The Challenge of Non-Communicable Diseases and Road Traffic ...

4 The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa
mentable at little additional cost, which focus on
prevention of common modifiable risk factors. They
include proven measures to reduce tobacco and alcohol
use, such as increased taxation; a ban on advertising,
promotion and sponsorship; protection
from exposure to tobacco smoke; and drink-driving
counter-measures. As overweight/obesity emerges
as an issue, measures are also being put in place to
regulate other ‘unhealthy commodities’ such as ultra-processed,
energy-dense, nutrition-poor food
and drink. To prevent RTIs, law-enforcement needs
to be combined with public awareness campaigns
and education to increase seatbelt use and helmet
wearing, and to reduce speeding and drink-driving.
Legislation and regulation can also protect against
some occupational and environmental hazards such
as outdoor air pollution, industrial waste and contamination
of drinking water and soil, which can exacerbate
asthma or be linked to carcinogenic agents.
It should be noted that policy makers need to avoid
the potential negative consequences that some population-based
actions might create. For example, it
is important to ensure that measures to alleviate under-nutrition
do not have deleterious consequences
for over-nutrition. And while developing a healthsupporting
environment that facilitates walking and
cycling can be part of a pro-growth and pro-poor
transport strategy, such an environment should also
be safe and protect vulnerable road users.
(iii) Promote ‘treatment as prevention’, and
effective care
Health services can implement a number of proven,
targeted preventive measures – at relatively low
cost – for CVD, diabetes, chronic respiratory diseases
and cancer, and acute and chronic conditions.
These measures include multidrug treatment for individuals
at high risk of a cardiovascular event; drug
treatment of myocardial infarction; glycemic control
and foot care for people with diabetes; and several
highly cost-effective interventions to combat cancer,
such as Hepatitis B vaccination for liver cancer prevention,
HPV vaccination for cervical cancer control,
and male circumcision to reduce high-risk HPV.
Prompt emergency care for RTIs and acute NCD
events can save lives, reduce the incidence of shortterm
disability and dramatically improve long-term
consequences for patients and their families. At the
same time, screening programs, for example for
cancer, can raise awareness of early signs and symptoms
of those cancers amenable to early diagnosis,
and increase the quality and coverage of effective
evidence-based treatment using standardized protocols
– thus can increasing survival rates. Where facilities
are limited, non-laboratory tools are needed
to support such screening and assess risk cheaply
and quickly. Where the majority of cancer is diagnosed
late, improvement in quality of life can be
achieved relatively inexpensively by improving access
to pain management and supportive care close
to home – palliative and home-based care programs
already in place for HIV/AIDS are transferrable to
other conditions.
(iv) Adapt and strengthen health systems
Together with other disease groups, NCDs and RTIs
face constraints across all main components of a
health system, but solutions can be shared across
programs and initiatives, and be part of a wider systemic
improvement.
Common problems faced by disease groups include
the heavy reliance on external financing and
the shortfall in total health expenditure per capita.
Health-care infrastructure is insufficient across all
tiers of service delivery – not just facilities but also
laboratory and diagnostic systems and capabilities
– while primary care is limited in many places.
The severe shortage and imbalanced distribution of
trained health workers is not just an obstacle to tackling
NCDs but also to the delivery of good quality
clinical services in general, jeopardizing achievement
of the MDGs and improvement of the overall
health of the poor. Moreover, all the main health and
disease programs draw from the same data sources
and share common challenges of weak information
systems, limited civil registration, and unreliable vital
statistics – which make it difficult to assess disease
burden and create a compelling political case
for action.
The chronic, life-long nature of many NCDs
heightens some of these issues. The limited financial
and social protection against the high costs of
health-care can mean that a life-long condition or