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In recent years, words like “sugar” and “pressure” have become part of our everyday conversation. These terms refer to two chronic conditions: diabetes and high blood pressure (hypertension). Once considered the problems of the elderly or the wealthy, they have now become common across all age groups and social classes, posing a serious threat to the health and well-being of millions.

According to the WHO STEPS Survey (2019/20), about one in four Nepalis aged 15 to 69 has high blood pressure, while nearly six percent live with diabetes. Experts believe these numbers are likely higher today due to changes in lifestyle, diet, and increasing urbanization. Perhaps even more worrying is the fact that many individuals remain unaware of their condition until it leads to severe complications such as heart attacks, strokes, or kidney failure.

The changing face of health in Nepal

Nepal has experienced rapid social and economic transformation in recent decades. While infectious diseases and maternal health once dominated public health priorities, a new challenge is emerging: non-communicable diseases (NCDs). Diabetes and hypertension now account for a significant portion of the disease burden. This shift is largely driven by lifestyle changes. Traditional Nepali life involved walking long distances, manual labor, and eating simple, fresh food prepared at home. Today, many people spend most of their time sitting at desks, in vehicles, or glued to digital screens. Physical activity has decreased, and diets have shifted toward high-calorie, processed foods laden with salt, sugar, and unhealthy fats.

Urbanization has brought many conveniences but also new risks. Fast food outlets, sugary drinks, and packaged snacks have become common even in smaller towns. Stress levels have increased as people juggle work, family, and economic challenges. All of these factors contribute to rising rates of obesity, diabetes, and hypertension often affecting people at younger ages than before.

Why are diabetes and high blood pressure dangerous?

Both diabetes and high blood pressure are often called “silent killers” because they typically cause no obvious symptoms in their early stages. Many people feel perfectly fine while the disease silently damages their organs. Diabetes, characterized by high blood sugar levels, can damage blood vessels, nerves, kidneys, eyes, and the heart. Uncontrolled diabetes increases the risk of heart disease, kidney failure, blindness, and amputations.

High blood pressure strains the heart and arteries, increasing the risk of stroke, heart attack, kidney disease, and cognitive decline. Alarmingly, these two conditions often occur together -about two-thirds of people with Type 2 diabetes also have hypertension. The combination of these diseases significantly raises the chance of severe health events and premature death. This dual burden places a heavy strain on individuals, families, and the health system.

The human and economic cost

Living with diabetes or high blood pressure requires lifelong management. Patients need regular doctor visits, medications, blood tests, and lifestyle adjustments. For many Nepali families, especially those in rural areas or with low incomes, the costs of treatment and travel to health facilities are substantial. Moreover, when these diseases lead to complications—such as strokes, heart failure, or kidney failure patients often need hospital stays and expensive procedures. Many lose their ability to work, and their families face income loss and increased care responsibilities. This creates a vicious cycle where illness leads to poverty, which in turn worsens health outcomes.

Early detection: The key to saving lives

Because these conditions develop silently, early detection is critical. Regular screening for blood pressure and blood sugar should be part of routine health care for adults, especially after the age of 35. Unfortunately, many Nepalis do not have easy access to these tests, and awareness remains low. Community health workers and local health posts can play a vital role in educating people and providing screening services. Schools and workplaces are also ideal settings for awareness campaigns and health checks.

Simple steps to prevention and control

The good news is that diabetes and hypertension are mostly preventable and manageable with simple lifestyle choices. Everyone can take steps to protect their health:

• Eat fresh, homemade meals: Limit salt, sugar, and processed foods. Increase fruits, vegetables, and whole grains.
• Stay physically active: Aim for at least 30 minutes of moderate exercise daily. Walking, cycling, yoga, or household work all count.
• Avoid tobacco and limit alcohol: Both increase the risk of these diseases and worsen complications.
• Maintain a healthy weight: Even modest weight loss can improve blood pressure and blood sugar.
• Manage stress: Practices like meditation, spending time with family, or enjoying hobbies can help.
• Regular health checks: Don’t wait for symptoms-check your blood pressure and blood sugar regularly.

What must the government do?

Individual effort alone is not enough. To address the growing NCD burden, Nepal’s health system needs strengthening:

• Expand screening and treatment services in all health facilities, including rural clinics.
• Ensure affordable access to essential medicines for diabetes and hypertension.
• Train health workers to detect and counsel patients effectively.
• Run nationwide awareness campaigns in multiple languages and formats.
• Regulate unhealthy food marketing and consider taxing sugary drinks and junk food.
• Promote physical activity programs in schools, workplaces, and communities.

Nepal has demonstrated remarkable success in tackling infectious diseases and improving maternal health. Similar political will and community engagement can help turn the tide on diabetes and hypertension.

Real stories, real impact

Consider the story of Ramesh, a 52-year-old businessman in Kathmandu. He never thought much about his health until he experienced sudden chest pain and was diagnosed with a heart attack. Tests revealed he had uncontrolled diabetes and hypertension both undiagnosed until then. After months of treatment and lifestyle changes, Ramesh now actively manages his health and advocates for others to get regular checkups. Stories like his are increasingly common. They highlight the urgent need for early detection and prevention across Nepal.

Our collective responsibility

Diabetes and high blood pressure may not cause sudden outbreaks or emergency situations, but their effects are just as devastating. These diseases steal lives slowly and silently, causing suffering for individuals and hardship for families. The good news is that with awareness, commitment, and coordinated action, we can prevent many cases and manage existing ones better. Everyone—individuals, families, healthcare workers, and policymakers—must come together to build a healthier Nepal. We have the knowledge and tools; now is the time to act. Let’s take control of our health before these silent killers take control of our lives.