The Time for Health across the Diaspora

India is an idea, as is the diaspora. It is a challenge and an unprecedented opportunity now to unite our people and policy makers towards urgent and necessary solutions, for health. There is a health crisis across the Indian diaspora, with high rates of heart disease and diabetes occurring on average ten years earlier, and other less known challenges. These affect people in the prime of their lives, devastating families and communities. The time for imagining is over. It is time for health across the disapora. New ideas are needed.

By Vivian S Rambihar MD, cardiologist and Vanessa Rambihar BHSc


The Year of India in Canada makes us reflect on India, our identity as Indian and as part of the Indian diaspora. The concept of identity and everchanging multiplicity of belonging that makes each of us unique, while sharing aspirations and values with people of Indian origin globally, has been discussed elsewhere with a complexity and fractal perspective. This article identifies a critical need and opportunity for health now, mentioning complexity science as a new idea for health, with details of achieving personal health.

Does being Indian matter in terms of health? The answer is yes and no. For the individual, sometimes it does, often critically so, other times not. For the Indian community and population, with shared values, customs and the imperative for change in the midst of a health crisis, it is tremendously important. What is incredible about India is that despite diversity, we share enough we can use to shape our individual and shared future. Most of us are Indian only slightly removed, and the following examples highlight many issues surrounding health and identity.

Mrs T lives in Canada and in Guyana. Her 91 year old father came from UP in India to Guyana at the age of 20 and stayed, while some of his fellow jahijis returned. This family lived in Guyana with influences directly from India and Indians. Living beyond 91 years attests to the longevity and good health many Indian families experience.

Rita is Indian, lived across the diaspora, including Guyana and now Canada. Her father became the High Commissioner for Guyana, his next posting as Consul General for Toronto announced during the 50th Anniversary celebrations of Indian Independence. He never saw Toronto, dying at 53 of a sudden heart attack even though he tried to live healthy. A few years later Rita took her son to see his grandmother who had returned to India. Her mother developed chest pain, went to the hospital, but had a heart attack and died

Vivian Rambihar (left) with Indian MoS External Affairs Preneet Kaur (right)


The 30 million people of Indian origin across the diaspora follow either of these two trajectories of health, or somewhere in between. Both of these people are “Indian” to different degrees, with different circumstances and influences. One followed the path many Indians do, fortunate to have good health into their 90s. The other is the too familiar pattern of Indians across the diaspora with heart disease or sudden death at a young age, reported by Danaraj, and Muir, 50 years ago in Singapore. We need to understand the Indian diaspora and its history to understand why this happens and what we must do to create a culture of health and a healthy diaspora.

India is one of the most diverse countries in the world. There are differences in language, culture, foods, geography, politics, health patterns and tremendous disparities in income, health access and much more. The Indian diaspora becomes a hyperdiversity, with varying adaptation to new surroundings and cultures through migrations and remigrations. Brij Lal writes in the “Encyclopedia of the Indian Diaspora” of diasporas within diasporas and of an overarching sense of shared culture that forges bonds that transcend time and place. It also forges complex, changing identity and difference, each Indian unique, yet part of overlapping changing subsets of belonging.

The 2011 event is in Toronto with the theme “Building Bridges: Positioning Strategy for the Indian Diaspora.” 2011 as the Year of India in Canada is an opportune time to position strategy for health in India and across the diaspora. The Global Organization for People of Indian Origin extended their mandate to include health in 2010, starting with an Inaugural Health Summit, while the Toronto PBD in June 2011 will include health in its agenda. The heightened awareness of India and the diaspora is an opportunity to raise health consciousness, by making health a priority and infusing health through all Indian activities.


Indian health is in crisis and is expected to take the economy with it. Cardiovascular disease and diabetes have exploded in India and across the diaspora, threatening each country’s economy, with health reciprocally linked to economics. The WHO states that health risks the economic future of India, with chronic diseases costing 237 billion US dollars over the next 10 years. The celebrated economic success of India will increase chronic diseases, increase disparities and increase poverty at the same time. Professor Dr K Srinath Reddy, President of the Public Health Foundation of India says that “the adverse effects on development are likely to be unaffordable for a country that is now on the fast track for economic power in the 21st Century.”

There is agreement on the need to make health in India and the diaspora a priority. Professor Reddy and coauthors write in the Lancet “To sustain the positive economic trajectory that India has had during the past decade….the health of all Indian people has to be given the highest priority in public policy.” They argue for multisectoral actions, with health “compounded by unequal economic growth, unplanned urbanization, water and sanitation crises, inequitable global trade, unhealthy trade policies and climate change.” The Center for Public Health and Equity in India suggests an emphasis on a bottom-up policy of active community engagement, and action on the social determinants of health instead, with emphasis on equity, health promotion and wellness. 

The increasing attention to non-communicable diseases (NCDs), especially the September 2011 UN High Level Meeting, will help reduce CVD and diabetes in India and the diaspora. The UN considers NCDs a global crisis across most countries and income groups, and hopes to inspire a sustained global movement for change. The Lancet claims that the substantial gains achieved in economic growth, health and living standards globally in the past century are now threatened by crises of our own creation - climate change, finance , food insecurities, and the crises in NCD’s, principally heart disease, stroke, diabetes, cancers, and chronic respiratory diseases. 


Gandhi linked the idea of personal self-improvement with the struggle for one’s rights and freedoms. In this Year of India in Canada, we can start with personal self-improvement, community action and policy change, to create a global grassroots movement for health, making it time for change and time for health across the Indian diaspora. Change begins with you. Think health in everything you do. Become the change by your choices and actions, and make your best health to make a healthy diaspora.


June 2011

click here to enlarge

 >> Cover Story
 >> From the Editor