Lifestyle diseases pose new burden for Africa

Anxiety grips Jennifer Nakazi as her phone beeps for the third time since she arrived at a busy bank lobby in downtown New York. She’s going to wire money to her family in Uganda. Her brother is calling with the latest update on their critically ill mother. After battling diabetes for almost a decade now, the 63-year-old matriarch has just been hospitalized after her blood sugar level hit a record high. Her blood pressure also shot up, raising fears she could also be hypertensive. “I hope we don’t lose our mother. It is not even two years since our father succumbed to diabetes. It’s a difficult time for us,” Ms. Nakazi tells Africa Renewal. She finally returns her brother’s call after wiring some $700. Their mother’s condition has stabilized and they are all relieved, but they know the struggle is far from over. Ms. Nakazi, 26, is careful about her selection of food, avoiding sugar and alcoholic drinks. She fears succumbing to diabetes or one of the other relatively new diseases on the continent whose numbers have more than doubled in recent years. Diabetes type 2 falls in the category of non-communicable diseases (NCDs), along with cardiovascular diseases, cancer and chronic respiratory diseases often referred to as “lifestyle diseases” because they are largely linked to the way people live their lives and to surrounding environmental factors. The four key risk factors for these diseases are unhealthy diets (foods high in fats, sugar or salt), tobacco use, harmful use of alcohol and physical inactivity. These behaviours set the stage for later development of lifestyle diseases such as high blood pressure, overweight, respiratory diseases, high blood sugar and high cholesterol levels. It is during adolescence or adulthood that these risky behaviours are typically established, experts say, and they are easily modifiable. Millions of lives could be saved by healthy diets, exercise and the avoidance of tobacco and alcohol. It is a path Ms. Nakazi is determined to take. NCDs are now the leading cause of death in most regions of the world, accounting for up to 70% of all deaths worldwide, according to the World Health Organization (WHO). In 2012, for example, the diseases killed 38 million people, of whom 80% were from developing countries, including those in Africa. About half of these people died prematurely—before the age of 70. Long considered diseases of the West and often associated with the urban and affluent in society, NCDs have crept silently into many corners in Africa, remaining relatively unnoticed as governments and the international community focus on combating communicable diseases such as malaria, tuberculosis, polio and HIV/AIDS. Time bomb Africa, home to 54 low and middle-income countries, will have the world’s largest increase in NCD deaths over the next decade. Although communicable diseases such as malaria, TB and HIV/AIDS and other conditions still predominate in sub-Saharan Africa, WHO projects that, by 2030, NCDs will become the leading cause of death. This would impose a significant burden on the continent, whose population will double within the next generation. “In Africa, NCDs are rising rapidly and are projected to exceed communicable, maternal, perinatal and nutritional diseases as the most common causes of death by 2030,” Dr. Oleg Chestnov, the assistant director-general for non-communicable diseases and mental health at WHO, told Africa Renewal. In North Africa, NCDs are already responsible for more than three-quarters of all deaths, and nearly half the population in this region already suffers from hypertension (high blood pressure), a well-established precursor to NCDs such as heart diseases, according to the WHO’s non-communicable diseases country profiles for 2014. In Algeria, Egypt, Libya and Morocco, for example, more than 75% of all deaths in 2012 were due to NCDs. Of immediate concern to public health planners is that 30% of all people in Africa have high blood pressure (above 140/90 mmHg millimetres of mercury — the unit measurement of blood pressure) and will most likely suffer from coronary heart diseases, stroke, renal or visual impairment or other related conditions. Negative effects The effects of these diseases are as devastating to the economy as they are to the people they afflict. At the national level, they impede efforts to fight poverty, making it difficult to achieve global development goals such as the Sustainable Development Goal (SDG) number three, which aims to ensure healthy lives and to promote the well-being of all people. At a broader level, widespread chronic illness translates into decreased labour outputs, lower returns on human capital investments and increased health care costs. In addition, the rise in NCDs will create what’s called a “multiple burden of disease” for already overstretched health systems, particularly in Africa, where communicable diseases such as malaria, TB and HIV/AIDS, as well as poor maternal and child health, remain a major problem. Treating people with NCDs is complex — involving advanced diagnostics and drugs, as well as intensive disability management and prolonged care. An ounce of prevention Although tobacco use is the single most preventable cause of disease, disability and death in the world, more and more young people in Africa are taking up the habit. “About one in 10 adolescents in Africa smokes cigarettes and the same proportion use other tobacco products such as chewing tobacco, snuff, or pipes. A half of all adolescents in Africa are exposed to secondhand smoke,” says the Washington, D.C.–based Population Reference Bureau (PRB), a nonprofit research organization. In Zambia, for example, about one-quarter of secondary school students aged 13 to 15 either smoke or use other tobacco products. In South Africa, the RPB report says, 24% of boys and 19% of girls in secondary school use tobacco. As for alcohol, heavy marketing in African countries and the portrayal of alcohol use as “cool” in many colourful advertisements, along with its easy accessibility, have exposed more youths to the vice. About 26% of boys and 21% of girls aged 13 to 15 in Namibia are current alcohol users. In Mauritius, 21% of boys and 14 % of girls in secondary school reported having been excessively drunk one or more times during their life. Way forward To curb this lifestyle epidemic requires global, national and individual commitment. Globally, WHO is mobilizing countries for collective action, especially African countries, many of which have inadequate NCD interventions. Under the SDGs adopted by UN member states in 2015, global leaders committed to an NCD target of reducing premature deaths caused by lifestyle diseases by 30% by 2030. They committed to national NCD reduction targets and to developing national policies and plans to achieve their goals, such as plans to reduce exposure to factors that put people at risk of the diseases and to strengthen health systems to cope with them. Some of the options that WHO is promoting to reduce lifestyle diseases are raising taxes and prices on tobacco products, implementing plain packaging or comprehensive bans on tobacco packaging designed to attract consumers, increasing taxation on alcoholic beverages and enforcing bans on alcohol advertising. Diet-related options include compelling companies to reformulate their food products to contain less salt to protect people from cardiovascular disease, and taxing sugary drinks, one of the main causes of the global epidemics of obesity and diabetes. Health systems can also provide essential drug therapies and counselling to people who have had a heart attack or stroke, or for people at higher risk of cardiovascular disease. Also, proven measures, such as vaccination against the human papilloma virus (HPV), can prevent nearly all cases of cervical cancer, which kills many women in Africa each year. So far there has been some progress, according to Dr. Chestnov. To date, 60% of countries globally have set targets to fight NCDs, while 92% have since integrated responses to NCDs into their national health plans. Others are trying to tax tobacco products to get financing for public health, but it is still a work in progress. The simplest and cheapest means of preventing and controlling these diseases is for individuals to make good lifestyle choices by opting for healthy diets (lots of vegetables and fruits and less sugar, salt and fats), avoiding tobacco and alcohol, and exercising. Unless urgent action is taken, the growing NCD epidemic will add tremendous pressure to already overstretched health systems and pose a major challenge to development in Africa. All in all, a rising NCD epidemic will require more resources for strengthening and adapting health systems. Given that the rates of social and economic growth in the African region are unlikely to keep pace with the rapid rise of NCDs, taking urgent preventive action now will be far less challenging than waiting to address a costly full-fledged NCD epidemic. African Renewal