The World Health Day 2016 theme is; “Diabetes, a non- communicable disease (NCD) directly impacting millions of people globally, mostly in low- and middle-income countries.” Each year, the World Health Organization, selects a priority area of global public health concern as the theme for celebrations of the World Health Day, which falls on 7th of April, the birthday of the World Health Organization (WHO). The WHO is focusing this year’s World Health Day, on diabetes – a largely preventable and treatable non-communicable disease that is rapidly increasing in numbers in many countries, most dramatically in low- and middle-income countries. The WHO estimates about 350 million people in the world have diabetes, with the disease the direct cause of some 1.5 million deaths. The goals of WHD 2016 are (1) scale up prevention, (2) strengthen care, and (3) enhance surveillance
According to the International Diabetes Federation (IDF) an umbrella organization of over 230 national diabetes associations in 170 countries to which Uganda is affiliate, represents interests of the growing number of people with diabetes and those at risk. Accordingly, 415 million people have diabetes in the world and more than 14 million people in the African Region; by 2040 this figure is estimated to more than double. It is critical that IDF reported 400,600 cases of diabetes in Uganda in 2015. It further reported that the world spends $935bn on managing diabetes and this figure is projected to escalate to $1,127bn by 2040. However, Africa only spends $4bn on diabetic patients, which translates into poor care and consequently complications, which are difficult to manage.
Not just a health issue
Diabetes – whose main forms are types 1 and 2 diabetes – is beyond a health issue. Diabetes and its complications bring about substantial economic loss to people with diabetes and their families and to health systems and national economies through direct medical costs and loss of work and wages. Diabetes is one of four priority NCDs targeted by world leaders in the 2011 Political Declaration on the Prevention and Control of NCDs and the Sustainable Development Goals (SDGs) 2016-2030. The Global Action Plan for the Prevention and Control of NCDs 2013-2020 provides a roadmap and array of policy options for attaining nine voluntary global targets, including an additional target to halt the rise in diabetes and obesity by 2025.
Working to prevent, detect and treat diabetes is also critical to development. Within the 2030 Agenda for Sustainable Development, Governments have set an ambitious target to reduce premature mortality from NCDs – including diabetes – by one third; achieve universal health coverage; and provide access to affordable essential medicines – all by 2030. In their study ‘Use of traditional medicine for the treatment of diabetes in Eastern Uganda: a qualitative exploration of reasons for choice’ Rutebemberwa, Elizeus et al (2013) found out that: Patients with diabetes use herbs because of community influence, inadequacies in the functionality of the health care system and easy access to herbs. High costs incurred in accessing biomedical medicine, with health facilities that provide diabetic care being far and sometimes having stock-outs of diabetic drugs, frustrate patients with diabetes. These assertions call up the Ugandan government to fast tracking Universal Health Coverage by increasing funding and legislating to make health goods and services claimable entitlements by all Ugandans seeking care against any disease in public health facilities. The Global Diabetes Scorecard Tracking Progress For Action concluded that, The low level of diabetes-related health expenditures has prevented a very small proportion (0.3%) of diabetes related deaths. Increased funding for cost-effective diabetes prevention and treatment is needed
Diabetes matters to all of us
Diabetes, therefore, is an issue relevant to Ugandans and the world over thus reconvening multiple stakeholders, including government, civil society, private sector, and intergovernmental agencies. While every country and community is at a different stage in addressing its diabetes challenge, there are a number of activities that Uganda can undertake at national and local levels beyond the 2016 World Health Day celebration, to help achieve its objectives of increasing awareness and trigger a set of actions to tackle diabetes. Whereas food security is central to human rights; health implications of processed foods– the sugars and starches, the oils and fats and trans- fats, the salt and cosmetic additives – the cheap ingredients and expensive advertising which make up the business model for like food processing companies makes many of our generation vulnerable.
Non regulation of Advertising and active promotion of unhealthy food products may constitute inducements to harmful behaviour, and does undermine the right to health and the right to food, two key elements in the protection of human rights. Civil society groups have repetitively called for a Framework Convention to protect and promote healthy diets during the 2014 and 2015 World Health Assemblies. Proposals for such a Convention have also been made in UN human rights meetings by the outgoing UN Rapporteur on the Right to Food, Olivier de Schutter, and twice by the outgoing UN Rapporteur on the Right to Health, Anand Grover. These calls have been further echoed at a meeting on corporations in the global food system and human rights which brought together legal experts and civil society groups in Oslo in late 2014.
Bit by bit the movement is taking shape, backed by a gradual shift in the social discourse. This has been especially true for sugar, where the food industry is realising that while it may win some battles it may be losing the war. The US Dietary Guidelines Advisory Committee called for maximum of 10% dietary calories from added sugars in its 2015 report, echoing a World Health Organization expert report which made the same recommendation, and added the idea that 5% might be a better target. The UK government’s expert committee on nutrition then consolidated this tougher level by proposing a target for population consumption of ‘no more than of 5%’ of daily calories from free sugars and minimising consumption of sugary soft drinks, followed by a report from Public Health England on the evidence for a range of public health initiatives to meet this target.
Meanwhile in the UK, celebrity chef Jamie Oliver has championed the concept of a sugar tax or soda tax, and in Mexico, a well-funded consumer campaign led to the introduction of taxes on snacks and sugar-sweetened beverages which appears to have reduced soft drink consumption by at least 6% over the year 2014, rising to 12% by the end of the year, and 17% among lower-income consumers – a significant improvement in public health nutrition. Taxes on sweetened beverages have followed elsewhere – Barbados, Chile, the Navajo nation in the USA and the city of Berkeley, California. Such moves to reduce soft drinks consumption have not always been successful, of course, with heavy investment in attack advertising and lobbying by the beverage industry, especially in San Francisco against a soda tax, and in New York City against the then mayor Michael Bloomberg’s attempts to limit serving size containers in fast food outlets.
The danger is that while in Europe and the Americas the soft drinks industry may be losing its battle to maintain sales of sugary soft drinks, in Africa, the Middle East and Asia it continues to enjoy expanding markets. In these regions there is a need to extend the social discourse we are developing in the western hemisphere into a legal discourse – one which makes the protection of dietary health a legal right, and a curb on the marketing of junk food the proper subject of an international treaty. Talibita Moses is a lawyer working with Uganda National Health User’s/ Consumer’s Organisation.
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