We need a sustainable strategy for tackling rising chronic diseases

Non-communicable diseases (NCDs) account for more than 50 per cent of total hospital admissions and over 55 per cent of hospital deaths in Kenya.

Chronic illnesses including cancer, heart attack, stroke, renal/kidney failure, stroke, and dementia among others, require extensive medical care and treatment.

Besides deaths and disability, chronic diseases pose a greater social and economic burden on the economy as they affect the working population. Their costs can outstrip a family’s cash-flows and/or medical insurance policy quickly.

As most households lack an emergency fund to take care of chronic illnesses, paying for medical bills in cash exposes them to catastrophic healthcare expenditure and extreme financial strain.

As a result of the high prevalence rate of chronic illnesses and the high cost of managing these conditions, more and more people are finding themselves financially drained. This is most common in situations where one does not have a medical insurance. In some cases, even with medical insurance, some may exhaust their annual limit or have a cover which excludes certain conditions.

The growing financial burden of these illnesses has prompted the insurance industry to introduce stand-alone critical illness cover, which ensures one receives the financial assistance in the event they are diagnosed with any of the mentioned diseases.

With the critical illness cover, the beneficiary is provided with a lump sum payment on the first diagnosis of any of the covered severe illnesses and life-threatening conditions.

While the insurance industry’s intervention is helping to address the financial burden of NCDs, several factors continue to constrain progress in the prevention and care of these chronic diseases.

They include underestimation of effectiveness of interventions, commercial pressures, institutional inertia and inadequate resources.

Existing healthcare systems are also ill-equipped to manage the rising chronic disease burden.

There is need for action to strengthen control and prevention and provide measures to better manage chronic diseases, especially in developing countries such as Kenya. NCDs are largely preventable through behavioural interventions.

Up to 80 per cent of premature deaths from heart disease, stroke and diabetes can be averted with evidence based behavioral and pharmaceutical interventions.

A public health approach of primary prevention is considered the most cost-effective, affordable and sustainable course of action to cope with chronic diseases.

While age, sex and genetic susceptibility cannot be changed, many of the risks associated with age and sex vary. Such risks include behavioural factors such as diet, physical inactivity, tobacco use, alcohol consumption; biological factors like hypertension, overweight, hyperinsulinemia and societal factors, which include a complex mixture of interacting socioeconomic, cultural and other environmental parameters.

Diet is a key risk factor for chronic diseases which if properly managed, can prevent these diseases. We need to place a stronger emphasis on protecting people from exposure to highly processed foods and beverages loaded with fats, salt and sugar.

Physical inactivity, is now recognised as an important determinant of health as the result of a progressive shift of lifestyle towards more sedentary patterns.

The country is still grappling with low levels of awareness of strategies of prevention and control of NCDs among health policy makers, planners and health care providers at both the national and county levels of government.

National action

To stem the impact of NCDs, we need to raise awareness at the highest levels to ensure all people respond to the challenges of NCDs.

There is a need to regularly formulate and review existing legislation, policies and plans and to identify gaps for prevention and control of NCDs.

There are several opportunities for national action, including strengthened interaction and partnerships; regulatory, legislative and fiscal approaches and more stringent accountability mechanisms.

We need to develop policy frameworks that reflect the national burden of critical illnesses, funding constraints and nature of the healthcare system while also taking cultural factors into account.

There is an opportunity to leverage primary care clinics established to deliver reproductive, maternal and child health to extend the provision of screening and treatment of cervical cancer and hypertension as well as patient education programmes.