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Moving lifestyle diseases to the front burner will save lives

A few years ago, some group of experts projected and warned of steep rise in non-communicable diseases (NCDs), especially in developing countries, saying there is the need to rein in these diseases due to the economic and public health cost, and also the debilitating effects of these conditions on individuals and families.

These predictions were published in technical reports, with one such report saying conditions such as heart disease, cancer, diabetes, chronic respiratory tract infections are expected to account for three quarters of the disease burden in middle-income countries, with sub-Saharan Africa accounting for 46 per cent of all deaths by 2030, up from 28 per cent in 2008.

A World Bank Human Development Network report, focusing on the growing danger of NCDs and how to act now to reverse the course, added that developing countries, in addition, would continue to grapple with the widespread prevalence of communicable diseases such as HIV, malaria, tuberculosis and a “double burden” of disease not experienced by their wealthier counterparts.

A similar report based on compilation of work published in two separate documents by the World Economic Forum, the Harvard School of Public Health, and the World Health Organization, also noted the economic consequences of NCDs, which  were going to be staggering, under a “business as usual” scenario, should intervention efforts remain static and rates of NCDs continue to increase.

According to the report, the cumulative economic losses to low and middle-income countries from specifically cardiovascular disease, diabetes, cancer and chronic respiratory diseases, in addition to other factors, are estimated to surpass $7 trillion over a period covering 2011-2025 (an average of nearly $500 billion per year).

Close to seven years has passed since all these reports were published with predictions on the rising incidence of NDCs, the cost to lives, finances and the health systems.

In Ghana, current figures estimate NCDs to account for 43 per cent of all deaths, according to a World Health Organization-Non-communicable Diseases (NCD) Country Profiles, 2018, document.

Lifestyle issues

The worrying trends of NCDs may have caused global leaders to sit up and think about the issue. In September,  this year, when heads of state and governments met at the UN General Assembly in the US, they pledged to deal with diseases such as cancers, heart and lung diseases, stroke, and diabetes, and to promote mental health and well-being among the global community.

Based on this meeting, the World Health Organisation (WHO) issued a statement targeting NCDs and saying there was an agreement from that meeting that efforts be directed at robust laws and fiscal measures to protect people from tobacco, unhealthy foods, and other harmful products, for example by restricting alcohol advertising, banning smoking, and taxing sugary drinks.

The statement called on food manufacturers to take several actions such as including reformulating products to reduce salt, free sugars and saturated and industrially produced trans-fats, using nutrition labeling on packaged food to inform consumers, and restricting the marketing of unhealthy foods and beverages to children.

The burdens associated with NCDs have taken centre stage in recent times at the UN High-Level Meeting on NCDs, as both developing and developed countries are suffering from the impact of these diseases.

In the US for instance, the American Diabetes Association estimates that the total cost of diagnosed diabetes, including lost productivity, reached $327 billion in 2017, a big jump from $245 billion just five years earlier.

These figures, quoted in a working group report by POLITICO, a news outlet, said the CDC has said that “one in three adults in the United States, about 100 million people, are living with diabetes or pre-diabetes.”

NCDs are largely associated with lifestyles and unhealthy eating habits. The food and beverage industries, coupled with the rapid urbanization and globalization are said to be drivers behind the NCDs scourge.

In Ghana, it is now common sight to see small table kiosk food vendors running fast foods joints everywhere, along urban centres, lorry parks, markets and public places.

The widespread nature of these fast food joints are attracting heavy patronage and outstripping that of traditional eateries, known as “chop bars”.

It is very easy these days for people to go on snacks and also buy street food and the easy-to-prepare take away noodles, fried rice, yam, chicken, pork and other high-fat meals. A situation, which is also posing big competition to giant multinational fast food companies in the country.

The new craze for fast food with sedentary lifestyles has however been linked to unhealthy habits pushing NCDs to the top of the list of causes of ill-health and deaths, especially among the younger generation.

The seriousness and implications of poor eating habits and other unhealthy lifestyles have gotten advocates and campaigners across the globe talking.

The online news medium, Pacific Standard, this year, carried an interesting article on why employers should stop giving away snacks and free junk food because it was “expanding employees waistlines and also creating ethical quandaries in the workplace.”

The article touched on good and bad companies’ practices of offering free snacks to employees, mentioning Google’s policy of free food to its employees, which has been mimicked by competitors like Uber and Facebook.

It said the policy of providing food in-house had some logic for companies swimming in cash and headquartered in secluded suburban campuses in Silicon Valley.

It meant employees wouldn’t have to travel far to eat. However the negative side was that this policy was affecting the health of employees.

According to the article, these free foods were mostly not full meals but cheap snacks and just free junk food, which encouraged employees to make bad health decisions.

Globalisation, the expansion of transnational corporations across the globe, telecommunication and the convergence of international markets are leading to the spread of local and foreign cultures from one country to the other, influencing what people wear, eat, drink and how they live.

It is very evident that multi-national companies in the food, communication, media and entertainment industries are producing and distributing their brands in several countries with specialized strategies for marketing cultural materials, food and other lifestyles.

No longer are local dishes the choice food for many people in developing countries such as Ghana, especially with the creation of globally branded foods, drinks and the positioning of international markets across borders, bringing in its wake cultural infiltrations, both wholesome and unwholesome.

The world is living in a period when culture is mass produced and distributed in direct competition with locally based cultures, with advertising serving as the conduit for the commercialization of culture, food, beverages and lifestyles.

This has become easier in this era of a fluid global village, where there is intensification of world-wide social relations which link distant localities in such a way that local happenings are shaped by events many miles away, including the trans-nationalisation of businesses.

Time to Act

An October 2018 statement, issued in New York by Vital Strategies, a global health organization, has called for the aversion of a global catastrophe and urged governments to act to stem the obesity epidemic.

“Today, nearly a third of the world’s population – almost two billion people – will tip their scales into the red zone of overweight or obesity. They are at risk of suffering serious health problems and premature death, largely because of the obesogenic environment in which they live,” the statement said.

The President and CEO of Vital Strategies, José Luis Castro, said: “Governments have the responsibility for health and must exert their power to implement promising and proven, cost-effective policies that can reduce the rate of weight-related diseases and premature mortality.”

The organisation listed taxes on sugary beverages and junk food, clear front-of-package labeling, marketing restrictions on unhealthy food and beverages, especially to children and strategic communications campaigns, as some effective ways of dealing with the threat of NCDs and obesity.

Recent WHO statistics show that NCDs, primarily cardiovascular and respiratory diseases, cancers and diabetes, currently account for the deaths of seven in every 10 people worldwide (41 million), including 15 million in the prime of their lives (aged 30-69), mostly from developing countries.

The world body has said that these diseases are largely preventable through public policies and can be done by dealing with risk factors: tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity.

It would be an uphill task in getting the business world and especially the food and beverage industry to buy into the global call to improve their game in today’s free market space.

However, the impact and devastating effects of NCDs cannot be left to economic, commercial and market interests to rule to the disadvantage of human lives.

The soaring NCDs statistics should serve as a wake-up call for all stakeholders including those behind the markets and food industry.

The WHO has said that although many proven interventions for NCDs exist, many countries are lagging behind in implementing them.

It said there are a number of reasons for this, but the main obstacles include: lack of political will, commitment, capacity, and action.

There is some good news however as governments have recently endorsed the Montevideo Roadmap 2018-2030 on NCDs as a Sustainable Development Priority.

This took place at the opening of a global conference on non-communicable diseases in Montevideo, hosted by the WHO and the Presidency of Uruguay.

The Montevideo Roadmap highlights the need for coordinated and coherent action from all sectors and the whole of society, as many of the main drivers of ill health lie outside the control of health ministries, systems and professionals.

It said non-state actors, including civil society and industry, have important roles to play, as well and points out that the bulk of NCD deaths could have been prevented by action against tobacco, air pollution, unhealthy diets, physical inactivity, and harmful use of alcohol including improved disease detection and treatment.

World leaders have meanwhile agreed to reduce “premature” deaths from NCDs by one-third by 2030 as part of the United Nations’ Agenda for Sustainable Development.

Health experts have said that in low-resource settings, health-care costs for NCDs quickly drain household resources, including the lengthy and expensive treatment and loss of breadwinners. These force people into poverty and stifles development.

Ghana as a country must rise up to the task of curbing NCDs.  A few years ago, the Ministry of Health in Ghana introduced a Regenerative Health and Nutrition Programme (RHNP) in 2006.

It also developed a health policy which clearly prioritizes the promotion of healthy lifestyles and healthy environments and the provision of health and nutrition services.

In one of its strategy for the management, prevention and control of chronic NCDs, which covered 2012-2016, the Ministry had stated that many of the determinants of NCDs lie outside of the health sector and therefore a multi-sectoral response is needed.

Adding that NCDs have been recognized as a development issue and that strategies and legislation would be enacted, strengthened or enforced in areas such as tobacco control, harmful alcohol use, food standards, food labelling, advertising of sweetened drinks, non-alcoholic and alcoholic beverages, traditional medicines, and tax subsidies to make medicines affordable.

These are all good intentions by the ministry but until they are acted upon, no meaningful results would be achieved to reduce illnesses and deaths associated with NCDs.

By Eunice Menka

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