Non-communicable diseases such as hypertension, stroke, cancer and diabetes, are no longer just a health issue.
They are a major contributor to poverty and underdevelopment in Africa due to the vicious interaction between low incomes, chronic ill health and medical impoverishment.
And the poor are hardest hit. For example, in rural sub-Saharan Africa, expenditure on insulin alone for one person with diabetes can wipe out 60 per cent of the entire household income.
We have heard stories of people living with NCDs who have had to make painful trade-offs such as cutting back on education for children or sale of assets to clear staggering medical bills.
Nearly half or 43 per cent of Africans live below the poverty line and many more are struggling just above the line.
These people have insufficient or no health insurance or access to universal healthcare. This means that when an NCD strikes, the entire household faces catastrophic out-of-pocket expenditure.
Yet NCDs are rapidly increasing and set to overtake infectious diseases as the main health problem in sub-Saharan Africa.
In East Africa, they are responsible for 35.6 per cent of deaths, up from 29.8 per cent in 2015, a 5.8 percentage point jump in just two years!
East Africa is also among the highest prevalence regions for cervical cancer, hypertension and rheumatic heart disease.
Worryingly, 15 out of 41 million people die from an NCD between the ages of 30 and 69; and over 85 per cent of these "premature" deaths occur in low-income countries.
The WHO has stated, “Of all the major health threats to emerge, none has challenged the very foundations of public health so profoundly as the rise of NCDs” and one commentator has noted that NCDs have “the potential to bankrupt health systems” in poor countries. On the economy-wide level, the World Economic Forum has estimated that, under a “business as usual” scenario, Africa will lose four per cent of GDP due to NCD mortality and disability in the period 2011-2025.
This is an urgent situation requiring urgent and radical action.
It was thus disappointing that last week’s UN General Assembly, which included a High Level Meeting (HLM) on NCDs, did not offer renewed global effort on the issue.
There had been measured hope for a global response akin to that which followed the UN Declaration on HIV/Aids in 2001. This hope was anchored in the gravity of the situation and because NCDs are now recognised in and are critical to achieving at least nine Sustainable Development Goals.
Momentum has been growing since the 2011 UN Political Declaration on NCDs. Global civil society has also been mobilising stakeholders to take the 2018 HLM as an opportunity to renew action and catch up on lost progress. We hoped for increased financing, new innovative governmental initiatives and concrete commitments.
However, just before the HLM, it was clear that not much would be achieved. The UN Political Declaration on NCDs adopted on September 27 fell short.
The global NCD Alliance described it as “vague and unambitious commitments” while the World Cancer Research Fund called it a missed opportunity “to shift the NCD landscape seismically.”
The UN grapevine spoke of donor fatigue over funding another costly global epidemic intervention. Geopolitical undercurrents also come into play: NCDs do not pose an infectious global health security threat such as Ebola or HIV. The emphasis is now on public-private partnerships, and corporations with disturbing conflicts of interest are getting interested.
But away from the UN, African governments have disappointingly not done enough to address the issue.
A large percentage of NCDs are preventable through the reduction of their four main behavioural risk factors: Tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. And they are curable or controllable if detected early.
But our governments have simply not put these in place. For example, there is widespread lack of cheap technologies like glucometers and blood pressure machines at lower-level health centres where they are needed most to save lives through early detection and prevention.
While governments have made some efforts on NCDs, they have taken a curative approach by supporting national referral treatment centres. For our low-resource countries, the best shot at success lies in prevention. Most people start treatment when it is too late to save them.
So while we continue to call for concerted action at local and global levels, the outcome of this year’s HLM underscores our emphasis that African governments have the foremost responsibility and must do more to invest in the health of citizens.
Given rampant poverty, we need an egalitarian approach following on universal health coverage that includes prevention and control of NCDs.
As Dr Githinji Gitahi, the CEO of Amref, noted at the HLM side event organised by the East Africa NCD Alliance in collaboration with Danish and global NCD alliances, “Africa does not need a UN resolution to buy blood pressure monitors.”
Such affordable interventions should already be in place and saving millions of people from preventable death.
David Mulabi is the CEO of the East Africa NCD Alliance. E-mail: [email protected]