“Africa rising” and the shifting disease burden

Customers place their orders at a KFC in Nairobi. (Image: Khalil Senosi)

In recent years, there has been increasing attention in academic and policy circles to the problem of non-communicable diseases in Africa. Some have gone so far as to identify a “shifting disease burden,” wherein conditions such as diabetes and hypertension are taking over from HIV/AIDS, malaria, and tuberculosis as the most serious medical problems facing the continent. It is true that diabetes, cancer, and heart diseases are on the rise in Africa. Indeed, non-communicable diseases are expected to overtake communicable diseases as the continent’s leading cause of death by 2030. There are several dangers, however, to simplistic narratives of a shifting disease burden.

For one thing, while both deaths and new infections have fallen, the HIV/AIDS epidemic is far from “under control,” and AIDS, malaria, and tuberculosis remain Africa’s biggest killers. Those infected with HIV require lifelong treatment, and continued prevention activities are necessary to guard against a resurgence of the disease. While, ideally, African governments would be able to independently determine and carry out their health-related priorities, in reality, most remain reliant to some extent on Western donors. The idea that the disease burden is shifting risks pulling donor attention away from already chronically underfunded programs aimed at combating communicable diseases.

From the perspective of Western governments and donors, though, there is something understandably attractive about the narrative of a shifting disease burden. This narrative seems to serve as a corrective to the Afro-pessimist narratives put forward by the development industry since the 1980s. A shifting disease burden implies that Western development efforts have succeeded, that Africa is “rising” out of poverty and disease, that Africans are (finally) joining the consumer capitalist global economy.

Take, for example, the following magazine quote:

Lifestyle diseases…are now beginning to take their toll in Africa…. Africa’s recent economic growth has created an emerging middle class that has adopted many of the West’s most damaging lifestyle choices…. A sedentary lifestyle has been encouraged with wider car ownership and leisure hours spent watching computer screens and TVs…. Fast-food chain outlets are proliferating and are popular with office workers grabbing a quick lunchtime meal. Many will, on their way home from work, also buy a takeaway for their evening meal in front of the TV, forsaking traditional African diets that tend to be more nutritionally balanced.

While it was surely not the intention of the quote’s author, the above passage illustrates the perversely triumphal nature of some narratives of a shifting disease burden. Yes, it’s a shame that more Africans are suffering from heart disease and diabetes, these narratives seem to imply, but this also means that they are progressing; that they are becoming more “like us.”

Indeed, discussions of the increased prevalence of non-communicable diseases in Africa parrot other simplistic tropes of “Africa rising”—the breathless newspaper articles about Africans (shocker!) using cell phones, the endless paeans to the continent’s “burgeoning middle class,” the Western government press releases proclaiming a shift from “aid to trade.” These developments are all “true” in some sense, but discussions about “Africa rising” are by their very nature myopic, failing to acknowledge the complexities of the phenomena they describe. They usually omit, for instance, any discussion of the ways in which African economic development has entailed growing inequality both within and between countries.

Similarly, discussions of the so-called shifting disease burden in Africa usually fail to recognize that, in the Western world, diabetes, heart disease, and hypertension are not “diseases of affluence” but rather diseases of poverty, disproportionately affecting the most economically disadvantaged segments of national populations. While activities such as eating fast food, driving a private car, and spending leisure hours in front of a personal computer and TV remain luxuries for the majority of Africans, this will likely not always be the case. Soon it will not be telecom company middle managers eating lunch at KFC; it will be the workers assembling cell phone components for a few dollars an hour.

This fact, it should be clear, is a reason to pay more not less attention to non-communicable diseases in Africa. This increased attention, however, must not come at the expense of the fight against HIV and other communicable diseases, and it must not become wrapped up in a simplistic narrative of “Africa rising,” which, while it may appear more laudatory or positive on the surface, is, like the Afro-pessimistic narratives that preceded it, a simplistic depiction that glosses over the root causes of global inequality and ignores much of what is important when it comes to the health of Africans.

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5 Comments
  1. And the narratives usually forget to mention that although more fast food chains are proliferating, in some countries (i.e Kenya), the prices are wildly out of reach for the majority. Although I don’t doubt that as Agriculture in these countries starts to be mechanized (in the name of progress), prices will gradually fall and your average low-income citizen will be able to afford fast food. And by then, the balance will shift, fresh food becoming a luxury for some, processed food becoming affordable.

  2. Doesn’t anyone else have the same reaction of horror at the thought of increasing consumption, excess, and mechanization? I agree with the position of maintaining programs for TB, HIV/AIDS, malaria, etc. (and indeed increasing the reach of such programs), but I also think that the transformation of African societies into more Western-looking ones is itself an unhappy prospect. Factory farms with inhumane conditions (for workers and animals), food monoculture at the expense of diet diversity, a shift away from meals as end in themselves to a means (family supper to eating dinner in the car), fast food working environments, and a general increased disconnect from the earth where food comes from and cultural traditions are sure to be part of such a shift. This is not meant to be a plea for some romantic ideal of life pre-Western influence, but a reluctance to welcome all progress as good or even inevitable. Instead of Western donors shifting into non-communicable disease programs, they should start a reformation at home of policies and practices that lead to greater rates of diabetes and obesity.

  3. Reblogged this on The Kente Weaver and commented:
    So from my Global Health Class by a former World Bank Director, I can definitely assert with some authority that the repercussions of the disease burden in Sub-Saharan Africa in particular, are more dire than they sound. We are actually suffering a “double burden of disease” one in which government’s are going to have to navigate combatting some communicable diseases that still ravage Africa especially (eg: malaria, NTDs, etc.) and non-communicable diseases that are increasing at alarming rates (eg: Cancer currently 4th leading killer in some Sub-Saharan African countries and incidences projected to rise sharply by 2030. Like I said before, without trying to sound alarmist, the repercussions are dire. And we are not helping ourselves at all by our oblivion to it, the lack of adequate awareness, government’s not looking for contingency plans and resources to take care of non-communicable diseases which are much more expensive to deal with! Hell, we cannot even pay up the expenses of dealing with out burden of communicable illnesses! We are also not doing a great job of modifying our diets (especially traditional meals) to healthier options. Even worse, is the influx of chains of Western fast-food restaurants, all in the name of “investment”! honestly, I have always been adamant about our receptiveness of KFC in Ghana, where a bucket of unhealthy oliy fried chicken costs 50Ghana cedis???!!! Whoa! That’s a lot of money by average Ghanaian standards. In fact, it is approximately equivalent to $25. Unbelievable. We tend to do more harm than good for ourselves because of a lack of foresight and vision. It makes you wonder who is truly running the helm of affairs in our respective nations and what kinds of degrees they received from university! Smh. I do not mean to insult anyone here but seriously, we need foresight and good governance. We need to protect the health of our people. They are all we have got.

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