Sick By Inheritance? How The British Left South Asia With A Health Time Bomb

Last Updated:June 09, 2025, 14:19 IST

The early onset of diseases like hypertension, high cholesterol, type 2 diabetes, and heart disease, even among those who appear fit, has puzzled doctors for decades

You may live a healthy lifestyle – exercise regularly, eat balanced meals, sleep on time. But for millions of South Asians, the biggest threat to their health isn’t their habits, it’s their heritage.

Behind the rising tide of heart attacks, diabetes, and kidney failure in South Asians lies an uncomfortable truth; where you come from matters more than how well you live. With over half the world’s heart patients today being South Asian, the numbers are alarming. And they’re not just statistics – this crisis cuts across borders, impacting not only residents of South Asia but also South Asians born and raised in the United States, Canada, and the United Kingdom.

The early onset of diseases like hypertension, high cholesterol, type 2 diabetes, and heart disease, even among those who appear fit, has puzzled doctors for decades. But emerging research is now making it clear; the answers lie not just in biology, but in history.

According to Dr Mubeen Syed, author of Healing from Our History: How Colonial-Era Famines Led to a Modern South Asian Health Crisis, the roots of this epidemic go right into the colonial past of the Indian subcontinent. His research draws a compelling connection between the historical traumas of famine, malnutrition, systemic neglect, and the modern-day explosion of metabolic and cardiovascular diseases in the region.

Between the 18th and 20th centuries, British colonial policies in India led to repeated, large-scale famines. These weren’t just natural disasters; they were the result of deliberate economic and agricultural policies that prioritised cash crops like cotton and indigo over food security. Tens of millions died, and generations lived with chronic malnutrition.

This history left behind more than just social scars. It altered the biology of survivors and their descendants. Epigenetic studies suggest that prolonged famine and stress may have triggered changes in gene expression -modifications that are still being passed down today.

The ‘Thrifty Gene’ Theory

Scientists have long debated the “thrifty gene hypothesis”, the idea that communities exposed to repeated famine evolved to store fat and use calories more efficiently. In an age of abundance and processed food, this once-life-saving adaptation has become a liability.

For South Asians, this may explain why diseases like diabetes and heart issues appear even in individuals who are slim, active, or seemingly healthy. Hidden visceral fat, insulin resistance, and inflammatory markers tend to be higher in South Asians, even at normal weights.

Colonialism not only created famine; it also shattered South Asia’s indigenous health systems. During British rule, medical care was primarily designed to serve the colonial bureaucracy and army. Rural populations and local communities were largely ignored. Investment in sanitation, clean drinking water, or basic public health infrastructure was minimal.

Traditional systems like Ayurveda, Siddha, and Unani were sidelined or delegitimised, narrowing access to care. At the same time, health education was neglected, leading to generational gaps in disease prevention and awareness.

This colonial neglect left newly independent nations with fractured healthcare foundations. Even today, many rural areas across India, Pakistan, Nepal, and Bangladesh lack adequate facilities. Where services do exist, they’re often underfunded, understaffed, and overwhelmed.

The rapid urbanisation and globalisation that followed independence further widened the health gap. As cities grew and Western diets took hold, physical activity plummeted. Fast food, processed snacks, and sugar-laden beverages became commonplace, especially among the middle class.

For bodies historically conditioned to scarcity, this sudden shift toward abundance was catastrophic. South Asians began experiencing a spike in “lifestyle” diseases at rates far higher than in many Western populations.

And yet, this isn’t just a South Asian story. From Toronto to London to San Francisco, diaspora communities, despite having access to modern healthcare, are showing the same vulnerabilities. Studies show that South Asians abroad are up to four times more likely to suffer heart attacks than their White counterparts. In fact, some of the youngest cases of cardiac arrest in Western hospitals are of South Asian descent.

Why does the past still haunt the present? Experts say colonialism didn’t just damage economies, it hardwired inequality into South Asia’s health systems, mindsets, and even genetic code.

Today, South Asia bears one of the highest burdens of non-communicable diseases globally. Cardiovascular diseases are the leading cause of death. Diabetes is skyrocketing. Kidney disease, fatty liver, and obesity are surging. And the region still battles infectious diseases, poor sanitation, and widespread health illiteracy.

The colonial legacy remains etched in malnutrition, urban poverty, and the slow pace of health reform. As South Asian nations attempt to rebuild, they’re forced to work on a foundation that was never designed for their wellbeing.

What Can Be Done?

The first step, doctors say, is awareness; recognising that for South Asians, early screening and aggressive prevention must begin earlier than in most populations. Genetic risks can’t be undone, but lifestyle interventions, tailored to cultural needs, can be powerful.

Public health experts also call for a reimagining of systems: better rural healthcare, culturally competent care for diaspora communities, renewed respect for indigenous medicine, and targeted research.

Above all, it’s a call to acknowledge the invisible wounds of history, and to begin healing with the knowledge that South Asia’s greatest health battle may not be in the future, but in understanding its past.

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