Opinion: Reaching universal health coverage means tackling malnutrition

A child is examined for malnutrition in Ethiopia. Photo by: Michael Tsegaye / UNICEF Ethiopia / CC BY-NC-ND

When faced with a crisis, our natural reaction is to deal with its immediate threats. So when, for example, children start presenting at clinics with symptoms of cholera in the middle of a humanitarian disaster, our tendency is to invest everything we have into saving lives by treating those symptoms as quickly as possible.

But what we’ve seen is that often the very children that we’ve treated and sent home soon return to the treatment centers — not for cholera this time, but because they are suffering from severe malnutrition. Too often, we focus on treating them for a deadly infection and in the heat of the action, we save lives but fail to restore health.

Yet, experience from managing epidemics has shown that when a population’s baseline nutritional status is poor, 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, 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 each year due to catastrophic out-of-pocket payments for health care, 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 noncommunicable 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 5. That same year, 10 million were overweight; almost double the figure from 2000. It’s estimated that by 2020, noncommunicable 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 health care 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 well-being 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 the Congo, Mali, and Tanzania.  

Then, to influence what people eat, we need to do a better job at improving food environments and education 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 programs 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 labeling, 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.

For more coverage of NCDs, visit the Taking the Pulse series here.
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About the authors

  • Ao%2520headshot%25206%2520aug%25202018

    Adelheid Onyango

    Adelheid Onyango is the regional adviser for nutrition at the WHO Regional Office for Africa. Dr. Onyango obtained a bachelor’s degree in education home economics from Kenyatta University in Nairobi before pursuing postgraduate studies to obtain a master of science and doctorate in nutrition from McGill University, Canada. She has dedicated more than 20 years of service in international public health and nutrition.
  • Bibi%2520headshot

    Bibi Giyose

    Bibi Giyose is senior nutrition and food systems officer, and special advisor to the NEPAD CEO. Previously, she advised the New Partnership for Africa’s Development Planning and Coordinating Agency, an organ of the African Union, on the same, and was an UNDP/UNAIDS regional project coordinator for HIV and nutrition. She holds an M.S. in international nutrition from Cornell University in Ithaca, NY, USA and a B.S. in nutrition and dietetics from Appalachian State University – Boone, NC, USA.