” Role of Sugar-Sweetened Beverages in Increasing NCDs in Pakistan”

Non Communicable diseases are those diseases that are not transmissible directly from one person to another and the major types include cardiovascular diseases, cancers, chronic lung diseases and diabetes. In Pakistan, if we visit an OPD of a well-developed hospital located in the heart of a city or a basic health unit of far from areas of small villages and towns, it will be evident that most of the people are present for the treatment of non-communicable diseases (NCD). A patient with no medical knowledge, can be totally unaware of the certitude that his complain of lethargy, restlessness, unintentional weight loss, aches and prolong fever comprising on months may be due to some undiagnosed Diabetes or early cancer.  Let’s talk about some facts and figures first. As per WHO findings, it stated that 71% of all deaths in the world are due to non-communicable diseases. In figures, UNICEF interpreted it as 41 million deaths.  So it is very clear that non communicable diseases (NCD) are becoming a big threat to the health systems throughout the world and in the developing countries like Pakistan where the budget cast is spent like a skewed graph tilted towards cure of diseases rather prevention. All NCD are affecting the masses in their own way but the alarming situation is being owned by cardiovascular diseases and diabetes. Again talking with numbers, Pakistan ranks 4^th among countries with most diabetics.  Pakistan ranks 18^th in the cardiovascular disease and it own 20% of the total deaths.  When we dig deep into the risk factors and causes of these diseases it can be easily concluded that, alcohol, obesity, sedentary lifestyle and high sugar intake (un healthy food habits) are some common examples among all. High sugar intake is not only directly associated with diabetes but also plays an important role in increasing obesity which in turn is a route cause for most of the cardiac issues and diseases. Obesity is the leading cause of hypertension beside smoking and high blood cholesterol which leads to angina/ myocardial infarction and so on. Personally I have been associated with Rawalpindi institute of Cardiology (RIC) as Rehabilitation House Officer and the numbers were alarming when I get into the OPD and surgery records. High sugar intake by a person with insulin resistance will have increased Insulin like growth factor (IGF) which helps cancer cells grow.

Particularly when we study high sugar intake in Pakistan, we come to know that sugar is not consumed too much through meals. From the middle class to the elites, taking only sweet meals or consuming sweet dish on daily basis along with the conventional food is not a common practice here. Then where this huge amount of sugar comes from? The answer is “Sugar Sweetened beverages” because they are highly consumed with no difference of class and gender. In summer, we have guests in the house; the very simple and easiest way of serving them is giving cold drinks that are mostly carbonated drinks/colas. These beverages are now becoming a must present item of parties, weddings and these kinds of other gatherings. In educational institutions, from primary to the university level, you can easily see students consuming carbonated drinks along with the food in the break timings. All the hostels, restaurants and different food chains mark a special corner in their menus and broachers for the carbonated sodas and surprisingly if you will order any food without any beverage, the waiter will ask you categorically in return about the cold drink. These gestures portray that the policy is to sell as many drinks as possible because these food shops get bonus for selling particular numbers of bottles or cans by different companies. On the other hand, the quantity of sugar ratio in these drinks is way too much than the expectations. According to a leading and famous cold drink brand, its 12 Oz can have 39 grams of sugar. These numbers are just ridiculous for the health safety because it is creating hell lot of problem for the entire nation and the situation is so worse that on this World Diabetes Day (14^th November), different organizations and diabetologists urge the government to declare diabetic emergency in the country for making certain precautionary and revolutionary measures for the control of diabetes because population to diabetic patient ratio is alarming.

A mass campaign against these beverages is required in order to bring down their utilization. One of the major factors of their high consumption is their easy and low cast presence. Among many others, one of the major steps to control this bombardment of sugary drinks in our life is making the availability of these injurious drinks to health more difficult by increasing the withholding and sales tax. According to the stats of the year 2015, 4426 million sugar sweetened beverages were consumed by Pakistanis of worth Rs. 387 billion but the tax generated from these money makers and disease sellers was just Rs 38 billion.  In percentage this tax becomes just the 9.8% of the total amount way less than India, Saudi Arabia and Qatar when we draw comparisons. However, in 2017, World Health Organization (WHO) recommended a 20% tax on sugary drinks and the institution stated that it is evident that these taxes will help a lot in reducing the consumption of drinks which are major contributors of obesity and high sugar intake.  This is my first hand observation also that the treatment and prognosis of patients with cardiac diseases became more effective if HBA-1c (sugar test) readings are taken care of. So these taxes will not only improve the health of the people but at the same time they will boost and help the struggling economy of the country. So it’s need of the time to run a focused campaign to highlight the health issues caused by sugar sweetened beverages through seminars and engaging electronic and print media to spread the message to large number of people. Moreover, the government institutions, especially those directly involved with the finance i.e. Federal Board of revenue (FBR) and other policy makers must absorb the sensitivity of the issue as soon as possible and have to take some brave and nerve wrenching steps on urgent basis in order to reverse the already been done damage. Public Health experts must work on the literature so that it develops a consensus among people, health experts and policy makers to collectively work together and get fruitful results.

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