These are dependable truths. They also save lives. Forewarned is forearmed. Don’t put the cart before the horse. Look before you jump.
These guidelines for common wisdom however are often missing on a scale that, considering the subject of saving lives, is unimaginable. Consider this: most health responses today depend on something terrible happening, first, that results in the deaths of thousands.
In Uganda, the HIV/AIDS epidemic allowed us to address culturally accepted, yet harmful, sexual practices. We turned a corner but in hindsight we could have been walking a straight path. Today a considerable proportion of the population embrace safe sex practices like correct condom use, minimizing the number of sexual partners, regular testing and treatment of the disease.
Prior to this civil war and economic strife, especially in the 1980’s and early 2000s, saw widespread malnutrition all-over the country. In response there were campaigns to promote a healthy diet (for children) and exclusive breastfeeding for the first six months. The twin epidemic sisters, Cholera and Ebola, that Uganda has dealt with in the past have highlighted the importance of sanitation and the quality of drinking water. In fact, there is a famous Ugandan public service announcement from the director of health services that “health is made at home and only repaired in the hospital,” about sanitary conditions and their contribution to good public health.
So why are the most resounding public health campaigns by design responding to a public health crisis but not trying to prevent one? How come health promotion is not the prophylactic of choice for the crisis of our age – the now proven reality that most people born today will likely die from a Non-Communicable illness? Better that the same NCD is a function of avoidable behavior?
How much further down the path of crisis do we have to go to embrace a public health philosophy that prevention is better than cure – as an age old and abiding truth? In 2014, the World Health Organization estimated that for people between ages 30 and 70 years, the probability of death from NCDs was 21% in Uganda. This covered the four main NCDs –Cancers, Hypertension, Diabetes and chronic respiratory infections. In other words, beyond covid19, the next epidemic is around the corner. While it may be non-communicable, it will wreck our health systems and livelihoods worse than covid19 could ever since the average Ugandan spends nearly half their income on health care (38.5% according to WHO, although the Ministry of Health puts a higher figure on this).
The cost of staying alive is arguably higher with NCDs like cancer and diabetes due to the lack of specialized services such as ICUs. It is a death sentence for most Ugandans living below the poverty line who, when they fall sick, are at the mercy of ICU and ambulance lotteries. In fact, for the sick who walk into a hospital the real policy failure is that their health authorities have failed, by act or omission, to put in their hands the power over their own health through public health education.
Most of the, often limited, innovations emerging within the health sector in the global south are focused on access to treatments. For example, health insurance cover, which also prioritizes class within the economy, only allows you to seek care for actual illnesses and not routine check-ups that allow you to nip diseases in their infancy or prevent them entirely. This approach, which puts profit ahead of customers’ wellness, is the recipe on which NCDs thrive.
What we need to do instead, even as we battle this latest pandemic, is to start an honest conversation about centering the maintenance and improvement of health in every home, school, sports betting shop, food market, and corporate office. The debate on whether lactating mothers should breastfeed in public spaces and at their workplaces should not be a feminist conversation but rather a comprehensive policy dialogue. This is a path to not just greater health and quality of life but also stronger, more resilient communities and economy.
We can get ahead of the NCD epidemic and save lives. But we must not leave behind the painful lesson that the current pandemic: basic sanitation and hygiene for example, ingrained in our daily lives, would have made todays covid19 a much simpler problem.
Joanitah Nvanungi Nalubega is currently pursuing a Masters in Public Health, focusing on the use of modern technologies to increase access to health services to people in low-resource communities of the world. She is also a 2017 Young & Emerging Leaders Project Fellow of the LéO Africa Institute.
