By Adelheid Onyango and Bibi Giyose
When faced with a crisis, our natural reaction is to deal with its immediate threats. Ateka* came to the make-shift clinic with profuse diarrhoea: they diagnosed cholera. The urgent concern in the midst of that humanitarian crisis was to treat the infection and send her home as quickly as possible.
But she came back to the treatment centre a few days later – not for cholera, but because she was suffering from severe acute malnutrition. Doctors had saved her life but not restored her health. And there were others too, who like Ateka eventually succumbed to severe malnutrition.
This scene could have taken place in any of the dozen or so African countries that have suffered a cholera outbreak this year alone. Experience from managing epidemics has shown that when the population’s baseline nutritional status is poor, the loss of life is high. Beyond malnutrition’s damaging impact on bodily health, it weakens the immune system, reducing the body’s resistance to infection and resilience in illness.
On the flipside, integrating the treatment of malnutrition in the response to humanitarian crises assures survival and recovery better than an exclusive focus on treating diseases.
As countries across the continent commit themselves to Universal Health Coverage (UHC), the same lessons need to apply. UHC is ultimately about achieving health and wellbeing for all by 2030, a goal that is inextricably linked with that of ending hunger and all forms of malnutrition.
With 11 million Africans falling into poverty every year due to catastrophic out-of-pocket payments for healthcare, no one can question the need to ensure that everyone, everywhere, can obtain the health services they need, when and where they need them, without facing financial hardship.
As wealth patterns and consumption habits change, the African region is now faced with the triple burden of malnutrition – undernutrition coupled with micronutrient deficiencies and increasing levels of obesity and diet-related non-communicable diseases.
In 2016, an estimated 59 million children in Africa were stunted (a 17 percent increase since 2000) and 14 million suffered from wasting – a strong predictor of death among children under five. That same year, 10 million were overweight; almost double the figure from 2000. It’s estimated that by 2020, non-communicable diseases will cause around 3.9 million deaths annually in the African region alone.
Yet most of the diseases that entail catastrophic costs to individuals, households and national healthcare systems in Africa could be avoided if everyone was living actively and consuming adequate, diverse, safe and nutritious food. After all, a healthy diet not only allows us to grow, develop and prosper, it also protects against obesity, diabetes, raised blood pressure, cardiovascular disease and some cancers.
To tackle malnutrition, achieve UHC and ultimately reach the goal of health and wellbeing for all, governments need to put in place the right investments, policies and incentives.
As a starting point, governments need to assure the basic necessities of food security, clean water and improved sanitation to prevent and reduce undernutrition among poor rural communities and urban slum populations in Africa. For example, reduction in open defecation has been successful in reducing undernutrition in Ethiopia, parts of the Democratic Republic of Congo, Mali and Tanzania.
Then, to influence what people eat, we need to do a better job at improving food environments and at educating them about what constitutes a healthy diet. Hippocrates asserted that “all disease begins in the gut,” with the related counsel to “let food be thy medicine.”
Current research on chronic diseases is reasserting the health benefits of consuming minimally-processed staple foods which formed the basis of traditional African diets. This information needs to be communicated to the public through the health and education sectors and complemented by agricultural innovation to increase production of the nutrient-rich grains, crickets, herbs, roots, fruits and vegetables that were the medicine for longevity among our hardy ancestors.
But until that awareness is in place, policies and programmes are urgently needed to protect and promote healthy diets right from birth. This includes regulating the marketing of breast milk substitutes and foods that help establish unhealthy food preferences and eating habits from early childhood.
In South Africa, for example, the country with the highest obesity rate in Sub-Saharan Africa, the government has introduced a ‘sugar tax’ that is expected to increase the price of sugary soft drinks. The hope is that this will encourage consumers to make healthier choices and manufacturers to reduce the amount of sugar in their products.
Finally, governments must create incentives – and apply adequately dissuasive sanctions when necessary – to help food manufacturers collaborate in promoting healthy diets through reformulation and informative labelling, for example. In cases of food contamination, we are very quick to take products off the shelves. Yet we are much slower to react to the illnesses caused by processed foods containing high quantities of salt, sugars, saturated fats and trans fats.
A shortcut to achieving Universal Health Coverage is to reduce the need for costly treatments. And there is no better way to do that than to ensure that everyone, everywhere, preserves their health and has access to safe and nutritious food: let food be thy medicine.
Adelheid Onyango is Adviser for Nutrition at the World Health Organization Regional Office for Africa and Bibi Giyose is Senior Nutrition and Food Systems officer, and Special Advisor to the NEPAD CEO.