Until recently diseases such as diabetes, hypertension, cancer, and asthma were viewed as diseases to affect only the richer parts of the world or the very old people. Though, these diseases were thought to only appear in developed countries. Such diseases are called non-communicable diseases and they so happen to appear not merely in the developed countries but also in the lesser developed areas of the world. Non-communicable diseases (NCDs) have become a global phenomenon with no boundaries in terms of age, the social status one is in, or one’s geographical location. Such diseases appear all over the world and they are now the leading cause of death on a global scale with causing 63% worldwide according to the World Health Organization.
Even if Africa is still battling communicable diseases such as Malaria, water-borne illnesses, Tuberculosis and HIV-Aids the continent also has to deal with the rising issue of NCDs. An example of such is in Kenya as more than half of the hospitalisations are a result of NCDs, which then lead to the cause of 55% of hospital deaths. This is an issues for countries such as Kenya and other countries on the African continent as in other African countries, since this further weakens their health system, which needs to be better prepared for communicable as non-communicable diseases. It is therefore crucial that prevention, early diagnosis and effective management of such NCDs in Africa is very well informed so that people in more vulnerable communities can change their lifestyles, as well as try to increase the access to medical care in need be in order to reduce the high rate of mortality.
Therefore, the idea to spread the word and information about NCDs to vulnerable communities is through the mouth to mouth tactic used by Amref Flying Doctors/Amref Health Africa with the use of community health workers (CHWs), who are trained and encouraged to speak to the community members. Information is used by explaining to people the prior symptoms of a disease since that information could be life changing as one could seek for medical help much earlier instead of dying prematurely to one of the NCDs diseases. Moreover, governments should respond to the urgent matters of the NCD issues, health care in general and the challenges diseases can bring to a society. For disease prevention to happen we need to see a co-operation between communities, healthcare workers and the government.
Great improvements have been made on reducing the burden of communicable diseases in Africa. However there has been a rise of NCDs, which are threatening the development as well as the health progresses made over decades. This also include the Millennium Development Goals related to poverty, education, child and maternal health. These NCDs are a significant socioeconomic cost to society due to the lack of productivity.
In sub-Sahara Africa, people that die from NCDs die on average 10 years earlier than people in developed countries. Higher poverty rates in the region exacerbate the challenges, and research shows that social context – in particular living in a love-income neighbourhood is important when looking at NCDs. So when we analyse inequality and poverty it already underlies high rates of communicable diseases and also gives rise to risk factors of NCDs such as smoking, diabetes, drinking and having a poor diet. This means that NCDs have a huge impact on health and human potential especially when looking at sub-Sahara Africa. Therefore, if we look at the impact NCDs has had on society with relation to the health economy and one’s human potential we could look at the example of diabetes in Kenya to show what NCDs do to a person and what its’ symptoms are.
While non-communicable diseases have historically been associated with high-income populations, more specifically in developed countries, evidence has shown that they are becoming prevalent among lower income groups as well. While in the past decades, donors and government have been putting all their attention on communicable diseases such as HIV, malaria and tuberculosis, the growing burden of NCDs is responsible for a high rate of deaths in Kenya. Even if there is limited NCD data availability and quality data from the Ministry of Health Management Information System had shown that NCDs accounted for more than 50% of total hospital admissions and over 55% hospital deaths in Kenya in 2012. The goal is that by 2030, the NCD related deaths in Africa including the deaths in Kenya are projected to exceed the combined deaths of communicable, nutrition diseases and maternal and perinatal deaths (WHO NCD fact sheet 2013). From now on the prevention and control for NCDs has become an important priority for the Kenyan government with regards to the National Medium Term Plan and National Health Strategic Plan.
Diabetes, a prominent NCD
One of the diseases that is often overlooked is diabetes, however it is one of the major non-communicable diseases of public health importance around the world. There are two forms of diabetes a person can have. They are separated in Type 1 and Type 2. Type 1 diabetes is when one has a lack of insulin production; meaning the cause is therefore unknown and it cannot be prevented. On the other hand, Type 2 diabetes is much more common than the previous cited version and accounts for 90% of all the diabetes cases. One can prevent Type 2 as it means that the body does not use the insulin of the body well.
Most diabetes patients also die from causes which are non-related to the symptoms of diabetes. They often pass away from cardiovascular complications such as a heart that stops beating or a heart attack. Diabetes damages many healthy working aspects in a body such as damaging a good functioning heart, blood vessels, kidneys nerves, eyes in most advances cases, which then can lead to death. Therefore, it is important to understand that diabetes is the leading cause of NCDs when put in relation to the disability-adjusted life years (DALYs). Diabetes has been pointed out as one of the leading cause of amputations and loss of limbs in the world, after accidents and injuries. Moreover, when speaking of NCDs as only reaching the more wealthy parts of the world it is not merely the case. However, diabetes and its negative impact has been affecting lower-income populations the hardest. This leads us to believe that poverty, lack of information and education and other social aspects are linked to each other and thus can create higher risks of diabetes.
Moreover, the health and socio-economic impact of the NCDs epidemic is impeding the achievement of the Sustainable Development Goals. This relates especially the case for Goals 2 and 3 which have an emphasis on health and nutrition. Both health and nutrition have an impact on women’s and children’s health, more specifically since poor nutrition during a women’s pregnancy and early life causes a predisposition to high blood pressure, heart disease and diabetes later in life for both the mother and the child. If we try to reduce poverty, through better spread of information, and better spread of expenditure of treatment the amount of NCDs deaths should diminish.
Similarly, because of the magnitude of the illness, the disabilities and premature deaths caused and the long-term care required, diabetes reduces productivity of the people who are suffering from it and it also increases health-care costs, thereby weakening national economic development. The burden of NCDs and diabetes in this case can be immensely reduced and prevented, with millions of lives saved and unnecessary suffering avoided, through recognised and affordable measures, many of which are complementary to global health efforts already underway.
A major issue in sub-Sahara Africa is the increased intake of unhealthy foods which is a major risk factor when looking at diabetes. Prevention can be the answer when changing the lifestyle such as switching to a healthy diet and by increasing the physical activity, as well as avoiding the unhealthy habit of tobacco and abuse of alcohol intake. The main issue with NCDs touching sub-Sahara Africa is that diet change or increase physical activity is hard to get. For one to change his lifestyle they should thus embrace a diet that helps diminish the sugar levels, engage and thus engage in physical exercise.
To conclude, as World Diabetes Day was on the 14th of November, it is important to outline the gravity of the illness and thus explain that it is a NCDs which could be prevented if more attention was given to providing good health information to the more vulnerable groups in society. It is therefore important to encourage Kenya as well as all the African countries to seek for medical attention and receive information on how to be healthy to ensure that such NCDs are diagnosed on time and treated before any complications might occur. Check-ups are thus crucial because many of the NCDs do not have symptoms at early stages. So, we strongly encourage members of the vulnerable communities to have good health habits concerning food, physical activity (whenever possible), which will reduce the risks of diabetes and any other NCDs in the long term.
*Patricia Vermeulen is CEO of Amref Flying Doctors.