Africa’s double burden
It’s time to re-think an old stereotype about public health in Africa.
In the past, fast-spreading diseases were the continent’s greatest threat—malaria, tuberculosis, HIV, measles, diarrhea, polio and other communicable diseases. These problems remain real and serious. But today, Africa’s future may depend even more on battling chronic diseases that aren’t spread between people, such as cancer, diabetes and cardiovascular disease.
A new burden: the growing threat of noncommunicable diseases
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The figures are alarming. The World Health Organization (WHO) predicts that by 2030, noncommunicable diseases will be the most common causes of death in Africa, exceeding the number of deaths caused by communicable, maternal, perinatal, and nutritional diseases.
The WHO expects to see more than a million new cancer cases in Africa every year by the end of this decade. The rate of diabetes in Africa is expected to nearly double over the next two decades. Even worse, three-quarters of people living with diabetes in Africa don’t even know they have it.
High blood pressure is estimated to affect up to half of adults in some African countries. Most people with high blood pressure don’t know they have it, so they are unlikely to be taking preventative measures, even though it’s a major risk factor for heart disease.
An old burden remains: communicable diseases
Many countries in Africa have made great progress in eliminating communicable diseases that were once common, such as river blindness and polio, and in decreasing the burden of diseases like malaria, where increased prevention and treatment have lead to a 33% drop in mortality since 2000. This burden is not going anyway anytime soon. In fact, the WHO estimates that more than 90% of the world’s 300–500 million cases of malaria strike in Africa, to cite just one example.
In addition, a clear line does not always exist between diseases that can be spread and those that cannot. For example, cervical cancer (a noncommunicable disease) is now the leading cause of cancer death among women in sub-Saharan Africa. It’s often spread by the human papillomavirus (HPV), which is communicable. Meanwhile, when people live with communicable diseases such as malaria and tuberculosis, the sicknesses weaken the body's defenses, thereby increasing susceptibility to NCDs.
This combined burden—from both communicable diseases and from those that can’t be spread—threatens both the lives of people living in Africa, as well as the great economic progress the continent has seen in recent years.
Overcoming the double burden
A solution to this double burden depends on understanding what’s causing it. The causes are complex. People are living longer (which is clearly good), but that is contributing to a rise in certain noncommunicable diseases that take hold only in adulthood. A second factor is unhealthy diets and decreased physical activity that result from rapid urbanization. They contribute to a third factor, the rise in obesity, which is linked to diabetes, cancer, and heart disease.
But knowledge alone won’t be enough. While healthcare providers across Africa have gradually learned to monitor and treat many communicable diseases, the continent simply needs more doctors. In fact, Africa has more than one-seventh of the world’s people, but only about 2% of the world’s doctors.
These numbers are serious, but they don’t have to spell doom. We know a lot about the causes of many NCDs, and we already know some of the solutions. More vaccinations can help, for example. Vaccines can stop certain viruses that lead to cancer, such as the liver and cervical cancers that are among the most common in Africa. They both might be stopped by widespread vaccination against hepatitis B and HPV. Regular testing of blood sugar can help stop diabetes, especially if people learn about healthy eating and the harm of eating a lot of sugar. High blood pressure can often be treated with relatively inexpensive medications before it progresses to full-fledged cardiovascular disease.
In every case, the starting point is better information, followed by regular monitoring, so that the diseases can be prevented or treated early and inexpensively.
A critical juncture
Today, Africa faces a fundamental question: Will its path to development follow those taken by other places, or will Africa chart a unique course? As other countries and continents have developed economically, they have seen many more cases of noncommunicable diseases. These diseases are rising in Africa, but they can be stopped. In fact, with a clear development strategy, quick action, and sufficient financial support, African nations can avoid some of the worst mistakes other countries have made.
Technology offers a good parallel precedent. Over the past decade, the dramatic increase in cell phone technology has fueled economic development in Africa. Instead of slowly building a vast network of landlines and stretching telephone wires across a massive continent, many countries in Africa skipped that step and simply built cell phone towers. This has generated innovative new uses of cell phones for commerce.
Can Africa take a similar leap in healthcare? New medicines, technology, and better education could enable Africa to avoid the crushing burden of noncommunicable diseases that have affected other countries on their paths to development.
All of the answers are not yet clear, but many are. Africa has faced more than enough burdens already. Now is the time to prevent a new one.