Frontline Africa Advisory

Good Sense and the Public Health Agenda

Good Sense and the Public Health Agenda

According to the Non-Communicable Diseases Strategic Framework 2013-2017 adopted by the Department of Health in 2013, “Non-communicable diseases (NCDs) are the leading causes of mortality globally, causing more deaths than all other causes combined, and they strike hardest at the world’s low and middle-income populations”. Non-Communicable Diseases, as the name suggests, are non-infectious and non-transmissible between persons. By their nature, they are they are of a long duration and generally slow progression. The 4 main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

At the September 2011 High Level Meeting of Heads of State and Governments on the Prevention and Control of Non-Communicable Diseases during the 66th session of the United Nations General Assembly, the UN declared that NCDs were not only a Health but a Development concern requiring a whole of government and whole of society approach.

The South African government signed the declaration on the Prevention and Control of Non-Communicable Diseases in 2011. The country set itself 10 goals and targets to be achieved by 2020, which are:

1. Reduce by at least 25% the relative premature mortality (under 60 years of age) from Non-Communicable Diseases by 2020;
2. Reduce by 20% tobacco use by 2020;
3. Reduce by 20% the per capita consumption of alcohol by 2020;
4. Reduce mean population intake of salt to <5 grams per day by 2020;
5. Reduce by 10% the percentage of people who are obese and/or overweight by 2020;
6. Reduce the prevalence of people with raised blood pressure by 20% by 2020 (through lifestyle and medication);

Flowing from the UN Resolution on Non-Communicable Diseases, the African National Congress, at its 53rd National Conference held in Mangaung in 2012 directed that government gear its public health agenda towards the promotion of healthy lifestyles. Thus, “government must embark on activities to promote healthy lifestyles through mobilization of individuals and communities to engage in physical activities, good dietary practices and reduction of harmful use of alcohol, tobacco and to control of substance abuse”.

To this extent, government has proposed legislation and regulations such as the Liquor Amendment Bill, the Sugar Tax and most recently, the Control of Tobacco Products and Nicotine Delivery Systems Bill which repeals the Tobacco Control Act 83 of 1993.

In common, all these bills have the intention of reducing non-communicable diseases. Further, they have the distinct convenience of shifting compliance away from consumers towards producers and manufacturers. One is tempted to ask; when will the government accept that South Africans above 18 years old are old enough to make their own decisions about their lifestyles?

Good intentions accompanied by bad execution can lead to undesirable outcomes. How government plans to ensure compliance and monitoring systems in relation to tobacco control is not clear and would require resources and personnel that are simply not there.

A revolutionary idea which government seems reluctant to consider is good old-fashioned sustained consumer education about the dangers of these products. Such education must go beyond the ineffectual labels and slogans such as ‘smoking kills’ or ‘drink responsibly’ that many of us do not even take note of on product packages and advertisements. Rather, education in the class room, in the homes, and in the communities is what is required to change behaviour over the long term, not some punitive measures imposed on manufacturers that will allow government to claim easy victories without a clearly demonstrable impact on behaviour. Put simply, government must give people the ability to make their own informed choices, rather than enacting legislation and regulations that impose a heavy burden on producers and traders without even a respectable level of certainty on likely outcomes.

Having said this, one does not take lightly the heavy cost imposed by these products. On the contrary, the costs are such that any efforts to reduce consumption that are misdirected must be avoided at all costs in order not to worsen the situation. For instance, the proposal to control electronic cigarettes as tobacco is likely to deprive smokers of an opportunity to get their fix without getting the toxic substances that come with tobacco. It also ignores the preponderance of scientific evidence which seems to point to these devices being the single biggest breakthrough in the fight against tobacco induced diseases. The result is that emotion is likely to trump good sense, as if the public health agenda is a zero sum game that exists in a vacuum.

One is hopeful that government will, sooner rather than later, realise the folly of its ways and accept that policy choices cannot be informed by our disdain for certain products. Rather, good science and proper socio-economic impact assessments must anchor all policy choices, accepting that some choices may not be to our liking, but still, on balance, offer the best available choice for a country such as ours.

Thembinkosi Gcoyi is the Managing Director of Frontline Africa Advisory. He writes in his personal capacity.

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