Non-communicable diseases (NCDs) are a major global concern with 80% of global NCD-related deaths occurring in low and middle-income countries (Population Reference Bureau, 2015). Sub-Saharan Africa continues to see a rise in NCDs and related risk factors with most NCD-related deaths in Africa occur from cardiovascular disease, diabetes, cancers, and chronic respiratory illnesses (WHO Africa, n.d.).
Health policies are a useful tool for intervening in both the public and private sectors for the health and well-being of the public. Health policy process studies show the most effective policies address both individual and environmental factors that contribute to health (WHO Africa, n.d.). There are several examples of policies structured in this way that focus on non-communicable disease (NCD) prevention and management.
The World Health Organization (WHO) took initiative in providing policy development guidance by issuing their advocacy for a “whole-of-government” approach to manage and reduce NCDs (Population Reference Bureau, 2015). This approach includes merging public agency sectors to adopt a multisectoral intervention for preventing and managing NCDs specifically related to cardiovascular and respiratory health. The WHO also recommends strategizing interventions, treatments, and prevention programs around the social determinants of health; the external factors that affect health such as physical environment (neighborhood, home, work), economic position, education status, age, and other influencers on quality of life. Social determinants of health significantly influence the spread or reduction of NCDs and policies developed should address them to effectively and strategically intervene. Below we explore, examples of sub-Saharan countries effectively developing NCD-reducing policies that address social determinants of health with a focus on the behaviours that drive these outcomes.
Tobacco is a major contributor to the decline in health and the development of respiratory and cardiovascular diseases. Smoking tobacco also increases the chances of developing cancer and other adverse health issues. Health campaigns surrounding tobacco cessation initiated in the 1990s and there was a variety of government responses. For example, in 1993 South Africa passed a tax increase on the retail price of cigarettes from 32% to 52% (Population Reference Bureau, 2015). The tax was in place from 1993-2008, during which cigarette sales fell 30%. The government also made revenue from the tobacco tax, increasing funding for social welfare, healthcare, and other community development sectors.
Like tobacco use, alcohol consumption is another major risk factor for NCDs. Many African nations implemented policies to deter people, specifically adolescents, from consuming alcohol. While some countries like Botswana implemented a tax on all products containing alcohol, countries such as Kenya, The Gambia, Ghana, and Zimbabwe simultaneously passed laws on advertising and labeling regulations (Population Reference Bureau, 2015). These types of policies place the responsibility on the manufacturers of the products to be more transparent with consumers. Additionally, these marketing restrictions limit the appeal to a younger audience, effectively deterring adolescents from purchasing the products. Some countries such as The Gambia have completely banned all television and radio advertising for alcoholic beverages.
Nutrition is a significant tool for preventing and treating NCDs. Changes in food production, manufacturing, transportation, and preparation have had negative impacts on health. Several African countries, such as Botswana, South Africa, Kenya and Ghana, have committed to introducing marketing advertisement restrictions on the food and beverage industry source.. Taxes on products with excessive sugar is another way to allow economic influence to deter health behavior. Finally, some nations have started passing legislation that limits the number of harmful ingredients such as salt, sugar, and artificial flavoring. South Africa passed a salt-reducing policy in 2013 which set out a plan to gradually reduce the mandated limit of sodium allowed per product. This policy aimed to reduce sodium contents in chips, bread, and other processed foods, often consumed by children and adolescents.
The strategies explored to implement strategic policies have proven effective in raising awareness and bringing attention to NCDs. For example, regulating food labels and advertisements better inform the consumer of the health risks associated with highly processed items. However, these policies are still lacking in terms of behavioral change. While educating a consumer on the contents of a product they will purchase is important, it may not actually deter them from purchasing and consuming the item. Therefore, a multi-sectoral approach is critical when implementing health policies. In addition to labeling, implementing taxes and increasing availability of healthier options would better result in behavior change. Effective policy implementation means creating change in several sectors to better encourage healthier choices.
Reducing NCDs across Africa has never been more important. NCD management is difficult and often unsustainable for healthcare systems causing financial burden and provider fatigue. More importantly, NCDs can be prevented with effective, well-rounded strategies like health policies. Implementing government-led policies and interventions effectively address social determinants of health which can be risk factors for NCDs. These interventions can be cost-effective for government agencies as well i.e., South Africa’s tobacco tax. Effective health policies utilize comprehensive tools for reducing NCDs, requiring a multisectoral approach and commitment to the well-being and health of the public.
About Author: Preetha Raj is a Master of Public Health Student from the Colorado School of Public Health. Her interests include health services and systems, healthcare financing, and global health. She currently serves as a research assistant at the Centers for American Indian and Native Alaskan Health at the University of Colorado Anschutz Medical Campus.