Sung Yan-jen (宋晏仁) takes a sip of his iced tea, winces and slams the glass back down on the table.
“I asked for no sugar,” says the eminent nutritionist at National Yang-Ming University, “yet it’s still sweet. That’s a tell-tale sign of the problem.”
And the problem is diabetes. For decades it has remained one of the nation’s top killers. With widespread use of high-fructose corn syrup, adverse societal factors and an highly-subsidized health care system, efforts to curtail the chronic disease are failing.
photo Courtesy of Sung Yan-Jen
Sung should know. Diagnosed with metabolic syndrome, considered a precursor to diabetes, Sung was obese through his twenties before he took control of his diet.
“Even though I was studying medicine, I still didn’t know what I should be eating,” he says. “I eventually realized it wasn’t about eating more or less, but eating right.”
SUSPECT SYRUP
photo: Lin Yan-tung, Taipei Times
Sung says that although there are many factors that contribute to the rise of diabetes, “but compared to other [food additives], high-fructose corn syrup has the most detrimental effect on human health.” The fact it is widely used and easily absorbed compounds it’s damaging effect, he says.
High-fructose corn syrup first hit the market in the 1970s and began to spread globally in the 1980s, the same decade diabetes-related deaths in Taiwan began a dramatic climb. According to the Ministry of Health and Welfare, in 2015 there were approximately 2.27 million diabetics, just shy of 10 percent of the nation’s total population.
Sung says high-fructose corn syrup has now become so pervasive that “it’s hard to find any processed food without it.”
Illustration: Tania C.
There is a good reason for this. The syrup is significantly sweeter than sugar and comes at a fraction of the cost, he says. It also tastes better, with Sung describing the flavor as “pure sweetness,” which can blend seamlessly into many foods.
He says convenience stores, bakeries and stores that sell takeaway drinks are among the worst offenders.
In response to the growing pandemic, Chia Shu-Li (賈淑麗), division director for the Health Promotion Administration’s Aging and Chronic Disease Control, held several public hearings on the matter in July when it was decided that, for the first time, dietary guidelines will stipulate that added sugars, including high fructose corn syrup, should not exceed 10 percent of daily caloric intake.
AN OUNCE OF PREVENTION
Statistics from the ministry of health show that diabetes-related deaths have plateaued since 2002, maintaining an average of roughly 10,000 per year. Meanwhile, the total number of diabetics continues to rise every year, suggesting that treatment has improved but prevention still lags behind.
Tsai Shih-Tzer (蔡世澤), Executive Board Member of Formosan Diabetes Care Foundation (糖尿病關懷基金會), says this is due to demographics because not only are the number of cases rising, diabetics are, on average, living longer.
Chia says, however, that these increases shouldn’t be viewed negatively because the disease is being detected earlier.
“The numbers are going up because we’re identifying cases we previously would’ve missed. This means we are able to get to those who need help earlier,” she says.
Sung doesn’t consider this real improvement though, as the number of deaths has not decreased and diabetes today remains the fifth leading cause of death.
‘SIMPLY DEVASTATING’
Sung says that the nation’s eating habits work against efforts to combat the disease. Taiwanese place great cultural importance on food, but in recent years this has become an object of obsession and has lead to a lifestyle of snacking and overeating.
Compounding the problem, processed food is easily available at night markets and 24-hour convenience stores.
Sung adds that his patients often feel frustrated as they struggle to follow the diet he maps out for them, and often say “there’s just no healthy food around,” a passive attitude that inhibits consumers from taking control of their diet.
Sung says a lack of recreational space, which is important at a time when computers and smartphones keep people inactive, makes exercising difficult.
Little enthusiasm for all things athletic may also be a factor. In 2014, the Health Promotion Administration released a report that showed 76 percent of Taiwanese over the age of 15 don’t fulfill the WHO’s recommended amount of weekly exercise.
“The whole environment in Taiwan is simply devastating to the patient’s health,” he says.
SYSTEMATIC CARE?
Sung goes further in saying the health insurance system can compromise the medical community’s ability to fight the disease.
“Taiwanese are so well-covered by their health care, they don’t face any financial risk if they get sick,” he says.
He adds that the National Health Insurance (NHI) has encouraged diabetics to take full advantage of the generously subsidized system, which leads them to “surrender their autonomy to take care of themselves.”
Low participation rates in programs run by the NHI such as DHI Diabetes Joint Care, in which patients are coached over several months on how to change their lifestyle and eating habits, reflect this phenomenon. The program teaches them about living with diabetes and managing their health, but most patients would rather just take the subsidized medicine, and so their condition doesn’t improve. Fewer than half of the patients who are advised to take the course attend.
Tsai says that adjustments to the health care system are needed, pointing to the large imbalance between the budgets of the NHI, which is responsible for treatment, over the Health Promotion Administration, which is responsible for prevention.
“We throw a lot of money at the NHI — even from sources which were not originally meant to fund it,” he says, referring to tobacco taxes. “We need to fine-tune this balance and allocate more resources to prevention,” he says.
Chia recognizes that funding is an issue — her administration’s budget is being cut year on year, she says, straining efforts to implement preventative measures.
Yet she is optimistic, saying that the health ministry is working towards an integrated approach that will see the health promotion and disease control agencies combined.
Tsai says Taiwan needs to take a more holistic approach, praising Singapore’s education system for factoring in diabetes prevalence among students in a school principal’s annual performance evaluation.
“We should not just be focusing on the student’s exam results, but their healthy development too,” he says.
Tsai adds that while there are a growing number of new preventative programs, referring to a recent initiative which offered free waistline checks at convenience stores, he still feels it’s not enough.
“I fear it’s too late,” he says. “We have to start earlier. Teaching children how to eat right must start in the home.”
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