Four Birds, One Stone: A New Approach to Preventing the Risk of Non-Communicable Disease

April 21, 2016

In 2015, a state of panic gripped Kenya after the country’s lone functioning radiotherapy machine broke down, leaving hundreds of cancer patients without access to treatment in the public system. One year later, the same crisis confronted our neighbors in Uganda after a decades-old machine gasped its last breath. Fortunately, both governments acted swiftly; in Kenya, a new, high-tech machine was installed in Kenyatta National Hospital at a cost of KES 300 million (about US $3m) while in Uganda, the government has released a whopping UGX 30 billion (or US $9m) to build seven bunkers to house even more sophisticated machines, each with a price tag in the billions.

The need for these machines indicate that, unfortunately, cancer is becoming commonplace in our region; few households can claim to not be touched by the disease. Whether celebrity or politician, grandmother, uncle or child, the chronicles of pain, struggle, hope and triumph end with frightening similarity: too few of these stories have a happy ending.

Of the over 40,000 cases recorded annually in Kenya and Uganda, the vast majority are diagnosed at either Stage 3 or Stage 4, when they have spread too far or into other organs, too late for a chance at a cure. This late diagnosis can partially explain why sub-Saharan Africa has the worst cancer survival rates in the world: another deplorable topping of the global charts for a region in dire need of improved investment in stronger health systems, improved health education and awareness and better understanding of the epidemiology of disease.

But with cancer, like with many other non-communicable diseases, there are things that we can do to slow its spread. Joining diabetes, diseases of the heart and circulatory system and chronic respiratory illness, some cancers may be avoided if a set of four risk factors is mitigated.

These risk factors are:

  • unhealthy diet
  • tobacco use
  • misuse of alcohol
  • inadequate physical activity

By committing to changing these behaviors we have the chance to hit four big birds with one big stone.

Newly released nationwide surveys in both Kenya and Uganda on non-communicable disease risk factors provide an opportunity to reflect and, more importantly, to act. The 2015 Kenya STEPs Survey and 2014 Uganda STEPs Survey paint a shocking picture of how we are exposing ourselves to mounting risks of NCDs; we eat and drink more, we move less and we are taking up smoking in far greater numbers.

These surveys must be a wake-up call for us as citizens and, more importantly, to our governments to find better solutions to the growing crisis of non-communicable illness.

The cost of doing nothing – or of only investing in expensive end-stage treatments – is too high for our young populations.

So where should we start? If we know that mitigating the risk of non-communicable disease starts with healthy and smart choices, we might have to go back to the beginning – back to when our mothers wouldn’t let us up from the table until we finished our veggies.

These days we’ve replaced healthy with tasty and, most often, with easy. Grabbing food on the run means that an anemic 6% of Kenyan adults get their recommended five-a-day fruits and vegetables. In Uganda the figure is 13% for women and 12% for men.

Maintaining that healthy diet can help to reduce the risk of some cancers as well as the chances of being obese – which itself is a marker for all sorts of non-communicable disease including heart disease and diabetes.

A healthy diet also restricts salt intake, which for Kenyans is even more of a challenge than adding fruit and vegetables. One in four Kenyans and Ugandans add salt to their food before they even taste it. Every shake of that shaker carries with it a risk of high blood pressure and lasting damage to heart, kidneys and brain.

High consumption of alcohol can also have an effect on weight and the organs most vulnerable to disease: the heart, the liver, the stomach and the pancreas. One in four Kenyan men drink alcohol daily and one in eight are heavy drinkers: so half of men who are daily drinkers are daily heavy drinkers. Beyond the long-term damage of over-consumption, heavy drinking can also mean you – and others who share the road with you – are at higher risk of traffic accidents leading to serious injury or death.

Another risk factor is tobacco – smoking or being around smokers. The Tobacco Control Act in Kenya has been around since 2013, yet one in four Kenyans is still exposed to tobacco in the workplace or in the home. Passive smoking – when you’re with someone who smokes, even if you don’t smoke yourself – has been found to be equally dangerous in terms of heightening the risk of cancer, chronic respiratory conditions or heart disease.

What all these figures mean is that we as individuals have the responsibility to remove the risks from our lifestyles – but that our governments also have the responsibility to develop systems to help us mitigate these risks. Without concerted action at the systems level, the burden on our overstretched health services will be even greater, and the costs of inaction will stymie our economic growth and development. Damage to a person’s health and body happens over the long term; it may manifest itself as a treatable condition, such as overweight, high blood pressure or diabetes, but can quickly deteriorate into a degree of suffering that can only be managed, not cured.

The STEPs Surveys demonstrated that we are not taking advantage of the second chances; we are not getting the regular health check-ups and screenings we need to make sure we’re healthy. More than half of adult Kenyans have never had their blood pressure tested – yet one in four of have high blood pressure. The same holds true in Uganda. Diabetes testing has even worse adherence with only one in 10 adults ever getting tested.

The World Health Organization has developed a list of Best Buys: tried, tested and feasible interventions with the strongest potential to save lives. These aren’t high-tech machines or radiotherapy bunkers, or larger ICUs: they are regular screenings, immunization against Hepatitis B, and higher so-called ‘sin taxes’ on alcohol and tobacco to serve as deterrents.


Better investment in education, awareness and prevention is a Best Buy for government; buying a bicycle and planting a kitchen garden is a Best Buy at home. We owe it to ourselves to live healthier lives, to take advantage of the economic development and innovations taking root in our countries and our region. It’s a better deal than expecting salvation from a high-tech machine that is likely to break down right when you need it the most.