Prioritizing Generationally-Affected South Asian Health

Prior to British colonialism, the Indian subcontinent was a global powerhouse, making up the largest economy in the world and accounting for nearly 30% of the global GDP between the first and fifteenth century. However, the British East India Company’s assumption of control of Bengal in 1757 marked the dawn of nearly 200 years of detrimental consequences. Alongside the oppression of human rights and the destruction of the Indian economy, British imperialists effectively siphoned all of South Asia’s wealth and resources. During colonial rule, the United Kingdom (UK) drained India of nearly $65 trillion, leaving a lasting legacy of poverty and economic inequality.

While the UK’s plunder of resources had profound impacts on India’s contemporary wealth, colonialism’s impact on health proved most devastating. Between 1757 and 1947, India endured 36 major famines, experiencing one approximately every other year in the second half of the nineteenth century. With only 17 famines in the 2,000 years before colonialism, these food shortages were directly linked to British policies that heavily taxed land, reduced spending on regions, and redirected food outside of India. Food scarcity forced South Asians to conform to extreme chronic conditions, making their genes “starvation-adapted.” To conserve energy, South Asian populations developed genetic tendencies to store fat and limit muscle growth. As these traits are passed down through generations, South Asians across the globe continue feeling the repercussions. 

Today, South Asians are genetically predisposed to several metabolic diseases, including diabetes, hyperglycemia, and cardiovascular disease, experiencing rates far higher than those of comparable populations. South Asians residing in India, the “diabetes capital of the world” are between four and six times more likely to contract type 2 diabetes. Additionally, while accounting for only 25% of the world population, South Asians make up 60% of all cardiovascular diseases. Genetics that have primed South Asians for famines have gravely affected our modern-day health while living in conditions without malnutrition. 

Yet, despite some of the worst rates of disease in the world, South Asians are largely unaware of their own genetic predispositions, reflecting a lack of policy and action taken to improve community health. With cultural factors, lifestyle choices, and environment contributing to the neglect of health, South Asians fall into a dangerous cycle: ignoring their health until it becomes life-threatening. When it comes to our well-being, we can no longer stand idle and wait for the worst to happen.  

Instead, we must make our health a priority by putting South Asians in the spotlight. While we may be “healthy” by Western medicine standards, we must create a new framework that properly educates and prepares South Asians to live a healthy lifestyle. To start, direct measures should be taken to improve health literacy. Currently, South Asians have severe misconceptions and knowledge gaps that make them unaware of risk factors, treatments, and preventative measures. By informing ourselves about ways to maintain our health, we put ourselves in a better position to prevent metabolic diseases. 

Organizations like the South Asian Public Health Initiative and Memorial Sloan Kettering Cancer Center’s South Asian Health Initiative have already begun making strides towards improving educational outreach and championing health equity for South Asians. However, beyond South Asians’ lack of knowledge on their individual health, part of the problem reflects an absence of knowledge about South Asian health in general. Our research and data fall short in properly representing the South Asian community and the diverse populations of the Indian subcontinent. By tailoring clinical and translational research and improving outreach for South Asians, the US can obtain more aggregated data that properly reflects our risks, needs, and areas for intervention. For South Asians across the globe, our “genetic fate” can be frightening. However, as Dr. Mubin Syed puts it, we can thrive by creating a “new normal” for South Asian health. Our “normal” should include earlier diabetes screening, regular monitoring of cholesterol and blood pressure, and consistent visits with primary care providers. In terms of lifestyle choices, South Asians across the world should prioritize nutritious diets, regular exercise, restorative sleep, and stress reduction.

We are often told about the progress of British rule, in which India was introduced to the English language, railroads, and telegrams; yet, we forget to recognize the intangible ramifications. While assigning blame to British imperialism does not progress our health, confronting our history can help us understand present-day risks and remedies. As a South Asian, it is time that we learn about our past to advance our future. By constructing a new standard specifically for South Asian well-being, we can combat our generationally affected health risks.