Small Island Developing States: NCD Burden and Challenges
Small Island Developing States (SIDS), most of which are in the Caribbean and the Pacific, face unique NCD challenges. They are among the most obese nations in the world, resulting in some of the highest diabetes prevalence rates globally.
Much of this is due to lack of food sovereignty. The World Trade Organization rules require open trade, facilitating importation of calorie-dense, nutritionally poor foods with long shelf life. The capacity to produce a variety of local fruits and vegetables is hampered by economies of scale and high cost of inputs many of which need to be imported from long distances away (e.g. farm equipment).
Many of these island states are classified as upper middle income and high income countries thus are attractive targets for “Big Food” and “Big Soda” and their aggressive marketing. This often includes marketing within school compounds, in violation of the human rights of these children to grow up in a healthy promoting environment.
NCDs and the SDGs
The General Meeting of the WHO Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases in November 2018 marked the latest opportunity for the leaders of the international community to review progress on non-communicable diseases (NCDs) under the 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs).
Addressing the burden of non-communicable disease constitutes an integral part of achieving SDG 3, “Good Health and Well-Being”. Premature deaths (before 70 years of age) owing to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes totalled about 12.5 million in 2016, accounting for 43 per cent of all premature deaths globally. However, there were 27.3 million deaths from all NCDs in all people aged less than 80. The target set out in SDG 3 is to reduce premature mortality from non-communicable diseases, through prevention and treatment, by one-third by 2030. SDG 3 also notes that indoor and ambient air pollution is the greatest environmental health risk.
NCDs and the Great Diet Debate
It is well kno
wn that poor diets are a leading contributor to the prevalence of non-communicable diseases such as diabetes and hypertension. But what measures can be taken to improve diets globally? Are there ways of shifting people towards healthier diets? This is the core of the Great Diet Debate.
The WHO has taken to advocating a sugar tax, as part of a so-called STAX (sugar, tobacco and alcohol tax) to combat non-communicable diseases (NCDs). On the face of it, this is a compelling idea – large industries producing poor-quality food are able to take over markets by pricing out competitors, so a sugar tax is a straightforward way to offset that process.
A joint statement by a group of health professionals published in the World Nutrition Journal noted: “In 2016, WHO published a recommendation to include fiscal measures to limit the consumption of sugary drinks as one of several interventions to tackle obesity and diabetes. We believe this recommendation must be explicitly re-stated as a cost-effective intervention . . . as it has been proven to be so in modelling studies and in countries where it has been implemented.”
Strategy and Partnership are Key in Combating Non-Communicable Diseases
Dr Abbas Gullet is the Secretary General of the Kenya Red Cross Society. In 2007 he was named “UN in Kenya Person of the Year” for his humanitarian work. He is also a member of the Defeat-NCD Partnership Governing Board.
The burden of non-communicable diseases (NCDs) is fast increasing, dealing a blow to low- and middle-income countries due to devastating economic consequences to families and communities. Worldwide, they have become the leading cause of death overtaking communicable diseases. We recognise the fact that NCDs are becoming an epidemic in our population with a health care system that is still struggling to cope with the infectious diseases and other conditions, therefore, making it a challenge to holistically focus on NCDs.
The fact is that the NCD burden affects people in their most productive years (30–70 years). It is a catastrophe because the majority of households are trapped in poverty as family members increase out-of-pocket expenditure to offset medical bills for these lifelong illnesses.