Non-communicable diseases (NCDs) are becoming a significant burden in sub-Saharan Africa, and road traffic injuries are rapidly emerging as a major cause of death and disability. By 2010, cerebrovascular diseases (stroke) and road injuries were already within the top 15 causes of years of life lost, joined by ischemic heart disease, diabetes mellitus, and hypertensive heart disease in Southern sub-Saharan Africa. Road traffic injuries are expected to be the number one killer of children aged 5-15 in Africa by 2015 if current trends continue unabated. Yet, this burden remains largely hidden.
A new Bank report, “The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa: An Overview” sheds light on the nature of these health challenges. Drawing on a comprehensive review of the literature and on input from policymakers, researchers, and practitioners, it addresses four questions: (1) How is the growing burden of NCDs and road traffic injuries changing the epidemiology of sub-Saharan Africa?; (2) What determines and drives this burden, and what are the commonalities with communicable diseases?; (3) What is the rationale for public intervention?; and (4) How could resource-constrained governments approach NCD prevention and treatment and road safety in a comprehensive, effective and efficient way?
The data show that action against NCDs and road traffic injuries in sub-Saharan Africa is needed, together with continued efforts to address communicable diseases and maternal and child health as well as to reach the Millennium Development Goals (MDGs).
Indeed, close relationships exist in cause, course and outcome between NCDs, communicable diseases, and maternal, perinatal, and nutritional conditions. There are common underlying social conditions, such as poverty and unhealthy environments, and commonalities across disease groups in causation, co-morbidity, and care needs. Frequently, both communicable diseases and NCDs co-exist in the same individual, and one can increase the risk or impact of the other, as happens for example with diabetes and tuberculosis. Maternal health, the intra-uterine environment and low birthweight may have long-term consequences for developing NCDs.
The report suggests that NCDs/road traffic injuries should not be tackled separately as a vertical program, nor should they displace communicable diseases as priorities. Instead, given resource constraints, and some shared determinants, characteristics, and interventions, there is scope for an integrated approach focusing on functions (prevention, treatment, and care) rather than on disease categories. Examples are cited of potential opportunities to integrate and add NCD prevention and treatment into existing services and programs. For example, interventions to improve maternal and child health – such as reducing malnutrition and exposure to smoke – are integral components of a continuum of preventive measures for NCDs.
Also, the report argues that proven, cost-effective, prevention interventions are needed, many of which (such as tobacco and alcohol taxes, road safety measures, and fuel-efficient ventilated cookstoves) require action beyond the health sector. These can deliver broader development benefits in addition to their benefits for health.
Ensuring an effective response, however, is a particularly difficult challenge in countries facing a double or triple burden of disease with a low national income level and weak health care systems. But as argued in the report -- and fully consistent with the health improvement and poverty alleviation objectives of World Bank work in the health sector, as reflected in the 2007 Health, Nutrition and Population Strategy, and in the recent “Connecting Sectors and Systems for Health Results” policy note -- efforts to address this challenge effectively in sub-Saharan Africa should be part of broader multisectoral effort, including health system strengthening programs and activities supported by national governments, public and private employers and businesses, civil society, and the international community over the short and medium terms.
It is expected that this report will advance the discussion on this topic in sub-Saharan Africa and beyond by heeding World Bank Group President Dr. Jim Kim’s advice at the 2013 World Health Assembly:
“For decades, energy has been spent in disputes opposing disease-specific ‘vertical’ service delivery models to integrated ‘horizontal’ models. Delivery science is consolidating evidence on how some countries have solved this dilemma by creating a ‘diagonal’ approach: deliberately crafting priority disease-specific programs to drive improvement in the wider health system. “Whether a country’s immediate priority is diabetes; malaria control; maternal health and child survival; or driving the ‘endgame’ on HIV/AIDS, a universal coverage framework can harness disease-specific programs diagonally to strengthen the system.”
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Report: The challenge of non-communicable diseases and road traffic injuries in Sub-Saharan Africa : An overview