If you were asked “What is the deadliest disease in Africa?” what would you say?
You might conjure up mental images of children clinging on to life whilst suffering from severe malnutrition or men and women queuing outside health clinics to receive vital treatments against communicable (infectious) diseases such as malaria and HIV/AIDS. Let’s not sugar-coat this – Africa is the second most populous continent in the world and it has taken decades of concerted effort to tackle these insufferable health crises. The prevalence of communicable diseases on the continent remains a major issue. However great strides forward have been made to address these and although HIV/AIDS is presently the leading cause of death in sub-Saharan Africa [1], the epidemic threat is on the decline as the number of new cases has sharply declined in areas with robust prevention and treatment programs declined. HIV/AIDS may not hold the title of ‘leading cause of death’ for long in Africa - there is a new kid on the block.
In fact, Africa’s next public health crisis has already landed and is already putting pressure on already overstretched healthcare systems across the continent, leading to the co-existence of communicable and non-communicable (NCDs) and therefore a double burden of disease. Back in 2011, it was only the second time in the history of the UN that the General Assembly met to discuss a health issue and the focus was on the threat, of “epidemic proportions,” of non-communicable diseases (NCDs); Africa region (unfortunately) got a special mention. The first time the UN General Assembly met on a health issue it was about AIDS.
Cardiovascular diseases such as strokes and heart attacks, chronic respiratory diseases, cancers, and diabetes are collectively known as non-communicable diseases or NCDs and are often thought to be the diseases of high-income countries in the West. However, NCDs occur much more frequently in low and middle-income countries, wherein 2005, cardiovascular disease alone killed five-times as many people as HIV/AIDS. [2] NCDs are already the leading cause of death in most North African countries, in keeping with the global trend[3] and it won’t be long before the rest of Africa follows suit. In fact, the World Health Organization (WHO) predicted that the rate of increase in deaths from NCDs in the Africa region as a whole will have outstripped that from infectious diseases, maternal, perinatal conditions and nutritional deficiencies by 2015 and the rate of deaths from diabetes alone will have increased by 42%.[4] We are now over halfway through the year 2017 and in less than a generation’s time, by 2030, it is predicted that NCDs will become the leading cause of death in sub-Saharan Africa.[5] When you overlay these troubling statistics with the fact that the majority of premature deaths from NCDs globally occur in those aged 30-69 years (earlier in African countries), then the economic burden of NCDs becomes very apparent, not just in terms of the ability of African countries to adequately fund medical care for its citizens, but also in terms of its citizens (the youngest population in the world) being able to contribute to the economic development and productivity of Africa through working in and/or creating jobs.
But is any of this surprising? The increasing urbanization of populations into major towns and cities is often associated with an increase in unhealthy lifestyle behaviors and risk factors for NCDs – the health effects of urbanization in Africa is no different. Suffice it to say that this does not bode well for Africa and Africans. Africa already has the highest levels of high blood pressure in the world; high blood pressure is a significant precursor for death and disability from cardiovascular diseases and it can be influenced by an individual’s lifestyle habits.
The four main modifiable lifestyle risk factors for NCDs are tobacco use, physical inactivity, harmful alcohol use, and unhealthy eating. While the connections between these lifestyle risk factors and NCDs are well documented, evidence on the effectiveness of interventions to address these risk factors among African populations is limited. That’s not to say that prevention and health promotion programs for NCDs don’t exist on the continent; it’s just that, as in other parts of the world, such NCD programs, particularly those that are non-legislative in nature and that involve low-cost, smaller-scale interventions, are not always well evaluated and the evaluation measures are often heavily focused on process outputs. Furthermore, at a national level where surveillance and data capture systems do exist (unfortunately this is not widespread across the continent), measures of program effectiveness such as mortality and morbidity reductions which are globally recognized healthcare outcome measures I might add, are inherently retrospective and it can take years to assess whether an intervention has had its intended impact on the target audience, by which time it’s is often too late. While of course, it is essential to identify trends over extended periods of time e.g. 3, 5, 10 years, proxy measures for effectiveness of health interventions can and should be routinely developed and evaluated alongside more traditional, long-range outcome indicators and measured over shorter timeframes and even in real-time or as close to real-time as possible.
It’s often the case that African institutions are encouraged to look outside of the continent for examples of best practices and solutions and the sharing of practices between African countries is not consistent. It’s fundamental to learn from others, but are there things that Africa could do differently or even better than other parts of the world and lead the way on when it comes to curbing the burden of NCDs? Insight gathering about the prevalence of risk factors and access to medical services, but especially local data on health behaviors, perceptions, attitudes and ultimately cultural sensitivities towards food, physical activity, alcohol consumption and tobacco use on the continent requires data collection systems and analysis that allows for increased development and review of innovative local interventions that can be more readily assessed prospectively and that can allow greater agility when considering what needs to be adapted, removed from or introduced into legislative, fiscal and structural strategies designed to address Africa’s double burden of disease and biggest prosperity threat.
By Margaret Ancobiah, MPharm
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About the author:
Margaret is a UK-based health expert with experience in healthcare policies and research. She is a member of the KASI Insight health advisory team.
[1] World Health Organization (WHO). Global Health Estimates 2015: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2015. (Geneva, World Health Organization; 2016)
[2] World Health Organisation (WHO), Fighting Africa’s New Silent Killers: Non-communicable Diseases (Brazzaville: WHO Africa Region, 2008)
[3] World Health Organization (WHO), Non-communicable Diseases Country Pro 2014 (Geneva: WHO, 2014)
[4] World Health Organisation (WHO). Fighting Africa’s New Silent Killers: Non-communicable Diseases (Brazaville: WHO Africa Region, 2008)