Health challenges

During this week’s Cabinet meeting, ministers gave the nod for a US$ 200 million loan from the World Bank to combat health-related issues in the country. What makes this noteworthy is that the funding will be used to fight malnutrition as well as non-communicable diseases such as diabetes and heart problems that are usually found in developed countries. This paradox needs a closer look as Sri Lanka cannot achieve growth without a healthy population.

According to UNICEF f or a country that suffers no significant food shortages and provides extensive, free maternal and child health services, it is rather contradictory that malnutrition affects nearly one-third of children and one quarter of women.

Consider this, almost one out of five children are born with low birth weight – around 29% of under fives are reported to be underweight, rising as high as 37.4%, in some deprived districts. In addition, 14% of children under five years of age suffer from acute malnutrition when their weight is compared to the weight of a normal child of the same height. Nearly 58% of infants between six and 11 months and 38% children between 12 and 23 months are anaemic.

UNICEF puts these issues down to improper feeding practices, exacerbated by ignorance. They also point out that micronutrient deficiencies and disease play a large role in malnutrition. Given the wide disparities that exist among the different provinces in Sri Lanka UNICEF recommends the development of a national policy on nutrition will help to define key packages of interventions and efforts needed to be taken by stakeholders.

At the opposite end of the paradigm are NCDs, which according to a World Bank report is to be expected given Sri Lanka’s middle income country status. But being richer does not make it more comfortable to read.

The World Bank points out demographic transition stems from a larger proportion of older people in a population as a result of increased longevity and reduced fertility that usually accompany economic growth. People are living longer and having fewer children. Generally the more developed a country is, the farther along in demographic transition it is.

As a result, older populations often face different types of diseases that can be more chronic and expensive to cure. NCDs have already become the largest contributor to disease burden in Sri Lanka, accounting for 85% of ill health, disability and early death. A South Asia regional study found that South Asians suffer their first heart attacks six years earlier than other groups worldwide.

This burden of NCDs will rise in the future, in part, due to further aging of the population with the doubling of the population over the age of 65 from 12.1% to 24.4% over the next 30 years. So what can be done?

The report encourages Sri Lanka to adopt a number of population-based and individual patient-based approaches to reduce unhealthy behaviours in the general population and control heart disease, diabetes, cancers and other NCDs. These efforts, such as more effective legislation on the use of trans-fats and tobacco as well as public education to reduce salt intake would help delay the onset of these diseases. Discouraging sedentary lifestyles, increasing awareness and promoting private-public partnerships to provide healthcare are also recommended.

With such polar challenges to face, Sri Lanka’s beleaguered health system will also have to get fit first.