Dr Gerald Yonga was an Associate Professor and Head of the Non-Communicable Diseases (NCD) Research-to-Policy Unit at AKU until retiring in January 2018. His advocacy helped lead to Kenya’s first NCD survey and strategy, and he plans to continue working on policy in this area. In this interview, Dr Yonga shares his insights on how to tackle the threat posed by NCDs.
Q: Where do things stand today with non-communicable diseases (NCDs) in East Africa?
A: NCDs cause about 30 per cent of all deaths in the region, and they are expected to become the leading cause of death, ahead of infectious diseases such as HIV/AIDS. The growth is driven by increased consumption of sugar, salt, fat, tobacco and alcohol, low consumption of fruits and vegetables, and reduced physical activity. Unhealthy foods are cheaper, cigarette smoking is rising amongst youths and educated women, and obesity is increasing and is still considered a sign of wealth. Moreover, poverty predisposes one to NCDs and NCDs contribute to poverty.
Q: What is the right approach to the problem?
A: The majority of the upstream drivers of NCDs lie outside the health sector, so we need to involve all sectors in prevention and control. For example, you need strong tobacco and alcohol control laws, enforcement and public education. You need policies that support healthy diets, and environments that encourage physical activity. The health system also needs strengthening. Most people in East Africa have never been screened for high blood pressure, and about nine in 10 have never been tested for blood sugar, cholesterol or cervical cancer.
Q: What about your own work?
A: In 2015, Kenya took a huge step forward with adoption of a national strategy for NCDs and publication of a national NCD survey, both of which I worked on as National Chair of the Kenya NCD Alliance. I recently completed a pilot study on integrating NCD screening into HIV/AIDS clinics, an area I’m also investigating through a project led by the U.S. National Institutes of Health’s Fogarty International Center.
Q: You are a cardiologist. How did you get interested in NCDs and public policy?
A: It’s easy to think in silos. You see patients with a blocked artery, you unblock the artery and you feel heroic. But then they return and more new ones keep cropping up! Eventually you get quite concerned about why they got heart disease in the first place.