Addressing Non-Communicable Diseases in Africa: The Overlooked Role of Regional Alliances - The Kenan Institute for Ethics at Duke University

Diseases no know boundaries. To address changing disease trends in the African region and the rest of the world, regional approaches must be better developed and implemented. Regional collaborations in Africa are promising but have historically been minimal and misguided. People and goods are increasingly moving around the world with ease and speed through globalization. Mobility across and within borders has complex implications for infectious diseases and non-communicable diseases alike. Yearly influenza seasons and outbreaks of diseases such as AIDS, SARS and Ebola do not follow political, geographic or cultural boundaries. Although increasing trade can be beneficial for economies, trade liberalization spreads health risk factors, including tobacco and alcohol. As economies develop, people’s lifestyles become more sedentary, contributing to growing global epidemics of non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, chronic respiratory diseases and cancers.

Russian Federation Health Minister Veronica Skvorsova, from left, Zimbabwe’s President Robert Mugabe, Paraguay’s President Horacio Cartes, Chile’s President Michelle Bachelet, WHO President Tedros Adhanom, Uruguay’s President Tabare Vazquez, Morocco princess Lalla Salma, Pan American Health Organization regional director Carissa Etienne, World Health Organization for Europe Director Zsuzsanna Jakab and General Secretary of the International Telecomunications Union Houlin Zhao, pose for a group picture during the WHO Global Conference on noncommunicable diseases, in Montevideo, Uruguay, Wednesday, Oct. 18, 2017. (AP Photo/Matilde Campodonico)

To address the impacts of globalization on health, regional politics and the role of regional organizations in global health governance must be better understood and utilized. Politics affect the conceptualization, creation and implementation of health policy, shaping who is entitled to services, which health issues are prioritized, who provides services and how health budgets are spent.

The African continent has gravitated towards regionalism in an attempt to catalyze development and strengthen African integration and unity. For example, the African Union’s adoption of the African Union Non-Aggression and Common Defense Pact acknowledged the AU’s right of intervention in member states to restore peace and security. Moreover, Africa is expected to have the world’s largest increase in deaths from NCDs, such as cardiovascular diseases, diabetes and cancers, over the next decade. By 2030, NCDs are projected to become the leading cause of death in sub-Saharan Africa. In most countries in Northern Africa, NCDs already account for more than three quarters of all deaths.

Unless urgent action is taken, the growing NCD burden will add tremendous pressure to health systems that are already overstretched. This action must take regional politics into account, as regional actors help to ensure that African voices are heard and reflected in the commitments and resolutions made by their governments to address NCDs. For instance, regional actors have raised maternal, newborn and child health to the highest level of policy decision-making on the African continent and beyond. Regional actors have also driven the expansion of evidence-based interventions to improve maternal and child health and served as platforms for researchers and advocates to pool their expertise. But this is only one example.

Thus far, regional approaches related to health in Africa, outside of maternal, newborn and child health, have been minimal and need to be better developed. Regional organizations can effectively promote regional health diplomacy and governance through engagement with international institutions, civil society, non-governmental organizations and public-private partnerships. Despite growing interest in regionalism throughout Africa, regional approaches to health have not currently met their full potential. For example, the South African Development Community (SADC) is an important member-based organization, headquartered in Botswana, with the main aims of supporting regionalism, development coordination and cooperation. However, SADC has a limited heath presence as a regional organization and diplomatic partner. It has been argued that SADC has the potential to promote regional health diplomacy by increasing its engagement with civil society and non-profit organizations, advancing its trade agenda related to medical purchases and focusing on training and retaining health professionals in the region.

Southern African Development Community (SADC) Council chairperson and South African minister Maite Nkoana-Mashabane attends a meeting in Gaborone in Botswana Thursday, Nov. 16, 2017. The meeting of theSADC Organ on Politics, Defence and Security Co-operation is being held to discuss the political developments in Zimbabwe. (AP Photo)

These recommendations made by academics to improve SADC’s role in health policy relate to a promising tactic in global health governance: regionalizing global health through diplomacy. Regional organizations can act as a broker in global health governance through “regional diplomacy.” Regional diplomacy in global health brings together the disciplines of public health, international affairs, law and economics to affect the transnational negotiations that shape and manage the global policy environment for health.

A lack of resources, continued conflict in the region and political differences are all obstacles to regional collaboration in Africa, but if governments form partnerships to address these challenges, use donor money effectively and invest in their own health systems, there is immense potential to create beneficial change and minimize the burden of NCDs.