The need to plan more healthy urban futures for a rapidly urbanizing African continent.
Sub-Saharan Africa (SSA), a region once primarily marred by poverty, malnutrition, famines and communicable diseases like AIDS, malaria, tuberculosis and tropical fevers, has now gathered much strength from urbanization. Today, SSA is the world's fastest urbanizing region. Worldwide, urbanization is a debatable issue. It does pose various kinds of challenges in the society.
On one hand, urbanization can spur economic growth. 50% of SSA’s gross domestic product (GDP) is contributed by 143 SSA cities and it amounts to $0.5 trillion. In 2018, SSA’s economic growth is estimated to increase 3.2% and it is 3.5% for 2019 (Saghir and Santoro, 2018). Well, these are all the bright sides of urbanization. Now, let’s examine the flip side of urbanization.
Urbanization leads to increased movement of population from rural areas to urban areas. This movement, in most cases, overpopulates the urban areas, decapacitating the infrastructure. SSA is experiencing an annual urban population growth rate of 4.1 percent, which is double the global rate. As of 2017, African urban areas contain 472 million people, with an additional 560 million people expected to move into SSA cities by 2040 (Saghir and Santoro, 2018).
An interesting biological fact as also pointed out by Atim Ukoh of Afrolems in this post is, people who grew up facing poverty and famines, tend to develop metabolic disorders. Due to lack of food intake, metabolism rate slows down, to retain every nutrients and calorie in the body. This coping mechanism continues even when a lot of food is available. With urbanization and economic growth, food availability increases. But, the metabolism rate remains slow and this leads to obesity and diabetes. The transition from rural to urban areas creates significant lifestyle changes among people. With this change in lifestyle, people are more physically inactive and intakes food which is rich in salt, sugar, and fat. In addition, foods like french fries are much cheaper than healthier foods like apples, fish, and fresh vegetables. Urban people are inclined towards cheaper, tastier and unhealthier food. These are the causes of rising rate of obesity and diabetes in SSA (Gettleman, 2018).
Diabetes is increasing exponentially in sub-Saharan Africa. This is eventually leading to an onward surge of life-threatening, non-communicable diseases like heart disease, stroke, and kidney failure. According to a report from the Lancet Diabetes & Endocrinology commission, co-led by Harvard T.H. Chan School of Public Health, 22% of adult population in SSA countries are suffering from diabetes, of which, 30% are aged between 55-65 years, pertaining to both the gender. Given the current, poor healthcare system, half of these population are being diagnosed and only 1 in 10 are receiving treatment. The cost of not addressing this issue is huge. Loss of labor productivity and deteriorating public health, are estimated to incur an overall cost (of diabetes) of more than $59 billion (equivalent to 1.8% of SSA’s GDP), by 2030 (HSPH, 2017). In the end, the pros and cons of urbanization cancel each other out and we are back to square one.
By 2030, it is projected that the burden of non-communicable diseases is likely to outstrip infectious diseases. However, policy interventions could water down the burden of these diseases. Building paths for cycling, introducing/encouraging ‘walk to work’ or ‘cycle to work’ twice a week, taxing motor vehicles, distributing free cycles, building more parks for walking, promoting events such as marathon etc. are some ways to decrease the magnitude of non-communicable diseases. “Strategies should include policy interventions to address over-consumption of unhealthy diets. This may include fiscal food policies, mandatory nutrition panels on the formulation and reformulation of manufactured foods, implementation of food and nutrition labeling, restricting marketing and advertising bans of unhealthy foods and making healthy food accessible” (Amugsi, 2018). Such strategies, proven successful in developed countries and if implemented in SSA, would create an incredible change in the battleground of combatting non-communicable diseases.
See also a previous related blogpost by Ebele Mogo, DrPH titled "Are our cities killing us?".
Nusrat Shafiquddin blogs with Engage Africa Foundation to research and create content around human rights, conflict and non-communicable disease prevention and management. Learn more about her and the rest of the team here. Stay tuned to Nusrat's updates by following us on Facebook , Twitter or Instagram.
References
Amugsi, D. (2018) ‘Scientists have seen a shocking rise in obesity levels in urban Africa over the past 25 years’, Quartz Africa. Available at: https://qz.com/1194268/obesity-is-rising-rapidly-in-africa-say-scientists/ (Accessed: 7 May 2018).
Gettleman, J. (2018) ‘In Kenya, and Across Africa, an Unexpected Epidemic: Obesity’, The New York Times. Available at: https://www.nytimes.com/2018/01/27/world/africa/kenya-obesity-diabetes.html (Accessed: 13 May 2018).
Harvard T.H. Chan School of Public Health (HSPH) (2017) ‘Diabetes increasing at alarming rates in sub-Saharan Africa’. Available at: https://www.hsph.harvard.edu/news/press-releases/diabetes-in-africa/ (Accessed: 15 May 2018).
MedicalXpress (2018) ‘Diabetes gene found that causes low and high blood sugar levels in the same family’, Queen Mary, University of London. Available at: https://medicalxpress.com/news/2018-01-diabetes-gene-high-blood-sugar.html (Accessed: 15 May 2018).
Saghir, J. and Santoro, J. (2018) ‘Urbanization in Sub-Saharan Africa: Meeting Challenges by Bridging Stakeholders’, Center for Strategic and International Studies. Available at: https://www.csis.org/analysis/urbanization-sub-saharan-africa (Accessed: 13 May 2018).