The problem with chronic disease is that there is no beginning or end. The story remains incomplete and, therefore, often untold.
According to the World Health Organization, chronic, non-communicable diseases are the greatest causes of death worldwide, due mainly to diabetes, cancer and heart disease. More shocking still, in all areas of the world except the African Region, NCD mortality surpasses deaths due to communicable, maternal, perinatal and nutritional conditions combined.
These “untold stories” aren’t only found in the heart of Africa, the slums of India or the villages of South America—they exist in our own backyard: Durham. Can you guess the leading causes of death in Durham? Yes—cancer, heart disease and diabetes.
But there is another untold story behind these diseases: obesity. Obesity is one of the greatest risk factors for these chronic diseases. We are all aware that cancer, heart disease and diabetes are debilitating diseases, but do we look at obesity in the same way?
As residents of Durham County, we live in a community that has remarkably high rates of adult and childhood obesity. Roughly 65 percent of all adults are either obese or overweight. What’s more, Durham County children now rank 97th out of 99 North Carolinian counties in regards to the incidence of childhood obesity.
We’ve all heard about how lifestyle changes and education can make a difference in these numbers. So what’s new, right? We live in a culture that emphasizes our health choices. Whether it’s learning about the wellness centers on campus or participating in competitions like Fit Campus and our own Prospective Health Challenge, we are entrenched in an environment where health is a focus.
Maybe that’s the problem—we think about our wellness, but do we ever stop to think about why overweight and obese adults in Durham don’t necessarily do the same?
Maybe they can’t.
Consider this: A 40-year-old, self-employed man named James resides in southeastern Durham with his wife and five young children. He is clinically obese and has developed high blood pressure and diabetes. His health condition is mismanaged because he lacks the finances to make regular doctor appointments or even travel to the closest free clinic 20 miles away. James’ worsening condition has forced him to miss several days of work in the past few months. His weight is the subject of mockery among his friends and cause for disapproving stares as he walks down the street.
What’s wrong with this scene? Here we see chronic disease as an issue of access—access to proper care, medication and treatment. The issue of access is precisely why the burden of disease is shifting to low-income populations in Durham. This intersection between obesity and social immobility is evidence that health is an issue of social justice, and James is facing the very injustices we should be fighting against.
Trends in improper care and treatment availability have trapped the poor in a state of debt, social exclusion and inadequate health care. A combination of incurring medical, travel and food costs, financial instability due to missed work days, stigmatization by the community and discrimination by medical personnel highlights the unavoidable fact that obesity affects far more than health.
These are the very reasons we need to take action.
So, as Duke students, we challenge you to expand your definition of obesity from simply a biological disease to a social pathology.
We challenge you to have the same shocked, visceral response that inspires action to combat diseases such as cancer. To fight against obesity with the same vigor that we attack other fundamental social injustices, such as the lack of rights for LGBT individuals or conflict minerals in the Congo.
We challenge you to act on an epidemic that was recently recognized by the World Health Organization as the number one threat to the future health of our planet, to go beyond the walls of our campus into the Durham community and learn how to write an end to the untold stories.
Shiva Kothari is a Trinity senior, co-president of the Prospective Health Care Club and co-chair of the Prospective Health Challenge and Sanjana Marpadga is a Trinity junior and co-chair of the Prospective Health Challenge. This column is the eighth installment in a semester-long series of weekly columns written by dPS members addressing civic service and engagement at Duke.
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