May 1: Today is the 20th annual World Asthma Day, an event held each May to raise awareness of Asthma worldwide. World Asthma Day is organized by the Global Initiative for Asthma, or GINA (www.ginasthma.org), a World Health Organization collaborative and 501(c)3 organization founded in 1993.
According to WHO estimates, 235 million people suffer from asthma, which can cause wheezing, breathlessness, chest tightness, and coughing. Although asthma cannot be cured, it is possible to control asthma to reduce and prevent asthma attacks, also called episodes.1 In the United States, approximately half of people with asthma had at least one asthma attack in 2012. More children (55%) than adults (49%) had an attack.
Asthma is the most common chronic disease among children. Asthma is not just a public health problem for high income countries: it occurs in all countries regardless of level of development. Over 80% of asthma deaths occurs in low and lower-middle income countries. Asthma is under-diagnosed and under-treated, creating a substantial burden to individuals and families and possibly restricting individuals’ activities for a lifetime.
Asthma attacks cause adults to miss work and children to miss school. These dangerous and sometimes life-threatening episodes reduce the quality of life for people with asthma. The good news is that we can raise awareness about asthma and how it can be controlled. People with asthma can prevent asthma attacks if they learn how to avoid asthma triggers like tobacco smoke, mold, outdoor air pollution, and colds and flu. Asthma episodes can also be prevented by using inhaled corticosteroids and other prescribed daily long-term control medicines correctly.
This year’s World Asthma Day theme is “NEVER TOO EARLY, NEVER TOO LATE. It’s always the right time to address airways disease.”” The theme provides a call to action for both patients and healthcare providers worldwide to evaluate symptoms regardless of the timepoint in one’s life they may occur and take actions to ensure that the asthma is controlled.
World Asthma Day was first held in 1998, and has grown each year to become one of the most important Asthma events globally. On World Asthma Day, hundreds of awareness-raising activities will take place in countries all over the world. Further information about GINA and World Asthma Day can be found at GINA’s website: www.ginasthma.org. Documents detailing GINA’s global strategy for diagnosis, management, and prevention of COPD are also available at www.ginasthma.org.
During the bus drivers’ strike let’s remember that good transport, or its lack, helps to shape our health. It is one of the social determinants of health.
The UK The Health Foundation’s new easy-to-read quick guide: “What makes us healthy?explains how your opportunity for health is influenced by factors other than health services and financial support. It helps to explain how, in our unequal society, South Africans don’t have the same opportunity. This is an introduction to the social determinants of health written by Natalie Lovell and Jo Bibby.
“So what causes heart disease? To some, the clear answer would be blocked arteries. But what causes those arteries to become blocked? Perhaps it’s the unhealthy food and drinks people consume, their lack of exercise, or their stress levels. And what, in turn, makes them feel stressed, shapes their opportunities to be active and determines their choices about what they eat and drink?”
“The answers lie in the circumstances in which people are born, grow, live, work, and age: the social determinants of health. These can enable individuals and societies to flourish, or not. These are the causes of the causes.”.
This post puts the UN High-level Meeting for NCDs priorities in a South African context. It does not dilute the global call but pegs the South Africa response.
1 Put people first
People living with, at risk of and affected by NCDs (PLWNCDs), young people, and civil society must be at the heart of the NCDs response.
For over 20 years the South African policy of Batho Pele or “people first.” The Life Esidimeni mental health tragedy it is clear that much more needs to be done to include us. No more talk. #EnoughNCDs.
Empowering and involving PLWNCDs and young people has been neglected. The knowledge held by PLWNCDs is undervalued in NCDs programme development, implementation and policy-making. They are under-represented as leaders and in organisations they are largely silent in decision-making processes. Let’s correct this state of affairs to realise the rights and responsibilities of PLWNCDs , which require supportive political, legal, and social environments that give all people the opportunity to speak up, especially those most vulnerable and disenfranchised. Let’s start with the South Africa National Health Commission as a key NHI platform for multisectoral stakeholder engagement and policy coherence.
A close connection with communities, civil society organisations (CSOs) provide people affected by NCDs with an essential voice in decision-making processes. CSOs raise public demand and engage with and apply concerted pressure on governments to ensure that resources and services reach and benefit affected communities, as well as hold governments and other sectors to account. Investing in civil society must be recognised as part of the global public good agenda.
2 Boost NCD investment
Scaling up investment for NCDs is a critical priority to achieve the 2025 NCD targets & the SDGs.
Sustainable and adequate resources for NCDs are severely lacking and remain a bottleneck in the response. NCDs receive just 1.3% of development assistance for health, making NCDs the only major global health priority without international financing. Closing the resource gap will require multiple financing sources, depending on the country-specific context. The expected result will be a blended stream of financing, including creating and optimising fiscal space for NCD investment domestically, exploring innovating financing mechanisms (such as taxation of unhealthy commodities), multilateral/bilateral funding, private sector engagement, and catalytic mechanisms, in line with the recommendations from the Third International Conference on Financing for Development in 2015. While domestic resource mobilisation is critical, for low-income countries allocating less than 5% of the gross domestic product to health, progress on NCDs will be impossible without catalytic funding from donors.
At a NDoH level the
3 Step up action against all forms of childhood malnutrition including obesity
Childhood obesity is an issue with a clear health and economic imperative for action.
Global political targets exist to ensure a ‘zero increase in overweight in under 5s’ and a ‘zero increase in obesity and diabetes’, and a WHO Implementation Plan to End Childhood Obesity to guide the response, centering around a set of population-based interventions. With insufficient progress to date and driven by unsustainable, unhealthy food systems and environments, childhood obesity is a major challenge that extends well beyond the health sector and demands political attention at the highest political level.
4 Adopt smart fiscal policies that promote health
South Africa has implemented tobacco, alcohol and sugar sweetened beverage taxes.
The tax on sugar sweetened beverages, the Health Promotion Levy (HPL) came into effect on less than a month ago and took 2 years of negotiations and activism. The tax is instituted with compromise 2,1 c per gram of sugar per 100 ml of the drink. A portion of the HPL is to be used for health promotion and treatment, hence the name.
In the 2018/19 financial year, Treasury has allocated R100 million to the National Department of Health from the HPL. Dr Yogan Pillay (Deputy Director General NDoH Programmes) confirmed, in a meeting this month, that R93 million is to be allocated for human resources to treat people living with cancer. The remaining R7 million is set to be used for a health promotion campaign for cancer prevention.
Alcohol and tobacco taxes taxes go into the broader fiscus with no directed health allocation. In the health budget on Furthermore, the money needs to be spent in the right places tackling the largest burden NCDs facing the country.In South Africa, we have adopted 3 major healthy lifestyle taxes to curb NCD risk factors and utilise the money collected to benefit the broader population.
5 Save lives through equitable access to NCD treatment & NHI
Access to prevention and treatment is a fundamental human right so that we can achieve the highest possible standard of physical and mental health and well-being.
Section 27 of the South African constitution entrenches the right to health and care. a number of law cases have upheld this view. The NHI programme for universal health coverage and access (UHC+A) is in Phase 2 of its roll out. NCDs prevention and treatment needs firm embedding.
Availability and access to lifesaving treatment, care and support for PLWNCDs is still out of reach for millions of African people almost all of whom live low- and middle-income countries LMICs).
This is despite global targets for 2025 to ensure 80% availability of essential medicines and technologies for NCDs. In South Africa for example, there is no state procurement of diabetes blood testing equipment and strips. Sadly the leading the leading cause of death in women and the group combination of diabetes, heart and vascular disease the number 1 killer over.
Access challenges relate to weak health systems in many LMICs, including the lack of adequate preparation and training of the health workforce, insufficient financial resources, poor procurement policies and weak supply chains, inefficient information systems, and lack of patient education and low health literacy.
Reducing the burden of NCDs is essential to achieve SDG UHC+A (Target 3.8) and the SDGs, goals focus on ending poverty in all forms everywhere and reducing inequalities within and among countries. Integration of NCD prevention and treatment the NHI programme and a strong focus on equity is fundamental to strengthen health systems to deliver for NCDs throughout the life-course and protect against financial hardship.
6 Improve accountability for progress, results & resources
Accountability is a crucial force for political and programmatic change.
Accountability is cyclical process of monitoring, review and action, accountability enables the tracking of commitments, resources, and results and provides information on what works and why, what needs improving, and that requires increased attention.
Accountability ensures that decision-makers have the information required to
meet the health needs and realise the rights of all people at risk of or living with NCDs. Multiple sets of commitments and targets for NCDs exist at the global level, as set out in the WHO Global NCD Action Plan and Monitoring Framework on NCDs, the 2014 UN Review Outcome Document, and the SDGs. Existing WHO and UN accountability mechanisms for NCDs can be complemented by independent accountability mechanisms, and at the national level, there is a need to strengthen accountability mechanisms, national targets, and improve data collection and surveillance systems.
RPN (ICU) Diabetes Nurse Specialist
SA NCD Alliance (SANCDA) Associate and Diabetes Education Society of South Africa (DESSA) member
Ramadan is approaching and people living with diabetes are advised to plan before starting the month-long fast. Approximately 100 million people with diabetes world-wide fast during Ramadan and most are able to fast the whole month. But this takes planning by all involved, including families, communities and health professionals.
What is Ramadan?
Ramadan is the ninth Islamic month and fasting during the day light hours is one of the five pillars of Islam. Muslims have been fasting during Ramadan for over 1400 years as prescribed in the Qur’an. Fasting is one part of the religious practices during Ramadan and adults must abstain from eating, drinking, sexual intercourse, use of oral medications, and smoking from before the sunrise to after sunset. There are no restrictions on food or fluid intake between sunset and dawn, however moderation is prescribed.
Most people consume two meals per day during Ramadan: one after sunset (referred to in Arabic as iftar or breaking of the fast meal), and the other before dawn of suhur (predawn).
When is Ramadan?
It varies according to the Muslim (lunar) calendar. This year it is approximately May 15th to June 14th 2018.
What are the diabetes numbers?
Over 425 million people worldwide live with diabetes
1 out of 2 adults with diabetes are undiagnosed.
About 80% of the world’s population live in low- and middle-income countries, like South Africa, where the greatest increase in diabetes will occur.
Diabetes is the #1 cause of death of females and the #2 cause of death for all in South Africa.
Muslims comprise almost ¼ of the world population and there are 148 million Muslims living with diabetes.
The International Diabetes Federation (IDF) projects that by 2045 the number of people living with the disease will more than double in the Middle East, Africa and South East Asia where the largest populations of Muslims live.
How does fasting affect people living with diabetes?
In people with diabetes the control of blood glucose needs more attention. Complications like low blood sugar (hypoglycaemia) and high blood glucose (hyperglycaemia), dehydration, and blood clots may occur. These are considered to be the “risks” of fasting and are potentially life threatening and require planning to avoid them such as changes to medication.
Preparation pre-Ramadan is essential and should include risk stratification. All planning must include education, nutrition, exercise, medication adjustments and monitoring. Ideally this should take place 6 – 8 weeks before Ramadan.
What about fasting when one takes medication for diabetes?
Islam does not burden its followers, there are exceptions for those who are unable to observe the obligatory fast. It is forbidden in Islam to exert oneself in any act that will bring harm upon oneself. Thus, if one is ill and the illness would be aggravated, or the pain would increase through fasting, then fasting is not required.
Those who do fast, are required to review their medication together with a health care practitioner and diabetes nurse specialist before Ramadan so adjustments can be made. In the event of any hypoglycaemia, the fast should be broken immediately and it is advised that the person should not resume fasting until a they consult a health care practitioner..
Who is a high risk during Ramadan?
Risk is assessed according to the following factors: type of diabetes, medication, previous Ramadan experience, hypoglycaemic risk, current complications, co-morbidities and individual work and/or social circumstances. Examples are old age with ill health, vascular complications, pregnancy and those doing intense physical labour.
What can be done to manage those at high risk of having complications?
Very high risk and high-risk patients should not fast. However, many will fast and these persons should be given the education on how to minimise the possible complications while fasting and thereafter. They should also be given an individualised management plan for reducing their risk for further complications.
The management plan should include pre-Ramadan visits, regular self-blood glucose monitoring before, during and after fasting, and a nutrition and exercise plan.
The plan must be individualised and tailored to the person’s circumstances, there is no “one size fits all.”
It is important to provide additional support to include emergency contacts and availability of a trained health care professionals in diabetes management at all times.
Include religious and community leaders, families and community members in the successful and uneventful fasting period.
Where can people find more information about diabetes and Ramadan?
Guidelines on the management of diabetes in Ramadan published in 2016 by the IDF Diabetes and Ramadan Alliance. These guidelines assist health care professionals and persons living with diabetes on the best practices in the preparation and treatment of those who will be fasting.
In September 2018 the United Nations High-Level Meeting on NCDs (UN HLM NCDs) takes place. People around the world are joining together to say: “We have had #EnoughNCDs and action is needed. Now!”
The SANCDA joins the global campaign convened by NCD Alliance together with our global network of people and organizations. We demand that our government prioritize NCDs as they have promised to do since 2011. So we are calling for governments to act going into the UN HLM NCDs.
This is what we are asking for as South Africans:
1. Put people first – you and me who live every day with NCDs.
2. Boost NCD investment so that empty promises stop and there is NCDs action.
3. Step up action on childhood obesity but don’t forget to beat childhood malnutritionin all of its forms.
4. Adopt smart fiscal policies that promote health and then put some money into NCDs prevention and treatment.
5. Save lives through equitable access to NCDs treatment through universal health coverage (NHI).
6. Improve government accountability to the people for progress, results and resources.
Please join us! You can show your support for the cause by championing a leader or personality who will support the fight against NCDs. Please contact us with your ideas and suggestions. We would love to hear from you. requests. For further information please checkin the back with the SANCDA for more on the movement and campaign as it progresses.
