PAKISTAN has one of the highest diabetes prevalence rates in the world. About one in three adults is living with diabetes here — some 33-34 million people. Shouldn’t there be public information campaigns to raise awareness about preventing/ living with diabetes? Where are these programmes in Pakistan?
Heart disease is the leading cause of mortality in Pakistan; it is responsible for an estimated 30-40 per cent of deaths. Pakistan’s cardiovascular disease rate is 648.6 persons per 100,000; the ischemic heart disease rate is 188 per 100,000 persons. Both are the highest in the region.
Some of the leading risk factors for heart disease are diabetes, high blood pressure, obesity, tobacco usage and air pollution. Around 20pc of our adult population consumes tobacco (there is a 32pc prevalence rate among men and 6-7pc among women). Other than printed warnings on tobacco products and a ban on tobacco advertisements, one does not see a significant campaign to prohibit or even discourage tobacco consumption.
Around 18-26pc of our adult population is believed to be hypertensive, with some 70pc undiagnosed. Neither do we have a public awareness programme for prevention of hypertension. We don’t even have sufficient diagnostic facilities. Most people discover they are hypertensive when health complications, like heart disease, arise.
Why does our healthcare system lack diabetes prevention and management programmes?
Breastfeeding initiation rates are low in Pakistan as is the exclusive six-month breastfeeding rate. Pakistan still has one of the world’s highest infant mortality rates and some 40pc of its children are malnourished. Contaminated water in the feed of infants is a major contributory factor. Sadly, despite the fact that breastfeeding initiation or knowledge about exclusive breastfeeding for six months and programmes for ensuring better support for mothers are not that costly — and far cheaper than addressing child malnourishment and high infant mortality rates — we are still without a major programme to support pregnant and lactating mothers.
Why are systems and markets so incomplete in these areas?
If a third of our adult population has diabetes, why does our healthcare system lack diabetes prevention and management programmes? It is true that we spend very little — as a percentage of GDP — on healthcare. But awareness, prevention and management programmes are much cheaper to run than curative programmes. Why is prioritisation in public health expenditure so warped? The neglect of large preventive or management programmes in the public sector in almost all the areas mentioned here is criminal to say the least.
The private sector provides much of the healthcare in the country. It makes sense for the largely profit-driven private sector to focus on curative rather than preventive programmes. Doctors, hospitals and pharmaceuticals earn a lot more if a person develops diabetes and lives with the condition for 20 to 30 years, rather than making lifestyle changes before full-blown diabetes sets in. On the other hand, much of our private health sector is not-for-profit. Yet even they lack large awareness or prevention programmes.
Some of the world’s leading cardiologists are working in the country. Many are working in Pakistan as well as in the US/UK. Given the widespread prevalence of heart disease, there’s a strong demand for cardiologists here. However, no hospital, insurance company or doctor has a good prevention programme in place. I have heard a number of doctors say that if you are a South Asian man in your mid to late 50s, it is likely you already carry some of the markers of heart disease. But if this is true, should the same doctors and hospitals not invest in programmes that raise awareness for South Asian men before they reach their mid-50s?
One could argue that there is no incentive for profit-focused doctors and hospitals to invest in prevention programmes. But, what is more surprising is that there are significant gaps in the provision of services even in curative care. So, you survive a heart attack. In most countries, hospitals and doctors offer programmes for rehabilitation that get you on the road to recovery by offering support for dietary and lifestyle changes, exercise, psychological and psychiatric support if needed, and of course, support for managing heart disease. But few, if any, hospitals or doctors offer such comprehensive support in Pakistan. Instead, you get a lot of hand-waving and general advice on lifestyle and dietary changes and instructions to get in touch with each specialist separately. Even where profits could be made, the services are missing. This is quite interesting. Has the market still not developed enough?
The same issues exist in other areas as well. If around a third of Pakistani adults are diabetic and large numbers are genetically predisposed to obesity, hypertension and heart disease, why are food manufacturers and restaurants in Pakistan not offering better options? Just displaying ‘no added sugar’ on a food label is not enough. Just saying the burger has ‘xx calories’ is definitely not enough. Manufacturers and restaurants should be developing tasty but healthy options for people living with diabetes, hypertension, obesity, heart disease, etc. But we do not see such developments even in the for-profit sector. It is not clear why this is so. It might be that the market has not caught on yet (try finding non-dairy milk options in mainstream shops) as such options do exist in other countries. Or is the market not thought to be discerning or large enough? Given the millions of people we are dealing with, I think that things are likely to change in the near future. But the near future might not be near enough for many.
Much of Pakistan’s disease burden is preventable and manageable — right from the time a child is born (breastfeeding awareness and support) all the way to adulthood (heart disease, diabetes, etc). The for-profit healthcare sector and food industry are benefiting monetarily from curative services — although there are many services that are not being provided — and have no incentive to invest in awareness and preventive programmes. But the responsibility of large awareness and prevention programmes lies with the state. Sadly, the state is more focused on the curative rather than the preventive aspect of healthcare services.
The writer is a senior research fellow at the Institute of Development and Economic Alternatives and an associate professor of economics at Lums.
Published in Dawn, June 5th, 2026