For as long as I can remember, my dad had one goal: to live longer than his dad did.
I never met my grandfather — or as we call him in Tamil: Appappa. He died of a heart attack when he was 56: before seeing his two sons become doctors, before his family escaped a civil war and left Sri Lanka and before meeting his seven grandchildren.
On my dad’s 56th birthday, he blew out the candles on a $15 Walmart chocolate cake. We sang an out-of-tune birthday song to him and my family spoke about my grandfather. It was joyful, uncut by the unspoken breadth of this eerie loss.
The majority of deaths in my family can be traced back to heart disease. By the time I was 10, all of my grandparents had died, three from heart disease-related complications.
My family isn’t unique in this regard. Like many South Asians, we have experienced multiple direct losses due to heart disease. In fact, South Asians disproportionally face higher rates of heart disease than the general population, making up 60% of global cardiovascular patients, despite only being 25% of the world’s population.
Even more jarring, one in three South Asians will die of heart disease before the age of 65.
My Appappa’s death shook every aspect of my dad’s family. They no longer had a stable income, so as a result, my grandmother had to sell her jewelry to keep their family afloat for a few months. The economic strain and emotional toll made my father so angry that he stopped believing in God.
It is hard to fathom that so many families in the South Asian community have to cope with these constant premature losses due to a health disparity that is not widely known and researched. Many may find it easy to dismiss this glaring disparity by blaming the affected community. Some, like Dr. Namratha Kandula, even go as far to say South Asians focus too much on their material success, not on their health. Another misconception is that this disparity is caused solely by South Asian cuisines’ excess ghee, bread and white rice.
However, blaming the community is reductive. Personal health choices are directly limited to the options available to us within our immediate environments. To adequately examine community health, it is more equitable and practical to study social, cultural and economic influences.
When analyzing the societal influence on health trends within the South Asian community, there is a glaring historical period that is often overlooked: British colonization and the famines it intensified.
Under the British Raj — the period of British rule over the Indian subcontinent — there were 31 famines across 120 years. These famines originated from uneven rainfall, but were exacerbated by exploitative, apathetic British economic and administrative policies.
Contrary to popular belief, famines were not due to a lack of food growth, but instead inequitable food distribution. Prior to British colonization, the government had measures in place to mitigate famines, such as distributing foods and funding relief projects. However, the British abandoned these efforts based on the flawed reasoning that famines were natural occurrences that, to their Malthusian benefit, reduced the population of colonized subjects. Consequently, they only provided a small section of the population with food rations, leaving many who could not afford the price of grain to starve. Not only did they leave vulnerable populations to starve based on their inability to pay, but the British government continued to raise taxes on the Indian people and increased exports of grains that could have been used to provide famine relief. This prioritization of economic gain was rooted in the British government seeing the Indian subcontinent as a cash cow — ignoring those who were suffering.
While the British government no longer occupies South Asia, their tepid response to the South Asian people during long periods of famine had a tangible impact on our health today. Many of the long-term health effects can be explained through the Thrifty Gene Hypothesis, which suggests that carriers of ‘thrifty genes’ were able to better survive famine due to their increased capacity for fat storage. Today, populations who adapted to carry these genes, which would aid their survival during periods of famine, are more likely to experience obesity, type 2 diabetes and heart disease.
Because of this genetic phenomenon, the grandchildren of a survivor of a single famine have an almost tripled risk of suffering from cardiovascular disease. To put this heightened risk into perspective, South Asians have survived 31 famines in the past 200 years.
While health disparities are often multifaceted and are not solely tied to genetics, it is undeniably clear that the lasting impact of the Thrifty Gene Hypothesis in South Asian communities can be directly tied back to the British Raj and its hand in the famines.
Rather than acknowledging their role in the mass starvation of millions of innocent people, the British reduce their colonization to ‘some good bits and some bad bits”. However, their role in the famines still affects us today, shortening the projected lifespans of us and our loved ones. Like my dad, so many have lost their own parents to heart disease prematurely.
Despite facing these constant reminders of colonization in my own life, I was forced to uplift colonization throughout my education.
Living in a white suburb in America, colonization was often celebrated. From as early as the 4th grade, my textbooks and curriculum glorified those who colonized Black and Brown people, calling them explorers and heroes.
My textbooks often applauded colonization for its role in spreading new technologies, education and religion. They seemed to gloss over the exploitation of natural resources, the introduction of new diseases and the destruction of existing political and economic structures.
It was degrading to write reports celebrating colonization, while my family has continued to suffer from this time period.
On top of the health consequences of colonization, both of my parents were displaced due to The Sri Lankan Civil War, which spurred from an ethnic conflict that resulted from British colonization. Their houses were bombed, they were forced to leave their home country and they had to start from scratch, culturally and financially, in a foreign country.
In many ways, my life has been and continues to be altered by the effects of the British Colonization. From my education, to my health, to the very country that I live in, I am constantly reminded of how British negligence affects my community and loved ones today.
Despite these significant genetic obstacles, my community has worked to challenge the effects of colonization. One recent example of this step in the right direction was when State Rep. Pramila Jayapal, D-Washington, passed the South Asian Heart Health Awareness and Research Act of 2020 to increase awareness and funding for heart disease in the South Asian Community. It’s empowering to see South Asians, who were once oppressed by British legislation, use policy as a tool to directly address health disparities. We, as a community, are making strides to raise awareness and expose the inhumane consequences of colonization.
Clearly, health effects are only some of the many consequences of colonization. Beyond advocacy within the South Asian community, we must continue to reckon with the impacts of colonization when evaluating and teaching it. Since so many of us are directly affected by the negative consequences of colonization today, let’s call it what it is: dehumanizing.
MiC Columnist Maya Kogulan can be reached at ukogulan@umich.