Despite scaling up action against NCDs over the past few years, Botswana’s progress toward addressing them has mainly been lacklustre. While there might be several reasons for this limited success, the absence of bold policy commitments is believed to be one of the main reasons for the partial progress in NCD prevention and management.
NCDs are a diverse group of chronic diseases that are not communicable, meaning you can’t catch them from another person. They include cardiovascular diseases, cancers, diabetes and lung diseases are the leading drivers of morbidity, mortality and disability. The World Bank collection of development indicators, compiled from officially recognised sources states that the cause of death by NCDs in Botswana was reported at 45.7 % in 2016. Last year, the minister of Health and Wellness, Dr Edwin Dikoloti highlighted that NCDs are now estimated to cause 46% of all deaths in Botswana. Reports also show that if there is no change in the current trends, well before 2050, NCDs will be responsible for over 50 percent of deaths in the country.
The increasing trends of NCDs is attributed to more people involved in risky behaviours such as tobacco use, excessive alcohol consumption, unhealthy diets and physical inactivity. Despite the fact that they are preventable, medical health professionals say if NCDs are not carefully monitored they could alter demographics and stunt development in Botswana.
According to the 2020 Global Nutrition Report: “Botswana has shown limited progress towards achieving the diet-related non-communicable disease (NCD) targets. The country has shown no progress towards achieving the target for obesity, with an estimated 29.3% of adult (aged 18 years and over) women and 8.1% of adult men living with obesity”.
Some health professionals are concerned that the impact of the growing prevalence of NCDs on medical health could jeopardise Botswana’s plans to achieve the global NCD targets. Currently the world has nine NCD targets to be achieved by the year 2025 and Botswana is nowhere near achieving majority of them. Some of the 2025 NCD targets include halting the rise in diabetes and obesity, a 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years, a 10% relative reduction in prevalence of insufficient physical activity, a 25% relative reduction in the overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases, at least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context. While insufficient physical activity does not relate explicitly to diets, it does have an impact on nutritional outcomes through its influence on energy balance.
The Botswana Multi-Sectoral Strategy for the Prevention and Control of Non-Communicable Diseases 2018-2023 says “a population based Non-Communicable Diseases and their risk factors survey (STEPS) conducted in Botswana in 2014 revealed adult prevalence of 29% for hypertension, 5% for diabetes, 30% for obesity, 18% for tobacco use, and 95% for unhealthy diet.” While prominent causes for heart disease, diabetes and cancer can be prevented, public health experts and researchers say Botswana needs preventive actions and efficient strategies to address risk factors such as tobacco, alcohol, obesity, blood pressure diet and physical inactivity.
Furthermore, unless the country moves to immediately address the burden of NCDs, there is likelihood that NCDs and conditions such as cancer, diabetes, cardio vascular diseases and diabetes will move closer to being one of the greatest threats to human lives in Botswana, just like HIV and AIDS. According to the World Health Organisation (WHO), “Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs, whether from unhealthy diets, physical inactivity, and exposure to tobacco smoke or the harmful use of alcohol”.
NCDs are also increased by modifiable behaviours such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol. The recently launched eighth WHO report on the global tobacco epidemic shows that Botswana although Botswana slightly reduced the adult daily smoking prevalence, the country still has one of the highest tobacco use prevalence in Africa and ranks 7th out of 41 African countries were data was collected.
According to health institutions, a person qualifies for a healthy lifestyle only when they do not smoke or excessively drink, engage in exercise for at least 2 hours 30 minutes a week, and have a body fat percentage under 20 percent for males and 30 percent for females. This highlights that achieving NCD targets will be a tall order.
Since NCDs increase burden of the healthcare system, government is advised to at least have health facilities to ensure effective diagnosis and treatment of NCDs rather than continue on this trajectory where patients are always referred to South Africa.
The 2030 Agenda for Sustainable Development adopted at the United Nations Summit on Sustainable Development in September 2015, recognises NCDs as a major challenge for sustainable development. SDG target 3.4 aims to have reduced by one third premature mortality from non-communicable diseases through prevention and treatment, and promote mental health and well-being by 2030.
A report entitled: “Diet and Non-Communicable Diseases: An urgent need for new paradigms” states that “Lack of access to integrated healthcare services for people who suffer from cardiovascular diseases (CVD) and other NCDs is also an issue. Processed foods high in trans fats, saturated fats, sugar and salt, plus sugar-sweetened beverages, are associated with increased risk of hypertension, diabetes, elevated cholesterol and CVD”.
An analyst, Gaone Matswe, who spoke to this publication indicated that as Botswana transitions from infectious to non-communicable diseases, she is hopeful that legislative and regulatory actions such as the Sugar Tax which was announced by former minister of Finance and Economic Development, Dr Thapelo Matsheka will add to successful NCD prevention and management by helping to modify the obesogenic environment. Botswana is slowly going through a transition from infectious to non-communicable diseases which is mainly caused by changes in smoking and drinking habits, physical activity as well as diet.
