Suffocating non communicable diseases with advocacy and policy
By Linus Aleke
It is the earnest intent of an advocacy group on moderate consumption of non-alcoholic carbonated and sweetened beverages, that its advocacy efforts should lead to maximal reduction, if not total suffocation of non communicable diseases amongst the population.
Regrettably, the sweetened beverage drink manufacturers, are also countering the advocacy group with all the power it can moster to continue to relish in the glamorous life style provided for by the high patronage induced profit.
Industry watchers said, this high patronage is what the advocacy group, under the aegis of National Action on Sugar Reduction Coalition, are not comfortable with and are now making certain demands from the manufacturers as well as proffering policy options that could help government, rescue the population from this life threatening non communicable diseases that are capital intensive to manage, which, of course, are cussed by high consumption of these sweetened carbonated products.
It is also, heart wrecking to know that the country lacks the basics, in terms of modern medicare facilities, not to talk of sophisticated infrastructure and equipments to manage these killer diseases, hence the humongous capital flight on account of medical tourism.
Federal Government data shows that Nigerians spend between USD1.2 to USD1.6 billion, (N664bn at 415/$) on medical tourism annually.
Of this amount, a conservative 70 percent, if not more, are spent on management and surgery of advance chronic non communicable diseases.
This huge amount, some development experts said, is enough to build few cotage hospitals that are well equiped to reduce total figure on medical tourism by over 30 percent, annually.
While, this is within the purview of government to do, or formulate workable policies, that will encourage private players to participate, as well as create an enabling environment to sustain this all inclusive participation, it is pertinent to note that the desired progress had not been made, not withstanding the intense advocacy on this subject under scrutiny.
But before attempting to highlight steps already taken by government to address this concerns giving the sustained advocacy, as well as the fresh demands from the advocacy group, it is imperative to attempt a definition of the concept that propelled this intervention, as well as the global statistics on the issue, so as to bring readers up to speed with the dangers that the advocacy group can not close its eyes and mouth on.
The term Non Communicable Diseases (NCDs), refers to a group of conditions that are not mainly caused by an acute infection, which result in long-term health consequences and often create a need for long term treatment and care.
An online knowledge resource, which, gave the above frightening scenario, added that these life shortening ailments, which, are associated with sugar sweetened beverage, include; cancers, cardiovascular disease, diabetes and chronic lung illnesses.
The online knowledge reservoir, further posited that, “Many Non Communicable Diseases (NCDs), can be prevented by reducing common risk factors such as tobacco use, harmful alcohol use, physical inactivity and eating unhealthy diets.
Other, include excessive consumption of non-alcoholic, carbonated and sweetened beverages, amongst several others.
Current global data reveals that Non communicable diseases (NCDs), kill 41 million people each year worldwide, equivalent to 71% of all deaths globally.
The statistics, added that in the region of the Americas, 5.5 million deaths are by NCDs.
It further revealed that each year, 15 million people, 2.2 million in the region of the Americas – die from a NCD between the ages of 30 and 69 years. According to the global data, over 85% of these, premature deaths occur in low, and middle-income countries.
Cardiovascular diseases account for most, NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million), globally.
According to the online resource, “These 4 groups of diseases account for over 80% of all premature NCD deaths. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets, as well as excessive consumption of carbonated drinks, increase the risk of dying from a NCD. Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs”.
But what has government done to address this issue? The Federal Government in 2021, enacted a legislation – Finance Act (2021), which imposed a 10 naira per litre excise tax on non alcoholic, carbonated and sweetened beverages.
This move, though inadequate according experts, was aimed at discouraging excessive consumption of sugar sweetened carbonated drinks in the country.
It is on the strength of the above that the National Action on Sugar Reduction Coalition, has continued to mount pressure on government at all levels to increase tax on non alcoholic, carbonated and sweetened beverages, to suppress the increasing prevalence of non communicable diseases in Nigeria.
This, the group said, compelled them to hold a peaceful protest in front of the Federal Ministry of Finance, Abuja, to draw the attention of the relevant government institutions to the issue.
The coalition, while commending the Federal Government on passing the tax law, maintained that a higher tax rate is needed to make a real health impact.
In a statement signed by the coalition’s Spokesperson, Ms.
Omei Bongos-Ikwue, the group urged the government to increase taxes on sugary drinks and invest the revenue into public health.
The excessive consumption of sugary drinks, she said, is known to be a risk factor for diseases like type 2 diabetes, heart disease, stroke and cancers.
“As one approach to relieve the burden on Nigeria’s over stretched health systems, the taxes can lead people to buy and consume fewer soft drinks. This would result in reduced diabetes incidence, increased economic productivity, and lower healthcare costs,” Ms. Bongos-Ikwue said.
The Coalition spokesperson, further explained that the taxes would be especially beneficial to the poor, who suffer the most from the high financial cost of non communicable diseases.
The statement added, “The poor are most responsive to price changes, and taxes will encourage them to buy less and prevent the future onset of costly, life threatening chronic illness”.
The group noted that the industry has consistently generated profits, yet make claims that the current 10 naira per litre tax will collapse their industry.
She said, Soft drink sales in Nigeria are the 4th highest in the world, with nearly 40 million litres sold each year, adding, this amounts to billions in profit each year at the expense of public health.
The coalition however, argued that the industry pays a 50% tax in Qatar, yet this high rate has not led to an industry collapse, stressing,
that increasing taxes will benefit the nation’s health without causing economic losses to the industry.
“Soft drinks are cheap; diabetes is not, read one of the placards displayed during the protest. Taxing soft drinks and other sweetened beverages is a way to prevent avoidable deaths and raise sorely needed revenue to invest in healthcare,” the statement concluded.
However, the group is now demanding that soft drink manufacturers should emulate tobacco industry on warning label on their product to enable every consumer to know that what they are taking are sweet but detrimental to their health.
The warning would also, help to minimize, if not eradicate the health hazards associated with excessive consumption of carbonated products.
The group said, the relevant government institutions, should
compel the manufacturers to warn citizens on the dangers inherent in too much consumption of their products.
Ms. Omei Bongos-Ikwue made this call, while presenting a paper on the health implications of soft drink, at a webinar session organized by the Gatefield.
She postulated that waring label such as, “Smokers Are Liable To Die Young,” which is boldly inscribed in every pack of tobacco brand, will not be a bad idea for
non alcoholic, carbonated and sweetened beverages products.
She noted that emerging facts shows that carbonated and sweetened beverages are even more dangerous than tobacco smoking.
The President of Nigerian Cancer Society and Co-Chair, NASR Coalition,
Dr. Adamu Alhassan Umar, said it has been scientifically proven that the global burden of non communicable diseases (NCDs) has been on the increase.
A key risk factor for NCDs, he said, is obesity which has a direct link to sugar sweetened beverage consumption.
He noted that an appropriate tax rate on SSBs is an attractive measure to curb the rising trends of NCDs.
Corroborating the above thesis on the non communicable diseases risk factors, the Industry Watch Initiative from the Food Policy Program at Global Health Incubator Call for Action, in a report titled, “Marketing Exposed,” noted, the report is its third report on industry interference and corporate capture.
GHAI said, “the preceding report (2020: Facing Two Pandemics, and 2021: Behind the Labels), focused on how marketing practices of ultra processed food and beverage products (UPPs) are affecting human and planetary health while also targeting vulnerable
populations. Serving as corporate washing practices that allow the industry to have privileged spaces in policy making tables”.
It also, exposed 5 reasons why a sugar sweetened beverage tax increase is good for Nigerians.
They include; “increasing SSB taxes can produce a shift in consumption behaviour and encourage people to drink less. The consumption of SSBs is increasing in low and middle income countries, including Nigeria. Between 2007 and 2021, Nigeria recorded a growth in per capita soft drink sales from 9ml to 14ml,1 and the country is the 7th largest consumer of SSBs in the world.
The WHO recommends a 20% tax on SSBs to raise the prices and reduce consumption. Nigeria’s current N10/litre tax on carbonated drinks doesn’t scratch the surface. The tax increase will raise the prices significantly which will discourage the buying and consumption of SSBs.
“An increase in SSB tax will reduce consumption and ultimately cause a decline in non communicable diseases (NCDs). SSBs are high in refined sugar and contain no nutrition. Consuming them raises the risk of non communicable disease, including type 2 diabetes, heart disease, high blood pressure, stroke, and many cancers. Type 2 diabetes is also one of the fastest growing global health threats, with an estimated 537 million adults living with diabetes today and 246 million more projected by 2045; 3 in 4 of these adults live in low and middle income countries”.
Nigeria, the group report said has the highest diabetes rates in Africa.
The data noted that raising the tax on SSBs will favour the poor by reducing healthcare costs, adding that an increased tax on SSBs will lead to reduced consumption by the urban poor who are one of the highest consumers.
“Reducing sugary drink consumption can have especially positive impacts among lower income populations, who in many cases experience type 2 diabetes and other NCDs at higher rates and greater personal cost to manage and treat the diseases.
In their paper titled, a review of population based studies on diabetes mellitus in Nigeria, by Dahiru T, Aliyu and AA, Shehu A, and published Sub-Saharan African Journal of Medicine 2016;3(2):59, the duo posited that in Nigeria, out of pocket spending comprises over 70% of healthcare expenditure.
“When a serious, long term illness strikes, even a middle class Nigerian household can be left on the threshold of poverty, talk less of a low income family. However, by raising prices, low income groups are most likely to experience the benefits of reduced consumption by buying less. The rising prevalence of Non Communicable Diseases (NCDs) in Nigeria is alarming, and rising NCD rates continue to stretch the country’s underfunded healthcare system. More than 200 million Nigerians have only N826.9bn proposed in the 2022 budget for their healthcare, which amounts to a measly N4,000 per person annually. An SSB tax could help alleviate the healthcare burden on Nigerians and the healthcare system at large. Higher SSB taxes offer the opportunity to provide revenue for specific health interventions. An SSB tax can generate considerable revenue for the government. This revenue can be reinvested into healthcare to fund health initiatives. This can contribute to progress towards universal health care”.
To this end, the Global Health Incubator Call for Action, appealed to governments to enact mandatory and comprehensive corporate marketing restrictions, based on independent evidence that include any form of advertising, promotion and sponsorship of UPPs.
Other measures, the group said, include, protect children and other populations that are in vulnerable situations or conditions from commercial exploitation through evidence based mandatory policies,
reject alternative policy proposals positioned by private actors that guarantee corporate autonomy and the maintenance of negative externalities. Exclude the UPP industry and its allies from the policy making table. This means that the sector should not be collaborating with designing the standards of compulsory public policies. As well as adopt mandatory legal frameworks to prevent t
he influence of private interests in policy making”.