Addressing Non-communicable diseases (diabetes) in Zimbabwe: Taking the bull by the horns

According to the World Health Organisation (2021), noncommunicable diseases (NCDs) are chronic conditions of long term duration caused by genetic, physiological, environmental and behavioural factors. The World Health Organisation (2021) estimates that NCDs account for 41 million deaths globally each year which is 71% of all deaths globally and of these 85% occur in low and middle-income countries including Zimbabwe.

By Enock Musungwini

This opinion piece focuses on diabetes as the NCD of interest particularly type 2 diabetes as it accounts for 92% of all diabetes cases globally. Diabetes is a condition that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces to regulate blood sugar in the body resulting in raised blood sugar level or hyperglycaemia (WHO diabetes factsheet, 2021). According to the World bank (2021) the prevalence of diabetes in Zimbabwe stands at 2.1% for the 20-79 years age group and the World Health ranking (2020) latest data published in 2020 showed that diabetes deaths in Zimbabwe reached 3344 and is now the 6th leading cause of death in Zimbabwe. NCDs can derail the country progress towards achieving the 2030 sustainable development goals particularly UN SDG 3 Target 3.4 aimed at reducing premature deaths from NCDs by one-third by 2030.

Firstly, I will explain two important public theories linked to the NCDs, their risk factors and control and these are commercial determinants of health and social determinants of health theories. According to the World Health Organisation, commercial determinants of health (CDoH) is a theory that highlights the role of the private sector commercial activities in relation to their impact on public health and wellbeing and how they are linked to health including NCDs in the general population. Furthermore, commercial determinants of health also include the enabling political and economic systems, practices and norms that are set, created, adopted, and implemented by private corporates to lobby, coerce and influence governments and local authorities to further their business profits and benefits at the expense of population health.

The large private commercial actors and corporates use their financial power, resources, and other business connections to undermine public health policies that have proven to be effective but because they threaten their profits and viability. A notable example is the internationally recommended WHO Best buys that have proved effective in addressing NCDs at population level and they include taxation on sugar-sweetened foods, ban on advertising of junk foods especially during TV prime time, correct labeling and packaging of nutritional foods and beverages and many others. Because of the threat on profits and business viability, these proven strategies are undermined because they are not favorable to businesses. Influential corporates will use resources to wage aggressive public relations campaigns and corporate social responsibility programmes that focus on less effective strategies like health education and awareness which overshadow visibility of those proven effective strategies.

The other public health theory is the social determinants of health model introduced by Goran Dahlgren, Swedish public health expert and Margaret Whitehead, professor of public health and renowned international expert in inequality and human health. They argued that individual lifestyle factors, social and community factors and general socioeconomic, cultural, and environmental factors interact in a complex way to determine one’s health. In the same vein, the World Health Organisation documents that social determinants of health refers to how the conditions in the environment and the surroundings in which people live, learn, work, network, play as well as their income levels have a bearing on their health and wellbeing. Furthermore, social determinants of health refer to those non-medical factors that have a bearing on the overall health and wellbeing of the population.

This theory is linked to social class inequalities and how they are linked to the health and wellbeing of populations as evidenced and supported by the UK Black report on health inequalities. The UK Black report on health inequalities was published in 1980 by a committee set up by the UK government and chaired by Sir Douglas Black to investigate the variation in health outcomes of groups in the UK as a result of their social class. The black report found clear differences in mortality rates across the social groups, with those from deprived or poor background and status having high mortality compared to those from less deprived and affluent backgrounds.

Against this background, it is therefore important and highly recommended that addressing the problem of NCDs particularly diabetes requires the government, Ministry of Health, key stakeholders and policymakers to take the bull by the horns and implement the recommended WHO Best buys. These includes implementing the WHO recommendations on the marketing of foods and non-alcoholic beverages to children by banning some coercive advertising especially during TV prime time, eliminate industrial high cholesterol and trans-fats by gazetting legislation that regulate and monitor their use in the food chain, applying effective taxation on sugar-sweetened beverages to reduce consumption and enforcing correct nutrition labeling to reduce total energy intake, sugars, sodium, and fats. The highlighted key policy recommendations known as best buys are cost effective, appropriate, and applicable to low to income countries like Zimbabwe.

Evidence has shown that taxation help to generate additional income from beverages and sugar sweetened drinks which can be used to fund sports, plays centres, gymnasiums and kids open spaces that will promote physical activity and reduce obesity. Other interventions and strategies that can be used in support and to compliment “best buys” includes promotion of exclusive breastfeeding, nutrition education and counselling in preschools, schools, workplaces and hospitals, mass media campaign promoting healthy diets and fruits including social marketing and promoting physical activity and exercising culture in the general population.

 About the author:

Enock Musungwini is a public health practitioner, health management consultant and development practitioner. He holds an MSc Public Health degree with a research award from London School of Hygiene and Tropical, an MBA and many other qualifications. He is a member of various professional associations, networks and organisations in Zimbabwe, Africa and International including being Country representative forthe UK based Health Information for All (HIFA), Member of South Africa based Africa Evidence Network Reference Group and Member of the NewZealand based International Government Science Advice Africa chapter Steering committee (INGSA-Africa).

While the author acknowledged and referenced articles from other organisations and individuals, the views expressed in this opinion piece as well as any errors or omissions, are the sole responsibility of the author.



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