by Chandani Dissanayake
Published on Ceylon Today on 07th July 2023
The United Nations has identified “Good health and well-being” as its third Sustainable Development Goal (SDG), signifying the need to ensure healthy lives and promote well-being for all at all ages. They targeted (Target 3.4) reducing mortality from non-communicable diseases through prevention and treatment and promoting mental health and well-being. As such, the UN Development Programme’s special report in 2022 emphasised that “The biggest health threats have shifted to non-communicable diseases.” Accordingly, Chronic Kidney Disease (CKD), known as kidney structural damage or chronic kidney failure, is a major worldwide public, social, and health issue.
This disease is rapidly increasing and remains an unsolved and formidable health and social issue in Sri Lanka. Currently, it has become one of the most pressing social and health issues of national concern in Sri Lanka. Looking at the latest progress report on CKD, there has been an increase in the year 2021 compared to 2020, and the Kandy district has recently experienced a progressive increase in CKD patients. Thus, it poses a public security emergency, and there is still no stable solution to combat the influence of CKD. Carlos et al. define the prevalence of end-stage renal disease patients in most developing countries as predicted to increase to 70% by 2030. Thus, it is a major security threat that impacts the quality of life in all aspects and the overall sustainable development of Sri Lanka as a developing country facing political and economic instability.
Due to the repercussions of the Covid-19 pandemic and the ongoing economic crisis, we currently lack adequate quality and essential medicine and healthcare services to ensure the healthy lives of people. Consequently, CKD poses a threat to the health security of humans. Additionally, the out-of-pocket spending and the cost of long-term treatment for CKD push people into extreme poverty, creating an economic burden on their families. Furthermore, CKD causes changes in family dynamics, domestic responsibilities, and social relationships within and outside the family. These changes lead to the creation of social, economic, and health inequalities and vulnerabilities among humans. Particularly, economic well-being in a country depends on labour productivity, but the increasing prevalence of CKD contributes to a decrease in labour productivity due to employees’ disabilities and absenteeism in the workplace. Thus, CKD is not only the most pressing health concern in Sri Lanka, but it is also linked to economic security, social security, and overall national security.
CKD is prevalent in many dry zones such as Uva, North Western, Central, and Eastern provinces in Sri Lanka. Factors such as the consumption of drinking water, agrochemical residues, high levels of contaminants, geographical distribution, poverty, food insecurity, and economic instability within families can be identified as risk factors behind the alarming CKD rates. Therefore, CKD poses a significant threat to national security due to increased premature death, lowered quality of life, and disabilities among humans, as well as social, economic, and health inequalities and vulnerabilities.
CKD is a non-traditional security threat that impacts the health quality of humans, economic security, social equality, as well as the sustainable socio-economic development of a country. So, what is the way forward? The government can conduct proper community-based awareness programmes to identify early symptomatic of CKD in collaboration with international agencies and public health programmes. These programmes can promote community health education among rural communities using a proper mechanism. Lack of access to clean water has been identified as one of the risk factors for the prevalence of CKD in rural areas. Therefore, we can re-implement rainwater harvesting structures with a proper monitoring system in rural areas to ensure safe drinking water security. Healthcare can be identified as a main dimension in ensuring human security in a nation. However, social inequalities and vulnerabilities have caused to create mental health issues among CKD patients and their families. Thus, we request the implementation of proper social health protection coverage for people and their families living with CKD to ensure their economic, health, and social security.
Most people with CKD and their family members are vulnerable and face inequalities within the community. Due to disabilities, absenteeism, and premature death, CKD eventually has an impact on national productivity and the quality of life for individuals. Humans can be identified as the centre of development in a country, and the loss of human productivity can destabilise labour market performance, economic viability, human capital accumulation, and the quality of life for individuals. Thus, CKD has complex implications for achieving national security in Sri Lanka and sustainable development in 2030. Therefore, this disease needs to be addressed in the political, social, economic, and scientific spheres with proper mechanisms.
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* Ms. Chandani Dissanayake is a Research Assistant at the Institute of National Security Studies (INSS), the premier think tank on National Security established under the Ministry of Defence. The opinion expressed is her own and not necessarily reflective of the institute or the Ministry of Defence.