At 27, Josephat Kamusa thought securing a job as a high school teacher in Nairobi would finally bring stability to his life. Instead, much of his salary now disappears into a silent and growing crisis at the intersection of health, poverty, and environmental inequality.
After turning 25, Kamusa lost support from the Diabetes Management and Information Centre (DMI), the implementing partner for the Changing Diabetes in Children (CDiC) programme in Kenya. For four years, the programme had helped him access insulin and diabetes care, shielding him from the crushing financial burden of living with Type 1 diabetes.
But aging out of the programme exposed him to a harsh reality that thousands of young Kenyans now face: surviving chronic illness in cities increasingly strained by pollution, rising food prices, urban stress, and weak public health systems.
“I used to get insulin, but now I have to buy it for myself, and you know how expensive it is,” he says.
Today, Kamusa spends about Sh2,500 every month on insulin alone, depending on pharmacy prices and dosage. Between rent, transport, food, and treatment, life in the capital has become a balancing act.
Yet for many young adults living with diabetes, the struggle goes beyond medicine. It is also shaped by the environments they live in.
Health experts warn that rapid urbanisation, changing diets, pollution, sedentary lifestyles, and climate-related food insecurity are contributing to the growing burden of non-communicable diseases (NCDs) such as diabetes across Kenya and Africa.
In crowded low-income settlements, access to healthy food is limited, safe recreational spaces are scarce, and healthcare facilities remain overstretched. Rising temperatures and erratic weather patterns are also disrupting food systems, making nutritious diets more expensive and pushing vulnerable families toward cheaper processed foods linked to chronic illnesses.
Kamusa’s story reflects this wider crisis, where environmental pressures and fragile health systems combine to deepen vulnerability for young people living with lifelong conditions.
The DMI Kenya is among organisations trying to close that gap by supporting children and adolescents with diabetes through structured care programmes. However, continuity into adulthood remains a major challenge.
“The age limit is by programme design. It falls under the Global Health Equity Programme, which promotes access to care among children and youth living with Type 1 diabetes across low- and middle-income countries,” says Erick Omondi, Project Coordinator of CDiC-Kenya.
Omondi explains that the programme assumes beneficiaries will have attained some level of independence by age 25. But the transition is often difficult because public health systems are not equipped to absorb young adults leaving donor-supported programmes.
“Another setback includes the out-of-pocket costs for insulin, needles, and self-monitoring of blood glucose,” he says. “Social Health Authority coverage is still limited, especially at primary health facilities.”
He adds that continuity of care after patients exit the programme remains “a thorny issue.” “Most beneficiaries are still dependent after this age, at least in one way or another,” he says. “The best bet would be a Universal Health Coverage model with strengthened public health services and financing.”
According to Omondi, Kenya still lacks a national diabetes registry capable of tracking long-term outcomes such as treatment adherence, complications, and glycaemic control after patients transition out of support programmes.
The growing diabetes burden is emerging at a time when Kenya’s health system is already under pressure from climate-linked disease outbreaks, pollution-related illnesses, malnutrition, and recurring droughts.
A 2024 presentation at the European Society for Pediatric Endocrinology estimated that about 127,000 children in Kenya are living with Type 1 diabetes, yet only around 5,000 are receiving treatment. To bridge the gap, the CDiC programme, launched in Kenya in 2009, had supported about 6,100 children and adolescents by 2025 and helped refurbish 41 diabetes clinics across the country.
But despite these efforts, many young people still struggle with interrupted treatment, transport costs, stigma, and the rising cost of insulin. For those aging out of support systems, the burden can become overwhelming.
For 27-year-old Elizabeth Nyawira Muriithi, survival now comes with a steep monthly cost. “A single vial of insulin costs more than Sh2,000, and I need several each month,” she says. “Test strips are about Sh1,200 for 50, and I test multiple times a day.”
After marriage, she was able to access diabetes care through her husband’s insurance cover, a privilege she says many young Kenyans do not have.
Health experts argue that the diabetes crisis cannot be separated from wider environmental and social realities. “There is an alarming rise in non-communicable diseases among children and youth, yet our health systems are still largely designed for infectious diseases,” says Dr Catherine Karekezi, Executive Director of the Kenya NCD Alliance. “This leaves young people vulnerable during transition into adulthood.”
Dr Jeremiah Nganda, a health systems researcher at Strathmore University, says the problem is deeply structural. “What we are seeing is a break in continuity of care,” he says. “Young people are supported in childhood, but once they age out, they are expected to independently manage conditions that require lifelong, expensive care.”
He notes that environmental and economic realities in informal settlements make self-management even harder. “In contexts where income is unstable, food insecurity is rising, and access to healthy living environments is limited, managing diabetes becomes extremely difficult,” he says. “We are transferring responsibility without building systems strong enough to support it.”
As Kenya confronts climate change and rapid urban growth, experts say the country must rethink healthcare not only as a medical issue, but also as an environmental justice issue.
