The Rise of Non-Communicable Diseases in Zambia and Strategies for Action
The UN high-level meeting on non-communicable diseases (NCDs) will take place in 2018. Every day I think about how much progress Zambia has made towards attainment of the nine global 2025 targets for NCDs, against a baseline in 2010. Historically, NCDs were considered health issues of high income countries, but currently low-income countries are experiencing the burden of NCDs at progressively higher rates.
The World Health Organization expects deaths from non-communicable diseases to rise by 15% between 2010 and 2020. In sub-Saharan Africa, chronic illnesses are likely to surpass maternal, child and infectious diseases as the biggest killer by 2030.
The World Health Organization (WHO) defines NCDs as ailments that cannot be passed from one person to another. They are generally slow in progression and of long duration. NCDs cause an estimated 70 percent of all deaths globally. A 2010 report suggests that NCDs are overtaking infectious diseases in terms of global mortality rates, and deaths from NCDs are forecast to exceed mortality from infectious, maternal, and child diseases even in Sub-Saharan Africa by 2030.
As Zambia celebrates progress in reduction of infectious diseases and maternal and child death rates, the globalization of unhealthy lifestyles, urbanization, and liberal market forces are fueling NCDs. The most common NCDs include cardiovascular diseases (like heart attacks and stroke), diabetes mellitus (Type II), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), epilepsy, mental illnesses, oral health, eye diseases, sickle anaemia, and injuries.
There still exists a misconception amongst Zambians that eating fast foods and having a large waist line is a clear indicator of financial stability. Going to the gym is considered a luxury. This perception has resulted in lack of information and awareness of NCDs as well as their severe implications on health and well-being.
These health conditions are largely associated with physical inactivity, unhealthy diets, and tobacco use and alcohol abuse. Unhealthy diets and physical inactivity show up in people mostly as raised blood pressure, increased blood glucose, elevated blood lipids and obesity leading to cardiovascular diseases. Additionally, excess sodium intake largely contributes to these health conditions in Zambia. There still exists a misconception amongst Zambians that eating fast foods and having a large waist line is a clear indicator of financial stability. Going to the gym is considered a luxury. This perception has resulted in lack of information and awareness of NCDs as well as their severe implications on health and well-being.
It is well known that poor health lowers household productivity and income. Households affected by any type of illness have lower incomes relative to disease-free households. Although ill health nearly always lowers household income, households affected by NCDs experience greater income loss relative to households reporting general infectious diseases. This is because expenditure associated with the acute and long-term effects of NCDs is high, resulting in catastrophic health expenditure for the households. Care and treatment cost studies have shown that NCDs reduce disposable incomes, leaving families with less money to use on other vital needs. It also negatively affects the future productivity of the patients. People hospitalized with chronic diseases usually end up poorer, and in many cases end up with huge debts.
According to the World Economic Forum, poor and middle-income countries will lose $7.3 trillion in output from heart disease, cancer, diabetes and lung disease by 2025.
It is evident that there is an equity problem when it comes to the cost and prolonged treatment of NCDs. This could be one of the reasons some Zambian locals have dubbed NCDs as rich people’s diseases. For instance, if a woman from a developed country develops a chronic disease, excellent treatment and rehabilitation services will be available and she can expect to receive affordable medications and much more if needed. Meanwhile, an average Zambian woman who falls ill will be expected to pay huge sums of money for care, and she might even be transferred to India. This will require her to secure money for the flight and treatment costs. If she survives and develops a chronic disease, then she may die prematurely as a consequence of inadequate treatment back home.
Disparities in opportunities of treatment exist also within countries — between poor and rich, cities and rural areas. The first and only cancer hospital was opened in 2007. This has helped reduce the cost of treating Zambian cancer patients abroad, which costs an average of $10,000 per person. But still, the poor are still unable to meet the cost and cancer patients from other parts of Zambia still have to travel to Lusaka to seek treatment. Thus, vulnerable and socially disadvantaged Zambians get sicker and die sooner than those in higher socioeconomic positions.
As much as poor budget affects healthcare, bad management and absence of goodwill also contribute negatively. As an example, fewer developing countries have signed the Framework Convention on Tobacco Control (FCTC) and voted laws that prohibits smoking in public areas but the laws are rarely executed. Additionally, the absence of early detection leads to many people being diagnosed at advanced stages. One other constraint that exists in low resource settings like Zambia is that the healthcare system is designed for acute and infectious problems. This is largely because that is what foreign donors mostly pay for. Only a small percentage of aid for health goes to chronic illnesses, as some chronic diseases may require lifelong medication. In other words, NCDs have not been priorities for donors.
The Zambian government has recognized the need to change the manner in which health services are provided to fight the rise in NCDs as an intervention measure. It is considering modernizing hospitals to meet the demand for specialized treatment arising from NCDs. It has also vowed to partner with the private sector to help curb chronic diseases. In particular, there have been mobile cancer screenings in Zambia to reach populations who may not seek out testing and preventative care. This has been possible through funding from the U.S. President’s Emergency Plan for AIDS Relief as part of Pink Ribbon Red Ribbon support, which offers screening through visual inspection and cryotherapy for treatment of precancerous cervical lesions in some communities throughout the country.
The focus should not only be on adopting national conventions and adhering to international recommendations but also on making pragmatic decisions. Prohibiting smoking in public areas, controlling alcohol abusers, encouraging physical activity, promoting healthy diets, and improving primary healthcare for screening and early detection of chronic diseases should be priorities.
Policymakers and governments are recognizing the importance of investing in people’s health as one of the necessary conditions for economic development. Thus, there is need for energetic decisions for the adoption of consequent strategies to help fight NCDs. WHO and many other organizations and associations are urging health decision makers to develop efficient preventive strategies to halt the growing trend of NCDs through the control of risk factors. The focus should not only be on adopting national conventions and adhering to international recommendations but also on making pragmatic decisions. Prohibiting smoking in public areas, controlling alcohol abusers, encouraging physical activity, promoting healthy diets, and improving primary healthcare for screening and early detection of chronic diseases should be priorities.
To be more practical in a low resource country, simple steps such as reducing salt in foods, offering inexpensive drugs, and raising tobacco taxes can make a big difference. This is the best way of curbing NCDs as well as raising money for healthcare. Sustainable efforts are those that raise money and provide care — chronic diseases are already a huge market, sadly.
Another important measure is putting in place a health financing plan through health insurance, and resource pooling as a route towards social protection. Alongside those efforts, improvement in the level of education in the public could also help by decreasing the risk of developing NCDs. It’s critical that the government sets aside a budget for campaigns across the country to increase awareness on NCD risk factors and early detection of symptoms to reduce mortality and costs associated with treating NCDs.
…young, vibrant leaders should be encouraged to engage locally and internationally to build accountability and action in the fight of NCDs through unique effective ways like storytelling.
Those efforts are all important, but perhaps the most effective way to prevent and control NCDs is through integration. Firstly, initiatives to integrate NCDs with other existing programs such as HIV, tuberculosis, maternal and child health should be encouraged. Integrating NCD interventions into the health system based on primary health and drug procurement and supply management system is another cost-effective approach.
I strongly believe that young, vibrant leaders should be encouraged to engage locally and internationally to build accountability and action in the fight of NCDs through uniquely effective methods like storytelling. The government should also provide incentives for training youth on NCDs and integrating them into the policymaking process through systematic stakeholder engagement and consultative review. The integration approach is right not only the best way from a cost-effectiveness point of view, but perhaps more importantly from an equity and social justice perspective. It would lead to provision of services that are coherent, high quality, and universally accessible.
Bevis Phiri was a 2016–2017 Global Health Corps fellow.