Make non-communicable diseases the next big thing

The patient outcry following recent breakdown of the radiotherapy machine at the Kenyatta National Hospital, the big number of patients waiting for treatment, related anger on social media, and fund-raising online are a tip of the iceberg of what is happening globally.

The pattern of diseases is greatly changing worldwide: for a long time, public health strategies have focused more on communicable diseases, nutrition, water and sanitation and maternal and child health.

Sub-Saharan Africa has made enormous progress by, for example, reducing mortality and prolonging life since 1970.

In the last 20 years, the region has succeeded in decreasing premature deaths and disability as a result of communicable diseases. Throughout the region, deaths from measles and tetanus have substantially declined since 1990.

Similar progress has been noted in Kenya, thanks to government efforts and support from donors, including the Global Fund, The Gates Foundation, World Bank, Pepfar, and DfID.

Globally, a significant population of children is surviving into adulthood and not dying before age five due to poverty related diseases.

On the other hand, the emerging epidemic of non-communicable disease’s (NCD) four big killers – namely cancer, heart disease, stroke and diabetes – present a unique global health challenge to both developing and developed worlds.

According to the World Health Organisation (WHO), the shifting health trends indicate that leading infectious diseases — diarrhoea, HIV, TB, neonatal infections and malaria — will become less significant causes of death globally over the next 20 years.

In 2008, WHO data indicated that more than 36 million people died globally from heart diseases, cancers, chronic respiratory diseases and diabetes.

Premature deaths from NCDs range from 22 per cent among men and 35 per cent among women in low-income countries to eight per cent among men and 10 per cent among women in high-income countries.

While majority of the populace characterise NCDs as diseases of the affluent, the reality is that NCDs are fundamentally diseases of poverty.

In most countries, NCDs do not only disproportionately affect the poor, but NCDs also perpetuate poverty in individuals, families, and the country at large due their expensive nature of management.

They do not only drag down economic growth, but also the health systems and work-place productivity. Economic output losses are estimated to be $7 trillion (Sh700 trillion) globally.

Now, what are we going to do? The good news is that the risk factors for the big four NCDs are well documented. These risk factors include poor nutrition, increase in tobacco use, excessive consumption of alcohol and lack of physical exercise.

These factors can be prevented by everyone at the lowest cost since they are dependent on behaviour change.

We have made a great progress as a country with tobacco control by having in place legislation that makes public spaces free of tobacco smoke, mass media awareness on dangers, enforcing advertisement, promotion and marketing bans and raising taxes on tobacco products.

While this is a comprehensive tobacco control package, the enforcement of smoke-free laws are inadequate.

Kenya observes the WHO Breast Cancer Month in October and great efforts have been made to use this period to create awareness not only on breast cancer but also on cervical cancer and prostate cancer screening for men.

However, we need to start doing things differently by identifying the gaps to achieve our overall goals and advocate for the same.

While raising awareness is good and might work in principle, an effective response to dealing with NCDs requires understanding these diseases better through monitoring or surveillance.

Just like the weather people are warning about impending El Niño rains, the same principle is true for public health.

We need to know what is happening, defend programmes that are working and fix those that are broken. In Kenya, we don’t stand on a common ground of NCDs denominator, we often rely on estimates.

That is the biggest challenge, not only for community prevention but also in clinical prevention. We need to know the exact figures. This is important because what gets measured gets monitored, evaluated and eventually gets improved.

A great British public health figure of the 1800 once said death is a fact and everything else is an inference. In Kenya, our death registry is incomplete and unreliable since the cause of death is rarely known.

Kenya needs to develop a robust NCDs surveillance system to monitor progress: the burden, actions, training of experts, and mitigation.

Strategy

Secondly, we need to identify interventions that are scalable. Community interventions provide a unique opportunity to control and prevent NCDs.

We should think about two broad pockets: prevention in the clinical setting and prevention in the community. But these two worlds of community and clinical prevention have to intersect.

In Mauritius, the government intervention saw the decline of use of cholesterol-laden palm oil for cooking with changes to better alternatives.

In 2007, the ministry of Public Health and Sanitation adopted the use of community health strategy through development of a community strategy policy.

This structure has been a major success factor in the control of communicable diseases, maternal and neonatal health-related diseases and deaths.

Kenya can learn from such successful strategies and identify ways to integrate some of the simple NCD prevention and control services.

Kenya’s public health system has concentrated a lot on managing NCDs, but this is expensive. Above all, we are a signatory to the recently launched Sustainable Development Goals (SDGs).

The SDG on health is anchored in universal health coverage, hence, as a country, we need to identify innovative ways to achieve this goal of quality and accessible health care for all, including access to NCD-related services to ensure zero deaths.

The writer is an operation research manager with HealthRight International in Kitale and Global Health fellow at the University of Edinburgh, Scotland.