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15 September 2011

NCDs in Uganda - and social differences in health behaviour

Susan Whyte is Professor at the Department of Anthropology at the University of Copenhagen and is specialized within medical anthropology. Since 1969 Susan has worked in Uganda, and has collaborated on three research capacity strengthening projects at Makerere and Gulu Universities on topics such as health systems, family relations and gender.

We asked Susan to explain to us how social differences play a role when it comes to the treatment and prevention of NCDs in Uganda.

How are NCDs a part of the health situation in Uganda?

The fight against AIDS has attracted immense resources and attention in Uganda and has overshadowed the growing problem of NCDs. It was not until 2005 that goals and guidelines for control of NCDs became part of the Health Sector Strategic Plan and a unit was established within the Ministry of Health. There are no reliable figures for the national prevalence of NCDs, although plans have existed for some time to carry out a survey. However, health officials state that NCDs are the major cause of death in the country. One District Health Officer asserted that NCDs are ‘the real Neglected Tropical Diseases'. Health workers and older people remark upon the striking increase they have seen in recent years.
Civil society organizations are emerging to mobilize funds and create awareness. The most active has been the Uganda Diabetes and Hypertension Association, which has now joined with the Heart Research Foundation, and the Uganda Cancer Society to form the Uganda NCD Alliance. Danida funding is supporting this effort through collaboration with the Danish NCD Alliance in a project coordinated at the Danish Cancer Society; members of the Copenhagen School of Global Health are also involved.

How are prevention and treatment connected?

Public health emphasizes prevention but in a situation where screening and treatment are weak, a holistic approach is necessary. This is especially the case for cardiovascular diseases and diabetes, where the 'lifestyle' measures recommended for prevention are similar to guidelines for those with diagnosed risk or disease. One of the problems we wish to research is whether having a member in systematic treatment for diabetes has a preventive effect on other people in the family. Treatment could actually be one way in which information about NCDs is spread.
Prevention may include better possibilities for screening, and these must be accompanied by availability of free treatment to those in need.

Why do efforts at control of NCDs reach some people more effectively than others?

Any attempt to change perceptions and practice reaches segments of the population unevenly. Health messages about diet and exercise are mediated by radio and print, and very importantly, by word of mouth. Preliminary research suggests that better educated people attend to these messages more carefully, and find them relevant to their situations. Many poor people feel that they do not have much choice in what they eat and how they live.
‘NCDs are diseases for the rich'. An old widespread perception was that only better off people developed diabetes and cardiovascular conditions (perhaps they were more likely to get diagnosed). Now, as several people explained to me, even poor people get these diseases, but only the rich can afford to buy medicine, when the government facilities cannot provide them.

How do you think gender and generation should be considered in preventing and treating NCDs?

The response to AIDS has demonstrated that women, perhaps even more than men, are active in prevention campaigns and motivated for testing and treatment. In the case of NCDs, we should consider where gender is most relevant. Women are more frequent users of health services. The very high fertility rate means almost all women attend antenatal clinics and these would be an obvious opportunity for health education and screening. Women prepare food, although men more often have the cash to buy items that cannot be produced domestically. High alcohol consumption is a big and neglected problem, affecting mostly men. Overweight and obesity have been found more common in females, at least among young adults.
Generation is as important as gender in addressing NCDs. Prevention programmes must reach the young who are establishing lifetime habits of consumption and physical activity. Adult children are deeply involved in care of their parents who develop NCDs as they grow older.

How do you hope your research will make a difference?

I see my task as supporting Ugandan researchers. At Gulu University in northern Uganda, we are undertaking a collaborative study on control of NCDs with two faculty members, who are training the next generation of health professionals. I hope also to provide a social science perspective for policymakers and activists at national and district levels-to challenge and engage them to think about social differences and changing values. I hope my research will make a contribution in Denmark too, in supporting young researchers who want to use qualitative methods to study NCDs, and in collaborating with academic and development colleagues.