The Challenge of Non-Communicable Diseases and Road Traffic ...

2 The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa
NCDs will become the leading cause of death by
2030. The burden from cancer alone is expected to
more than double between 2008 and 2030. By 2015,
RTIs are expected to be the number one killer of
children aged 5-15 in Africa. Yet, although funding
to developing countries for NCDs grew sixfold from
2001 to 2008, it still comprised less than 3 percent
of overall global development assistance for health.
NCDs and RTIs are preventable causes of premature
mortality and morbidity. They reduce productivity
and consume resources that could otherwise
be used for social and economic development.
Health-care needs for chronic conditions and disabilities
resulting from NCDs and RTIs increase
pressure on existing fragile health systems, and impose
large health and social care costs. NCDs can inflict
substantial financial and psychosocial burdens
on individuals and their families, particularly where
treatment costs are mostly paid out-of-pocket and
are lifelong.
NCDs and RTIs also have consequences for sustainable
development. Some of the changes in lifestyle
practices that increase NCDs and RTIs, such
as increased car use, are also linked to greenhouse
emissions and climate change.
Drivers, Determinants and
Commonalities
Communicable diseases have long been the leading
causes of death and the disease burden in SSA – and
in many countries still are – but rising incomes, population
growth and ageing, globalization, rapid urbanization
and changing lifestyle practices are shifting
the disease pattern. In particular:
• Africa’s population is growing rapidly enough to
double within a generation. The high proportions
of young people, in combination with the relatively
early age at which some chronic conditions
manifest themselves, exacerbates the situation.
The proportion of elderly persons is projected to
double in many African countries between 2000
and 2030, accounting for a substantial proportion
of the projected increase in cancer.
• SSA is urbanizing faster than any other region.
Living in an urban environment is associated with
decreased physical activity and increased cardiovascular
risk, while air pollution is an emerging
issue. The risk of crashes and injury increases with
a poorly regulated transport sector, the lack or non
-use of seat belts, hazardous road environments,
poor maintenance of vehicles and roads, and deficient
monitoring and enforcement.
• Over the last 20 years, SSA has seen a shift in the
attributable burden of disease of risk factors away
from risks for communicable diseases in children
towards those for NCDs in adults. A nutrition
transition is underway, with an increase in female
obesity in some population groups; and lifestyles
practices are changing. Tobacco use among young
people has increased, particularly of products
other than cigarettes. Harmful alcohol consumption
is a common risk factor for both NCDs and
RTIs (a well as for intimate partner violence and
HIV), and is expected to increase with further
economic development – Africa already has the
highest prevalence of heavy episodic drinking of
any region.
Close relationships exist in cause, course and outcome
between NCDs, communicable diseases, and
maternal, perinatal, and nutritional conditions.
There are common underlying social conditions,
such as poverty and unhealthy environments, and
commonalities across disease groups in causation,
co-morbidity, and care needs. Frequently, both communicable
diseases and NCDs co-exist in the same
individual, and one can increase the risk or impact
of the other, as happens for example with diabetes
and tuberculosis. Maternal health and practices,
the intra-uterine environment and low birth weight
may have long-term consequences for developing
chronic diseases. Interventions to improve maternal
and child health – such as reducing malnutrition and
exposure to smoke – are also integral components of
a continuum of preventive measures for NCDs.
The Rationale for Public Intervention
From an economic perspective, government intervention
is justified as a means to achieve a net improvement
in social welfare. That is, it is justified
when private markets fail to function efficiently
or when the social objectives of equity in access to