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            18 / 07 / 16

            ​Diabetes may not discriminate but it feels very different around the world

            • Anyone working in the business of managing global fast-moving consumer goods (FMCG) brands is acutely aware of deep cultural differences between one market and another. For sure there are sometimes commonalities, but they can’t be taken for granted. The guardian of a female hair care brand, for instance, knows only too well that hair takes on different significances from one culture to another: here a blank canvas for empowered self-expression that says ‘no-one owns me’; there a symbol of fitting in through acceptance of the rules of feminine allure; elsewhere the expression of professional capability and determination in a man’s world. Brand guardians must tailor their communications to these rooted cultural conditions.

              For anyone who hasn’t managed a brand in the world of healthcare, it might be tempting to think that such cultural specificities are of minor importance. After all, a disease is a disease and a drug will either work or it won’t. But this would be a mistake. Our work understanding the cultural territories in which healthcare brands operate tells us that disease is experienced in profoundly different ways from one culture to another. And at times, those differences seem far more significant for healthcare brands than for FMCG brands. Yet, our experience is that these cultural differences are often not considered. Nowhere has this been more apparent to us than in the world of diabetes care.

              Type 2 diabetes, like any disease, is the same physiological condition wherever you go. For sure, there may be specific and different culturally-related reasons explaining its prevalence in one region or another – a high rice diet and an ageing population in Japan, the obesity epidemic in the US, very high sugar intakes among Maghrebin populations in Marseille, rapid urbanisation and high fat diets in China, and so on. And there may also be varying genetic dispositions by region too. But what’s going on in the body – the pancreas not producing enough insulin, or the body’s cells responding inadequately to the insulin produced, resulting in high blood sugar levels – is pretty much the same everywhere.

              But the experience of the condition varies radically and highlights spectacularly diverse cultural propensities. Perhaps the one thing common to all is that, like any chronic disease, the diagnosis of diabetes reminds the patient of his (the disease is more common among men) mortality, a mortality that, in varying measure from culture to culture, we choose not to dwell on.

              The Japanese response to this fear is to subject the disease to a state-managed, almost military structure. On diagnosis, the patient is put to bed for two weeks, even if he feels OK, and is given daily training on how to manage his illness. Thereafter, he must prick his finger to test his blood sugar levels five or six times daily, log his results and report them to the specialist monthly. Failure to comply may result in strict reprimands. The irony is that the specialist will not base subsequent treatment plans on these figures, relying instead on the more complex HBA1C test, which provides him (the doctors in Japan are also mostly men) with evidence of the patient’s sugar levels over the period. The patient’s duty is to comply with the structures of society in his testing, his diet and his exercise regime.

              The Indian response only involves the family and visits to the doctor when the patient feels ill. Speaking to middle-aged Indian men about their diabetes in a recent study was, frankly, a dead loss. They didn’t have a clue. Rather, it was the women in their family who had all the knowledge and who worked tirelessly to make sure the sufferer got the right diet. Blood glucose monitors are pretty few and far between here, for empowering patients with the regular knowledge of their own blood sugar levels would deprive their general practitioner of the cut he gets from the blood testing lab. It’s not the individual who has the disease in India; it’s the whole family.

              In the US, the disease over-indexes among the poor and African Americans. And many come from communities with strong Christian traditions. When they talk about the disease, there’s an assumption of personal responsibility, something you’d expect in a culture with Protestant roots and a frontier mentality. But many also talk about treatment in the language of redemption. I failed, I was in denial, I had my epiphany, I changed my ways (through treatment, monitoring and regulating my diet), and I came back. While they may welcome the support of friends and family, this is all about the individual’s personal journey back to righteousness. And if they have access to a specialist, it will be a dialogue, with professionals, like Patch Adams, keen to help the individual take the true path, but not to impose it on him.

              One disease, but markedly different experiences of it, in all kinds of culture related ways. Needless to say, diabetes isn’t the only therapeutic area where this applies. In fact, it’s fair to say there’s a cultural element at play in the acceptance and treatment of most diseases. From acne to cancer, the society you live in determines how the disease and its treatment will affect you.

              Anyone in the business of communicating the merits of drugs or treatment aids in any sector to consumers or indeed to health care professionals, ignores these kinds of difference at their peril. For they are engrained in the cultural perceptions of individuals, in local narratives and myths and also, of course, in healthcare infrastructure.

              Health through the Culture Lens is a weekly series exploring important cultural currents in health and pharma.

              Image credit: Impact

              • Article by James Parsons