By Henry Owino
There is a growing global concern about Non-Communicable Diseases (NCDs) also commonly known as lifestyle or chronic diseases. Scientists and researchers across the world are worried by unhealthy diets, which are a leading cause of death and disability globally, while overweight and obesity are on the rise across the world.
Lifestyle diseases are linked to how a person lives their life. They are characterised by diseases whose occurrence is primarily based on the daily habits of people and is a result of an inappropriate relationship of people with their environment.
Chronic disease because they are long-lasting conditions that often require ongoing medical attention or can limit daily activities. These diseases develop slowly over time and can be caused by a combination of genetic, physiological, environmental, and behavioural factors.
World Health Organization (WHO) is worried by the alarming rates of five major NCDs, namely, cardiovascular diseases (CVDs), cancers, diabetes, chronic respiratory diseases and mental ill-health. These five NCDs are the leading causes of death and disability worldwide.
The global health agency considers the five NCDs are health conditions also triggered by other five key modifiable risk factors for such as; tobacco use (including the effects of exposure to second-hand smoke), alcohol consumption, excess body weight (overweight and obesity), lack of physical activity, unhealthy eating and air pollution.
The five leading diseases and five risk factors are currently known as 5 by 5 approach to NCDs. It is favoured by WHO, hence focuses on five diseases and five modifiable risk factors. These factors are behaviors and exposures that can be changed to reduce or increase a person’s risk of developing the NCDs listed above.
Additionally, they can also be prompted by poor sleep hygiene, and low adherence rates to medical regimens such as recommended regular cancer screenings. Remember, ‘Prevention is better than Cure’.
Researchers affirm the burden of NCDs is particularly pronounced in low- and middle-income countries, where they are often associated with rapid urbanization, changing lifestyles, and aging populations. In Africa, the five NCDs accounts for about 50 percent of all deaths and have emerged as a significant public health concern in many African countries.
Local Context Comparison
Closer home in Kenya, NCDs is a major public health concern and the situation is not any different. The latest Kenya Demographic and
Health Survey (KDHS)2022, data has shown an upward trend in overweight and obesity prevalence, especially among women, rising from 25% in 2008 to 33% in 2014 and 49% in 2022, largely driven by unhealthy food consumption.
According to Kenya Ministry of Health, NCDs account for 43% of all deaths and 50% of hospital admissions. This is due to limited knowledge of unhealthy foods among the Kenyan population.
To avert this trend, increasing consumer knowledge through an easy-to-understand labeling of packaged foods is an essential first step. Second, is reducing the consumption of unhealthy foods and preventing of diet-related NCDs.
Kenya Scientists and Researchers from African Population and Health Research Center (APHRC) in collaboration with Non-Communicable Diseases Alliance Kenya (NCDAK) have been in the forefront sensitizing the public on unhealthy diets owing to increasing chronic diseases.
The APHRC is a premier research-to-policy institution, generating evidence, strengthening research and related capacity in the African research and development ecosystem, and engaging policy to inform action on health and development.
Whereas NCDAK, is a national umbrella body bringing together all organizations, patient groups, public benefit organizations (PBOs), community-based organizations (CBOs), and professional associations involved in the advocacy, prevention, control, care, and rehabilitation of persons living with or at risk of developing Non-Communicable Diseases (NCDs).
Community Responsiveness
According to Dr. Catherine Karekezi, the Executive Director NCDAK, the organization is leading advocacy efforts against NCDs to create synergies and advance progress towards the sensitization of NCDs target set in 2030 for its prevention and control in Kenya.
“The NCDAK’s mission is to lead a nationwide movement dedicated to reducing the burden of NCDs in Kenya. For instance, it is dedicated to addressing the growing challenge of NCDs in Kenya by uniting all the stakeholders across sectors to drive impactful change,” Dr Karekezi affirms.
The NCDAK Executive Director emphasizes that non-communicable diseases are linked to three primary nutrients of high concern; sugar, salt and fats. They are main contributors to dietary NCDs with five other modifiable risk factors.
“The disease burden in Kenya has shifted from predominantly communicable diseases to a rapidly rising burden of NCDs and injuries, which now account for two-thirds of the disease burden in Kenya’s,” Dr. Karekezi, states.
Healthy diet maintains or improves overall health by providing the body with essential nutrients: A balance of macronutrients (protein, carbohydrates, and fats), micronutrients (vitamins and minerals), fibre, and sufficient hydration.
Whereas unhealthy diets are high in sugars, salt, saturated fats and trans- fats. Unhealthy foods are generally high in calories, while being low in essential nutrients like vitamins, minerals, and fiber. Examples include processed meats, sugary drinks, fried foods, and many fast foods. These foods are often highly processed and may contribute to various health problems.
The 2030 Agenda for Sustainable Development Goal (SDGs) sets a target to reduce premature mortality from NCDs by one-third through prevention and treatment. The SDG 3.4 aims to ensure healthy lives and promote well-being for all ages.
Specifically, the target focuses on reducing premature deaths among people aged between 30-70 from major NCDs; cardiovascular disease, cancer, chronic respiratory disease, and diabetes.
Nutrients of Concern for NCDs Prevention and Management
Anne Swakei, Programme Officer, NCDAK explains the three primary nutrients of concern as follows:
- Sugar: Excessive intake of added sugars, particularly from sugar-sweetened beverages and processed foods, is linked to obesity, type 2 diabetes, and cardiovascular diseases.
- Salt (Sodium): High sodium consumption is associated with elevated blood pressure, increasing the risk of heart disease and stroke.
- Unhealthy Fats: Diets high in saturated and trans fats contribute to the development of heart disease and other NCDs.
Swakei adds that certain food products have been identified as increasing the risk of NCDs such as heart disease, diabetes, stroke, and certain cancers. These foods are typically high in added sugars, unhealthy fats, and sodium, and often lack essential nutrients. Key categories include:
- Ultra-Processed Foods (UPFs)
UPFs are industrial formulations made mostly from substances extracted from foods, with little to no whole food content. Examples include packaged snacks, sugary cereals, instant noodles, and soft drinks. High consumption of UPFs has been linked to increased risks of obesity, type 2 diabetes, cardiovascular diseases, and certain cancers.
- Processed Meats
Meats that have been preserved by smoking, curing, salting, or adding chemical preservatives, such as sausages, bacon, ham, and hot dogs, are associated with higher risks of colorectal cancer, heart disease, and type 2 diabetes.
- Sugar-Sweetened Beverages (SSBs)
Drinks like sodas, energy drinks, and sweetened teas are high in added sugars and contribute to weight gain, insulin resistance, and increased risk of type 2 diabetes and heart disease.
- Salty Snacks and Fast Foods
Items such as chips, fries, and fast-food meals are typically high in sodium and unhealthy fats, contributing to hypertension, cardiovascular diseases, and other metabolic disorders.
- Foods High in Saturated Fat and Trans-Fats
Foods like baked goods, fried items, and certain margarines contain unhealthy fats that can raise Low-Density Lipoprotein (LDL) thus ‘bad’ cholesterol levels, increasing the risk of heart disease and stroke. Reducing the intake of these foods and replacing them with whole foods, thus minimally processed foods.
Alternative and Possible Solutions
“Whole foods are those that are unprocessed and in their natural state, meaning they haven’t been refined or altered from their original form. Examples of whole foods include fresh fruits and vegetables, whole grains, nuts, seeds, beans, lentils, fish and healthy fats which can significantly lower the risk of NCDs,” Swakei explains.
The Kenya Constitution 2010, Articles 46 requires consumer products to have n
ecessary information about the ingredients of foodstuff. This therefore requires manufacturers to clearly label the food product contents in terms of amount of; sugar, fats and salt to alert consumers on choice based on health conditions.
The Kenya Ministry of Health has proposed front-of-pack warning labels (FoPLs) as a strategy to improve consumers’ understanding of healthy foods and guide their choices. When consumers understand the healthiness of foods, they make better choices, hence reducing the risk of chronic diseases such as diabetes, heart diseases, cancers and associated deaths.
Implementing Article 46 to letter and spirit, all consumer food products will have their ingredients legibly labelled.
The FoPLs is a system that displays simplified nutrition information on the front of food packages, helping consumers quickly identify and compare products based on nutritional content. This is often done using symbols, colours, or words to highlight key nutrients like saturated fat, sugars, and sodium.
For instance, the labels will highlight the three primary nutrients of high concern: sugar, salt, and unhealthy fats. The labels have been proposed to have clear warning symbols or messages such as; “high in sugar”, “high in fat” or “high in salt”, to alert consumers to products that exceed recommended thresholds for specific nutrients as potential health risks.
“This system of FoPLs places nutritional information directly on the front of packaged food products, not at the back with small, illegible fonts. The measure is intended to try to make people choose healthier options depending on their health conditions but not because of adverts or slashed prices,” Swakei elaborates.
The aim is to make it easier for consumers to make healthier food choices at the point of purchase.
She reveals that Kenya is at a critical point in its fight against lifestyle-related illnesses. The NCDAK team is really pushing for a system to be enacted into law. This is owing to the lack of transparent food labelling, which continues to leave consumers vulnerable to unhealthy dietary choices.
NCDAK has been promoting FoPLs for pre-packaged foods since its registration in July 2012 to inform consumers with quick, easy-to-read details about the health content of the food they are purchasing. So, it is high time the Kenyan Government prioritised it as policy because more delay worsens NCDs’ situation.
“We are urgently calling for the mandatory warning labels on the front of packaged food and beverage products that exceed recommended thresholds for the three nutrients of concern,” Swakei, NCDAK Programme Officer, emphasised.
Health experts have also called on the government to speed up the implementation of front-of-pack labels regulations in a bid to protect consumers from health risks associated with excessive consumption of sugar, salt and unhealthy fats.
The FoPLs restrictions mean that traders will have to reorganise their shelves and be limited with food products that are high in fat, salt, and sugar. Again, consumers are also going to be curious about frequently deceptive advertisements, and seasonal offers such as buy three-for-two and buy-one-get-one-free while shopping, or such promotions will be limited in supermarkets altogether.
Most advertisements about foods are done on billboards and televisions, driving preferences towards unhealthy foods. So, Fopl is likely to reverse this trend as consumers are going to be more informed, empowered and motivated to choose healthy diets.