Type 1 Diabetes – Worth a Shot
Today is my “diaversary”. This May 13th marks the 28th year that I have been poked, prodded, and injected a dozen times or more per day since I was diagnosed with type 1 diabetes at 13 years old. It is the one day each year that I reflect honestly on what it means to be diabetic. I won’t lie—that usually involves a few tears.
But this year, my first at The Defeat-NCD Partnership, that brief moment of self-pity is gone. Three decades is a long time to live with a chronic illness, but it is a luxury that my fellow type 1s in low-resource countries do not have.
Leveraging new technologies to fight NCDs
Around the world, rapid demographic, sociocultural, and economic transitions have driven a surge in non-communicable diseases (NCDs). Increased affluence has been a double-edged sword, bringing people up out of poverty while predisposing them to NCDs like diabetes, cardiovascular disease, chronic lung diseases, and cancers. Rates of these illnesses are skyrocketing, with a staggering 71 percent of global deaths due to NCDs.
There is no magic bullet to solving the challenge of NCDs — but expanding affordable access to healthcare by investing in technology is a crucial first step. By developing and rolling out the use of digital tools, The Defeat-NCD Partnership is bringing innovative technology to each of our four key pillars — national capacity building, scaling up community health, access to affordable essential medicines and supplies, and financing.
New reports: South Africans now most likely to die from NCDs
Over the last ten years, South Africa has seen the number of people with NCDs increase to the point where the numbers are higher then those suffering from communicable diseases.
Today, South Africans have a 51.9 per cent chance of dying from an NCD – diabetes, heart diseases and stroke being the most likely culprits – according to the NCD Countdown 2030. South Africa is also the country with the highest obesity rate in Sub-Saharan Africa, with two-thirds of women and one-third of men overweight or obese. This goes hand-in-hand with the fact that 25 per cent of children in the country are undernourished.
Diet has at least something to do with this increase in NCD rates in South Africa. The average South African is eating the caloric equivalent of an extra candy bar a day, according to the World Health Organization (WHO). South Africans spent more money on fast food and coffee in 2018 than in in 2017, according to Stats SA, and already in 2017 there were about 50 fast food chain brands with 5,800 brand outlets across the country. Ninety per cent of South Africans lived within five kilometres of at least one fast food outlet, and families visited these outlets an average of twice a week in the higher income bracket and once a month in the lower income bracket.
NCD care among transient populations: one size does not fit all
From what little research does exist, we can see that the Roma seem to suffer from increased morbidity from NCDs and that they have poorer access to health services and uptake of preventative care. In one study that took place in Ghent, Belgium, researchers found that the Roma population had a number of barriers to care such as financial constraints, mobility issues and not knowing the language. They also have a lack of trust in care providers, which tends to make attempts to get care emergency-only situations.
While it is true that nomadic pastoralists and other mobile groups such as migratory workers and refugees live beyond the reach of established healthcare programmes that serve sedentary communities, groups like the Roma do tend to tread the same ground from year-to-year. Healthcare facilities should therefore not be difficult for them to get to. For other nomadic peoples, using methods from epidemiology, geographic information systems, and anthropology, solutions can be devised to improve service provision to these difficult to reach populations – as has been done in East Africa. There, it was found that Nomadic populations living within a general area can be made more open to modern health care once the barriers are lessened.
An NCD case study from Iran
Over the last decade obesity in Iran has risen from 14.2 per cent in 2005 to nearly 65 per cent in 2018. At the same time more than 55 per cent of the population were physically inactive, doing less than 150 minutes of physical activity through the week. This meant that 45 per cent of men and 65 per cent of women in Iran did less than two and a half hours of exercise per week.
In Iran, 20 per cent of children have inadequate physical activity because there isn’t proper education and cities in the country are not built for outdoor activity, said Afshin Ostovar, the Health Ministry’s director for non-communicable diseases in the Tehran Times. Earlier in the year, Maryam Hazrati, the deputy health minister for nursing, mentioned that 82 per cent of premature deaths in Iran can be linked to non-communicable diseases (NCDs). This is in line with the worldwide average according to the World Health Organization (WHO).
Though the facts are bleak, coordination, policymaking, planning, national programmes and commitment to reduce the effect of NCDs can be turned around.
The security implications of NCDs
Since 2014, the United States has been looking at health and healthcare as a security issue. The Global Health Security Agenda (GHSA) is a partnership of 64 nations and other stakeholders to help build countries’ capacity to help create a world safe and secure from infectious disease threats and elevate global health security as a national and global priority. GHSA was set up at the beginning of the 2014 Ebola crisis but can be looked at through the prism of NCDs.
The reality is that some NCDs like diabetes and CVDs can lead to an impaired immune function. This makes the fight against infectious diseases much more difficult and because the double burden tends to take place in low- and middle-income countries, they are often accompanied by unhealthy exposures and environments. Experts, institutions and policies need to start supporting the prevention and control of these two overarching disease categories. Patients with NCDs have an increased susceptibility to infectious diseases. This means that the infrastructure that needs to be developed to support one burden could very well support both.