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non-communicable diseases in El SalvadorEl Salvador has experienced rampant public health problems for generations and has recently made commendable successes in addressing these problems. However, non-communicable diseases in El Salvador continue to be stubborn roadblocks that cost many citizens their health and their lives.

Non-Communicable Diseases (NCDs) in El Salvador

Non-communicable diseases are those that cannot be directly spread from one person to another such as Alzheimer’s, cancer and diabetes. Like the rest of the world, NCDs are a leading cause of early death among the adult population in El Salvador. Estimates show about 71% of all global deaths result from NCDs, the majority of which come from low-and middle-income countries. During the 2011–2015 period, in El Salvador, one of the most impoverished and most dangerous countries in Latin America, cardiovascular disease accounted for some 12% of deaths. Chronic kidney disease followed at 6.3% and cancer at 5.4%.

Many of the factors leading to high death rates from non-communicable diseases in El Salvador are lifestyle-related. Sedentary lifestyles, smoking and poor nutritional choices all contribute to NCDs such as diabetes and cardiovascular disease. Poor nutrition is common in many low-and middle-income countries. A health survey among El Salvadorians found almost 94% of citizens consumed too few fruits and vegetables and almost as many consumed an excess of sugary beverages. With this information, it is no surprise the survey also found relatively high rates of overweight and obese adults. Obesity is synonymous with NCDs. Furthermore, chronic kidney disease is particularly prevalent among El Salvadorian adults. This results from excessive use of anti-inflammatory medication, inadequate hydration and exposure to agrochemicals in the workplace.

Previous Healthcare Efforts

Public health problems are nothing new to El Salvador. The Ministry of Health has been ramping up efforts to address these problems since 2009. Some of the main concerns in the past have been the fragmentation of the health sector and high rates of uninsured citizens. In 2009, the Ministry of Health implemented a National Health Strategy to correct these issues. Throughout this program, increasing equity of access to health services, improving the quality of these services and strengthening the monitoring and oversight capacity of the Ministry of Health have been top priorities. In order to accomplish these goals, El Salvador increased its public health expenditure by 33.7% from 2009 to 2019. The country also increased the amount of these expenditures allocated to the public health sector by 8%.

Many of these efforts have paid off, albeit modestly. Because of the National Health Strategy, more public health services have reached impoverished and remote citizens in El Salvador. Expanding access to healthcare has had a positive effect on the country’s economic outlook. The income-poverty rate decreased from 46.4% in 2008 to less than 34.8% in 2013 and extreme poverty dropped from 15.4% to 9.1% in the same period. Furthermore, El Salvador’s Gini coefficient (measure of income inequality) decreased from 0.47 in 2009 to 0.41 in 2013, in large part due to public service equity efforts such as those executed by the Ministry of Health.

Non-Communicable Disease Efforts

Even with all this progress, the problem of non-communicable diseases in El Salvador remains. Non-communicable diseases account for more than 65% of all deaths in the country. Therefore, the Ministry of Health teamed up with the World Bank and Access Accelerated in 2018. The two wanted to specifically fight NCDs through the project El Salvador Addressing Non-Communicable Diseases. This project focuses specifically on improving the prevention, detection and treatment of cervical cancer as well as the prevention of common NCD risk factors. In fighting cervical cancer, El Salvador received more than 86,000 HPV screening tests and almost 30,000 doses of HPV vaccines. Both prevent cervical cancer by taking early action.

Besides cervical cancer, the program works to fight other non-communicable diseases in El Salvador. It accomplishes this by training healthcare workers, providing workshops on nutrition and expanding access to mental health resources. The arrival of COVID-19 has disrupted some of these programs. However, it also forced organizers to rethink how to properly deliver care in continuation of their public health efforts. New methods have included providing health education through social networks, improving the delivery of medication, increasing the use of telehealth and making home dialysis available for chronic kidney disease patients. These approaches to healthcare spurred by COVID-19 will likely live on in the post-pandemic world. Many changes like switching to telehealth are increasingly popular, both in El Salvador and around the world.

The Road Ahead

As in most other nations, non-communicable diseases in El Salvador weigh heavily on the population. However, El Salvador has proven during the past decade that improving access to healthcare for impoverished citizens, treating NCDs proactively through preventative measures and championing new flexible ways of delivering healthcare are positive steps any country can take to make an impact on national public health. Though researchers will not know the full effects of recent programs for some time, early results are promising. Physicians are administering more HPV tests and vaccines, more public health services are reaching low-income citizens and pandemic-era practicalities are proving so popular that they will likely be hallmarks of global healthcare in the years to come.

Calvin Melloh
Photo: Flickr

 Diseases in Africa
Communicable diseases such as malaria, tuberculosis and HIV/AIDS are still the biggest health concerns in Africa. However, the World Health Organization (WHO) projects that by 2030, non-communicable diseases (NCDs) will become the leading cause of death in Africa. Currently, only two percent of all donor funding goes to chronic diseases. NCDs in Africa is an issue that deserves more attention.

Non-communicable diseases in Africa include diabetes, cardiovascular and chronic respiratory diseases, as well as cancer. These diseases often stem from unhealthy lifestyles, like diet, smoking, drinking and physical inactivity. These behaviors can cause high blood pressure, weight gain, respiratory ailments, high blood sugar and cholesterol levels.

NCDs are already the leading cause of death in most regions of the world. These diseases cause the deaths of 38 million people each year and almost three-quarters of these deaths occur in low and middle-income countries. Projections show that NCDs in Africa will see the biggest growth globally in the next few decades.

Widespread chronic illness is detrimental to the economy and poverty reduction initiatives in developing countries because they result in decreased labor outputs, lower returns on human capital investments and increased healthcare costs. Non-communicable diseases should thus be afforded more attention in discussions about alleviating global poverty.

There are several initiatives working to address the issue of NCDs and the impact they will have on developing countries. The WHO created a Global Action Plan for the Prevention and Control of NCDs, which focuses on national actions to address harmful lifestyle choices that cause NCDs. This includes the taxation of tobacco and alcohol products and targets education programs on healthy living.

However, the increase in cases of non-communicable diseases in Africa will also require more resources to strengthen and adapt healthcare systems to deal with the growing disease burden. In 2014, only 49% of African countries reported that they have the necessary funds for the early detection, screening and treatment of NCDs.

One program working to solve this issue is Access Accelerated, a partnership between the World Bank, the Union of International Cancer Control and more than 20 pharmaceutical companies. The Access Accelerated initiative aims to address the access barriers to NCD medicines in low-income countries. Novartis Access, for example, is providing 15 NCD treatments in Kenya at $1.00 per treatment per month. This program will roll out in 30 other developing countries over the next few years.

Providing affordable medicines is just one of the aspects of creating sustainable solutions to the growing burden of non-communicable diseases in Africa. Other priorities include training healthcare workers to deal with NCDs, educating local communities about these diseases and improving healthcare infrastructure and distribution networks in rural areas.

Helena Kamper

Photo: Flickr