Shadows of the silent epidemics

As the UN calls for a global summit on non-communicable diseases (NCDs) here in New York, more than half of the people that die this year in Nepal will die from conditions that our health system never even really bothered to care about.

Non-communicable diseases like cancer, diabetes, respiratory diseases, heart diseases and mental diseases now account or an overwhelming majority of deaths in Nepal, even in people too young to die; leading to huge loss of life and economic productivity.

What were once thought were “diseases of affluence”, have now sucked the well-being of poorer nations like ours into a tailspin, and all the while NCDs have been under swept the carpet.

It has now been recognised that such “diseases of affluence” have now been disproportionately concentrated in poor and middle income countries. While health systems in richer countries are poised to handle such epidemics- or at least they have the systems in place and a tacit understanding about where the problems lie, we fail on both accounts. First we have not been able to acknowledge the kind of toll these diseases have been exacting, second we don’t have health systems capable of facing off such diseases.

The disheartening irony is,  for something that is causing majority of annual deaths, it’s hardly even mentioned in the  government’s annual health report- the department of health services’ flagship annual publication. Tucked away in one far away corner of the report is a graph that shows 80% of the reported illnesses in the year was with non-communicable diseases. After that there is a deafening silence.

Reference is made about immunisation, health education, reproductive health and control of infectious diseases, the kind of fodder that has been the staple of our health sector initiatives and their resulting annual publications. Vertical programs have been enacted across the whole health system to tackle disease conditions funded by global organisations with deep pockets. It feels like the health system has been amnesic all along about other half of its own body- the un-funded, un-cool half called NCDs.

The government’s only strategy against something that is killing 3 out of 5 people in the country is it intends to carry out some “nutritional interventions” to take care of heart diseases. As an added bonus it is throwing in some health education. And all that education amounts to is some money spent on flyers that will eventually be racked up in a dark dusty almirah in health posts village after mountain village.

There seems to be a ready resignation that it is okay to die with a chronic disease.While a young woman dying of an infection for example feels us with a just moral outrage, it is blatant hypocrisy to not demonstrate the same against something like a COPD or a heart attack when that death could entirely have been prevented in the first place.

Non-communicable diseases will kill more than 40,000 people in Nepal this year, more than combined due to all infections and reproductive health issues put together.

Evidence from the developed world has shown, much can be done to halt and revert the tide of such epidemics.

And it’s not that we need a pile of resources before we can start to tackle such conditions. There is enough we can do with out a slush-fund of money; all we need to do is drive ourselves out of our inertia. Like at least recognise that we have a problem first.

A few easy policy initiatives can take us a long way in battling NCDs. We already have one of the highest smoking and alcohol abuse rates anywhere. When all else in our economy seems to be failing the liquor industry is pegged at around Rs 10 billion and growing at 20% annually, and tobacco industry is fledgling. Add to that cigarettes are available to kids, we have one of the highest female smoking rates in the world and alcohol is more readily available than clean water, we have a potent recipe for a violent disaster.

Evidence shows strict regulation of alcohol and tobacco use can greatly impact incidence of NCDs in the future. Strict control of consumption coupled with excise taxing of these industries can significantly alter the epidemiological landscape of such diseases. None of this requires donor money to start with. Further more excise from the liquor and tobacco industry can form a significant source for our health system funding strategy. The cancer hospital at Bharatpur is a case in point. And we should ensure that good dietary habits, which have been our saving grace thus far, don’t go to the doldrums like they have in the inner city ghettos of rich nations.

It is not clear what sort of strategies the global UN meet at New York can come up with to battle these menaces. The last time such global UN event was held for health ten years ago, resulted in the creation of the Global Fund to Fight AIDS TB and Malaria (GFATM), a revolutionary funding mechanism and a paradigm shift in way we handle these three killer diseases. What good will the UN meet come up with this time over is any body’s guess; all we can do is pray that they don’t come up with a set of better funded vertical programs that address a few issues and then splinter whatever remains of the health system to rot in dereliction. Because to handle these beastly epidemics of NCDs, we will need a cost-effective, viable and robustly functioning health system above anything else.

This article first appeared in The Republica 9.21.11

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