5 April, 2011, Esther Nakkazi
Why do I believe that mental health should be part of the agenda, with the other NCDs?
By Dr Florence Baingana
For the first time in the history of the UN, the General Assembly scheduled for September 2011 in New York is going to focus on Non-Communicable Disorders (NCDs) but without mental health, which is grouped among NCDs.
Why do I believe that mental health should be part of the agenda, with the other NCDs? There is a link between mental health and all the Millennium Development Goals (MDGs). People with mental disorders are likely to be among the poorest of the poor, and would require targeted attention if MDG 1, to reduce extreme poverty and hunger, is to be met. Children with mental and neurological disorders are often the ones who repeat classes, drop out of school, or become difficult to manage students, interfering with achievement of, universal primary education MDG 2.[frax09alpha]
Violence against women has mental health consequences and hinders promotion of gender equality and women empowerment MDG 3. While studies show that up to 18% of children may have mental disorders, the issue is never considered or addressed when child health programmes are being designed making reduction of child mortality, MDG 4, hard to achieve.
Maternal health, MDG 5, often deals with just the reproductive health functions of women, and yet depression, the commonest mental disorder globally, is found four times in women than in men. The mental health of women also impacts on the health, nutritional and educational outcomes of their children, hence impacting on MDGs 1, 2 and 4. There are many mental consequences of HIV/AIDS, MDG 6; and poor people living in slums, MDG 7, are more prone to alcohol and drug abuse.
Besides making MDGs impossible to meet, the case for mental health on the UN Agenda stands as follows; since disorders were classified and grouped together, mental and neurological disorders or neuropsychiatric disorders have always been included among non-communicable disorders. As the name suggests, these are disorders that cannot be passed on from one person to another, unlike the communicable disorders. The most commonly known communicable disorders are HIV/AIDS, TB and malaria, typhoid, cholera, Ebola, measles, whooping cough, etc, which make up the biggest percentage of the Burden of Disease.
However, it is increasingly being recognised that non-communicable disorders (NCDs), such as cancers, diabetes, cardio vascular disorders, as well as mental disorders, are on the increase, not just in the developed world, but also in sub Saharan Africa and South Asia, two of the poorest regions of the world. In 2001, WHO estimated that deaths due to NCD were 59% of all deaths globally. Another measure, the Disability Adjusted Life Year (DALY) which measures those who do not die, but live with a disability, estimated that 46% of the total DALYs globally were due to NCDs in 2001, 13% due to neuropsychiatric disorders.
From about 1978, to the present day, rates of depression in Uganda have consistently been at about 28% in women, ranging from 8% to 50%. A survey carried in Maseno, Kenya found common mental disorders (CMD) to be at about 10.8% of the population. Common mental disorders, as the name suggests, are those that occur very commonly, including anxiety disorders as well as depression. In Tanzania, in 2010, a survey found rates of CMD at 3.6% in women and 2.5% in men and 3% for the general population. Various surveys done in sub Saharan Africa, have confirmed that rates of mental disorders range from 11 to 64%. The rates are higher in special populations, such as those affected by conflicts.
Although these statistics are well known, when the very first UN General Assembly on NCDs is being planned, to take place in New York in September 2011, mental health is not included in the NCDs that are to be discussed. This is a huge over sight.
A WHO African Region Ministerial Consultation on NCDs in Brazzaville, to develop a common position for the Africa Region, as part of the preparatory activities for the UN General Assembly, is to take place from 4th to 6th April 2011. I urge all East African and African Ministers of Health to propose or support the inclusion of mental health into the UN General Assembly Agenda as an item of the African Ministerial position to be presented in Moscow and New York.
A second preparatory event is the Global Forum on NCDs to be held in Moscow on 27th April 2011, which is open to all stakeholders. I would, urge, all health ministers and mental health NGOs from the East African Region, that attend this Forum, and to lobby for the inclusion of mental health in the deliberations of the High Level Ministerial Meeting (HLM), scheduled for 28th and 29th April, 2011, also in Moscow.
Deliberations of Health Ministers from around the world, as well as the deliberations of the Global Forum will influence what is discussed at this event, which in turn will influence the September UN General Assembly Agenda.
Integrating mental health into development efforts will accelerate achievement of the MDGs. If East African mental health NGOs and East African Ministers of Health speak with one voice, mental health will be an agenda item on the UN General Assembly meeting on NCDs. Mental Health: Out of the shadows.
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