaviour for disease prevention and health is seriously under-estimated.

– As told to Lisa Mamone

Banner image: iStock