Non-communicable diseases: Are all hands on deck?

Alice Sagwidza Tembe, CNS Correspondent, Swaziland
What has been known by a significant number of people is that there are some diseases one gets through contact with another person who has them (communicable diseases), and some diseases are not passed on through contact (non communicable diseases or NCDs). When epidemics like TB, Ebola, and HIV surfaced, it was a war like situation for which the world armoured itself with knowledge through research and clinical studies. 

Preventive measures and equipment were designed and improved upon; treatment was found; and now management is the buzz word. However, the progress, investment and commitment, both clinically and otherwise, has been painstakingly slow for dealing with NCDs.

According to the World Health Organisation, NCDs killed 40 million people in 2015, equivalent to 70% of all deaths globally. The 4 main NCDs-also known as chronic diseases, as they last for long duration and generally have a slow progression- are cardiovascular diseases (heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. 80% of the premature deaths due to NCDs occur in low- and middle-income countries.

A chat with Siphiwe Mhlanga (name changed), a 50 year old woman who survived breast cancer, reiterates the need for focused attention on NCDs today. She said: “…Honestly, I do not even know when it all started. I remember collapsing at work and being taken to the hospital. When I came to, I had no explanation and that did not help much. So I was tested for pregnancy, and HIV. That was early 2014. I became sickly thereafter; my body wasted away; I had no appetite. But there was no particular pains. 7 months later, the doctors wanted to repeat HIV tests as they thought that I may be a carrier hence the antibodies for HIV were not showing. By end of 2014, my family put in a lot of funds to take me to South Africa for better medical care and that meant ambulatory transport for me, transport for my husband and sister and their accommodation while I was admitted. My two children travelled often to come and check on me. After two months when I was getting ready to be discharged, some laboratory results came back and the doctor asked for my discharge to be delayed. Only then did the physical examination indicate the breast cancer diagnosis. By then, I had given up hope and was preparing myself for my last mile…..”

Many governments have not even begun to appreciate the high socio-economic cost of NCDs, not just by burdening the health systems, but also by resulting in loss of income of the sufferer and by depleting productive population. NCDs are primarily driven by four major risk factors comprising tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets which means that they are largely preventable.

As noted by Cristina Parsons Perez, Capacity Development Director at the NCDs Alliance, in a webinar organised by CNS on 4th July 2017, the issues failing the NCDs management include weak political commitments, limited funding for NCDs, unprepared health systems and commercial conflicts.

There has been poor progress towards prioritising NCDs national intervention programmes. According to the WHO Country Profiles 2014, benchmarking the 2011 Moscow UN High level meeting commitments (to strengthen global and national initiatives to prevent NCDs as part of national health plans on NCDs), Swaziland had established an operational Unit within its Ministry of Health. However, on the other checklist questions that included developing operational policies and strategies to reduce harmful use of alcohol, promoting physical inactivity, reducing burden of tobacco use and promoting heathy diets, and developing evidence based national guidelines/protocols for managing NCDs, the Kingdom’s response has not been very positive.

Indicatively, without an operational plan or strategy it is easy to overlook need for resource allocation, hence interventions remain a wish. While we generally talk of ‘weak health systems’, it is important to note that the health systems cannot be strengthened for the unknown. The footnote on WHO Country profile for Swaziland indicated that mortality estimates have a high degree of uncertainty because they were not based on any national NCD mortality data. Clearly, the slow motion reaction to funding and the weak reaction of the health systems could be accelerated if the magnitude of the problem was clarified.

In Swaziland, selling healthy eating, responsible alcohol intake, and encouraging physical activity is socially taken to be amplifying one’s weakness in an active school yard— it makes one unpopular. Fast food with high oil and salt content, as well as pre-cooked oven ready meals packed with harmful preservatives, are the convenience of today’s robust lifestyle. Further, this is the generation of ‘screeniosis’—everyone is looking at some sort of screen (smart phones, computers, television) during most parts of his/her waking hours. All these discourage mobility and rob ones time to prepare and watch what and how much they eat. In the African loose talk, “…When happy we share a drink, when sad we share a drink, if we are not sure how we feel, we share a drink to resolve the feelings”. Abstaining from alcohol at a business function brands one as untrustworthy. Smoking tobacco is fashionable, the brand and how you hold the cigarette defines who you are in society. Well these are the social norms prevalent in the likes of Swaziland’s societies.

Our economy thrives on this entire buzz. TO curb and manage NCDs it seems inherently like fighting the Fortune500 muscle; so once more, it is ‘war’ on NCDs.

Alice Sagwidza Tembe, Citizen News Service - CNS
July 10, 2017