South Asians make up 25% of the world’s population yet account for over 50% of global cardiovascular disease deaths (WHO) and are six times more likely to develop type 2 diabetes than Europeans. Despite these alarming numbers, the true causes of these disparities are often overlooked. Doctors frequently attribute them to diet and lifestyle, advising South Asians to eat less ghee, rice, and sugar, reinforcing the idea that individual choices are to blame. But if food were the sole factor, why do these disparities persist across generations, even among those who adopt Western diets?
The answer lies not just in personal habits but in history itself. For over a century, thirty-one famines under colonial rule deprived millions of food, forcing survivors into biological survival mode. But famine did more than kill—it left genetic scars, altering how the body processes food, stores fat, and regulates insulin. These trauma-induced changes passed down through generations, are explained by epigenetics—the study of how environmental stress modifies gene expression. The exact biological adaptations that once helped famine survivors endure starvation now increase the risk of diabetes, obesity, and heart disease in their descendants today. The British Raj presided over thirty-one famines over the course of 120 years, an astonishing failure that underscores how British economic policies worsened, rather than alleviated, starvation. The most infamous, the Bengal Famine of 1943, killed up to 3 million people—not due to a lack of food, but because grain exports were prioritised over local relief efforts. Unlike pre-colonial rulers, who enacted famine relief measures, such as food distribution and tax reductions, the British government adopted a laissez-faire approach, treating famine as a natural and beneficial event. Malthusian ideology—the belief that population growth will inevitably outpace food supply—provided a convenient excuse for inaction. But the damage did not end when the famine was over. Starvation rewired the biology of its survivors, permanently altering their genetic expression. The stress of famine triggered epigenetic changes that increased fat storage and insulin resistance—traits that, while once adaptive in periods of extreme deprivation, have now contributed to higher rates of diabetes, obesity, and cardiovascular disease among South Asians today.
For decades, scientists believed that genetic inheritance was fixed—that we are born with unchangeable DNA. However, emerging research in epigenetics has proven otherwise. DNA methylation, a process where environmental factors modify how genes function, plays a crucial role in how bodies respond to stress, including famine, malnutrition, and trauma. During starvation, the body shifts into survival mode—storing fat more efficiently, slowing metabolism, and increasing insulin resistance. But when these changes occur in sperm or egg cells, they become heritable, affecting future generations. This means that the biological imprint of British-imposed famines is still present in South Asians today, making them more prone to diabetes, heart disease, and obesity.
Several landmark studies reinforce this link: (1) the Overkalix Study (Sweden) found that grandchildren of men who experienced famine had higher rates of cardiovascular disease than those whose ancestors had stable food supplies; (2) Brown University research found that famine exposure doubles the risk of diabetes and obesity in subsequent generations; and (3) the Gambian Study demonstrated that nutritional deprivation during conception altered DNA methylation patterns in offspring, impacting their long-term health. Transgenerational PTSD, a concept first observed in Holocaust survivors’ descendants, demonstrates how trauma can influence stress responses, anxiety levels, and even behaviours such as food hoarding. Similar patterns have been noted in Rwandan genocide survivors’ offspring, reinforcing the idea that trauma is not just psychological—it can be biologically embedded. The South Asian experience with famine follows the same pattern. The starvation endured under British rule left a genetic imprint, influencing not only disease prevalence but also how future generations respond to stress, hunger, and survival. The impact of British rule on South Asian health is not just a relic of the past—it is an ongoing crisis. The famines orchestrated under colonial rule did not just starve millions; they left a biological imprint that still manifests in disease susceptibility today. Yet, despite overwhelming evidence, Western medicine overlooks this historical and genetic reality. Most medical research is based on white populations, failing to account for the unique metabolic and cardiovascular risks faced by South Asians.
To move forward, we must fund research into South Asian genetics and integrate epigenetics into medical guidelines. Rather than blaming individuals for their health struggles, public health institutions must recognise that the consequences of colonialism are still unfolding in our bodies. Ignoring this biological legacy is not just a failure of medicine—it is a continuation of historical injustice in a new form.