by Danielle Doughman, Policy Outreach Manager, APHRC
Non-communicable diseases, or NCDs, are illnesses or conditions including cancer, high blood pressure, diabetes, and obesity that progress slowly over time, and are increasingly a cause of death in the developing world. Worse, many people have an NCD and don’t even know it, which means an NCD can silently wreak havoc on a person’s body when they could otherwise be able to take action to treat or manage it.
But the goal isn’t to simply treat or manage these conditions—we want to stop them before they start so that people can live longer, healthier lives. The lack of political prioritization of NCD risks can be just as deadly as the risks themselves, which include unhealthy diet, excessive alcohol consumption, tobacco use, and insufficient exercise. Because NCDs usually develop slowly over time, they are more difficult to gain dedicated governmental resources. Elected officials or political appointees tend to give attention to urgent crises or high-profile causes (think terrorism or HIV/AIDS) or ones that can be addressed in a five-year political cycle, not over the course of a lifetime. So the question is, how does the public health community create allies outside the arena of traditional health actors to help prevent, identify and treat NCDs? Considering that the vast majority of deaths in low- and middle-income countries may be attributed to NCDs by the end of this decade, it’s imperative that policymakers in the countries of sub-Saharan Africa take action sooner rather than later.
How we talk about NCDs impacts how we build support to fight them – especially politically – and how we design public policy to combat their spread.
NCDs are defined by what they are not—not infectious. It’s common that policymakers (at least those not trained as health professionals) will be unfamiliar with what NCDs are, especially after decades of focus on communicable, or infectious, diseases such as malaria, tuberculosis or HIV/AIDS. Even people with hypertension or diabetes themselves don’t often identify that they have an NCD, per se, but rather their specific condition. It is hard to build political will when people are not even sure what you are talking about.
Especially challenging is the fact that by the time NCDs become a health issue requiring medical intervention, it is too late for the systemic changes that could make a meaningful difference in a person’s – or a community’s—health and wellbeing. For example, whether or not there are fresh fruits and vegetables, clean water instead of sugary drinks or beer, or areas safe for children and adults to play football, for example, would be matters better dealt with in departments of government that deal with urban planning, finance, infrastructure, and others. Policy, program, and infrastructural changes must be put in place now to ensure long and healthy lives for the next generation.
A challenge-and an opportunity- is that many preventive measures are outside of the health sector. Social determinants of health lie beyond the scope of health alone, and potential solutions must involve an inclusive network of stakeholders. Some of those stakeholders might not yet realize the power they hold over citizens’ health, because they don’t traditionally consider cancer and diabetes a part of their scope as officials in agriculture or education. APHRC believes that multi-sectoral action is a promising approach to NCD prevention. An APHRC-led expert working group on multi-sectoral approaches to NCDs in sub-Saharan Africa is exploring the possibilities.
The first step to increase political will for NCDs prevention is to reconsider how we talk about them. Risk factors for NCDs—what you eat, how much alcohol you drink, whether or not you smoke—are sometimes called “lifestyle choices,” which implies that people willfully court these diseases through their conscious choices, when in fact it is living conditions largely tied to poverty, lack of education, pollution, and other social determinants of health that are drivers of NCDs.
NCDs are sometimes referred to as “luxury” or “developed country” illnesses, as if it is more prestigious or desirable to have cancer than an infectious disease such as tuberculosis. Newsflash: diseases, infectious and non-infectious, are all bad, and they all deserve government attention and resources.
Careless language undermines our work to increase political will to tackle NCDs head-on. It confuses the conversation about the seriousness and pervasiveness of NCDs when even health experts use glamourous terms like “luxury” and “affluence” in conjunction with diseases such as diabetes and cancer. Let’s commit to stop using these words as we pursue multi-sectoral action for non-communicable diseases across sub-Saharan Africa, starting now.