Q&A: Africa lacks chronic disease policies – WHO’s Tedros

WHO director-general Tedros Adhanom Ghebreyesus speaking at the Reaching the Last Mile Forum in Abu Dhabi, United Arab Emirates, November 2019. Copyright: Photo courtesy of Reaching the Last Mile Forum.

Speed read

  • Non-communicable diseases (NCDs) pose ‘major challenge’ for sub-Saharan Africa
  • Problem will impact socioeconomic development
  • Universal health coverage needed to prevent NCDs from developing

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There is a lack of strategies to tackle chronic diseases such as cancer and heart disease in the African region, posing a key challenge for those working to improve healthcare on the continent, according to WHO director-general Tedros Adhanom Ghebreyesus.
Low- and middle-income countries account for 85 per cent of the 15 million people who die prematurely every year from non-communicable diseases (NCDs) such as diabetes, cancer and heart disease, according to the WHO.

“Scarce resources and lack of policies and strategies for controlling NCDs are key challenges in the African region,”

Tedros Adhanom Ghebreyesus, WHO director-general

It means there is an urgent need for universal health coverage to help countries prevent these diseases, and detect and treat them when they arise, Tedros told SciDev.Net following the Reaching the Last Mile Forum in Abu Dhabi, United Arab Emirates, last month.

You are the WHO’s first African head. How has this perspective influenced your policies?

My background brings a uniquely African and developing-country perspective to this role, along with a deep understanding of the opportunities and challenges related to health in low-resource countries. As health minister of Ethiopia, I saw first-hand the casualties of a weak health system and I initiated a number of reforms precisely to address those weaknesses by investing in infrastructure and seeking new financing models.

Most importantly, we invested in the health workforce, which is the lynchpin of any health system. The results are well documented, but what I want to stress is that I understand the challenges faced by authorities when there are few resources to draw on and multiple health threats.

I also know from experience that if we want to improve the health of our populations, the choice is a political one and it must be backed by determined action. Which is why I spend a lot of my time visiting countries and talking to decision-makers. 

Sub-Saharan Africa is facing a tipping point in chronic diseases such as cancer and heart disease. How can we stall this emerging epidemic?

Non-communicable diseases pose a major challenge, particularly in sub-Saharan Africa. In some African countries, such as Mauritius, Namibia and Seychelles, NCDs cause over 50 per cent of all reported adult deaths. This implies that NCDs will soon be a leading cause of ill health, disability and premature death in the region, and will have an adverse impact on socioeconomic development.
Progress in implementing comprehensive NCDs strategies and policies has been hampered by … lack of resources. Scarce resources and lack of policies and strategies for controlling NCDs are key challenges in the African region.
The NCDs challenge needs to be tackled through promotion of universal health coverage to ensure health systems are geared towards preventing, detecting and treating these conditions, protecting people from harmful risk factors and products, like tobacco, foods and soft drinks high in salt, sugar and transfat, promoting physical activity in schools and communities for boys and girls, [and] preventing marketing of unhealthy products.
[Last month] WHO and the African Union signed a memorandum of understanding (MoU) to formalise our cooperation on improving access to quality, safe and effective medicines through an African Medicines Agency, fighting epidemics like Ebola together with the African Center for Disease Control by building core capacities for health security and investing in preparedness, [and] working together to implement the Addis Ababa Call to Action on universal health coverage and invest in primary healthcare.
The three pillars of our new MoU will help us realise our shared vision for a healthier, safer, fairer Africa.

How can the WHO help close the gap in life expectancy among developed and developing countries?

We can begin to close the gap in life expectancy between developed and developing countries through universal health coverage, starting with primary healthcare. Primary healthcare should be the first level of contact with the health system, where individuals and families receive most of their healthcare – from promotion and prevention to treatment, rehabilitation and palliative care – as close as possible to where they live and work.
For example, we need to make sure that pregnant women access care to safely deliver healthy babies, that children get vaccinated so they do not fall sick and die of preventable diseases, and that people of all ages can access the health services they need throughout the course of their lives.
But we need to also tackle the reasons why people get sick that lie outside of the health sector: such as the quality of the air they breathe, the water they drink, the food they eat, and the conditions in which they live, work and play. So you need a multisectoral response that addresses the root causes of disease and not just the diseases themselves.

How do you see the WHO’s role changing as the climate crisis intensifies?

WHO has long been an advocate on environmental issues and their health impacts, and this is a growing concern globally. Despite the evidence, political action and investments remain largely insufficient – only about 3 per cent of health resources are invested in prevention, with approximately 97 per cent spent on treatment, increasing healthcare costs.
WHO is advocating for assertive action to reduce emissions which can rapidly improve air quality, save lives and contribute to food security, as well as slow the rate of near-term climate change by 0.6 degrees Celsius by mid-century.
This includes: technology investments in agriculture, energy, forestry, and industry sectors, promoting renewable energy to decarbonise our energy grids, adopting energy efficiency programmes; and integrated waste management solutions, and designing and planning cities that support more sustainable transport systems, district energy systems and energy efficient buildings.
This interview has been edited for brevity and clarity.