Double Health Burden in Developing Coutnries in the Post-MDGs Goals


Determinants of health or risk factors of health in this article are described, from downstream to upstream, as biological, behavioral, societal and structural determinants.

However, the pathogenesis and pathophysiology of health burden in this article is classified as either communicable or non-communicable disease.

In epidemiological transition, developed countries have seen their efforts tailored towards eliminating communicable disease burden with a subdue shift towards non-communicable disease burden with concurrent demographic shift from stark increase in population growth rates due to medical innovative in disease therapy and improvement in personal hygiene to a re-leveling of population growth due to subsequent declines in fertility rates. Through this phenomenon, as a public health specialist, I may describe developed countries as progressing towards single health burden. On the other hand, developing countries like African continent as a whole is going through intense double health burden.

This article, therefore, expounds on the dual facets of double health burden in Africa.

The first facet of double burden in Africa is manifested in malnutrition. Malnutrition is this article is defined in terms of body-mass-index BMI) measurement as either underweight (BMI<17.0) or obesity (BMI>30.0). Studies have shown that there are 220 million and 300 million population with underweight and obesity, respectively globally.  Of these, 170 million underweight population and 120 million obese population are from developing countries (Professor David Sanders from “WHO Collaborating Centre for Research and Training in Human Resources for Health”).

The second facet of double health burden in developing countries like Africa is witnessed through equal burden of both communicable and non-communicable diseases (NCDs). The plight of population living in developing countries due to communicable diseases is today very conspicuous as many African countries are struggling to achieve the Millennium Development Goals (MDGs) which are to be measured and evaluated in two years time.

On obesity in Africa, South Africa is now the world’s third fattest country after the U.S. and U.K. according to results of the GlaxoSmithKline (GSK) national health survey released September 8, 2010 where the results have shown that 61 percent of the adult population in the country is overweight, obese or morbidly obese and worse enough 17 percent of children under the age of nine in RSA are overweight (Source: “Our pot bellies rank with world’s largest.” Cape Times. 9 Sept. 2010).

In Malawi, NCDs are on the increase too such that the country had lost, among many people, two prominent figures in June, 2005 and April, 2012 in positions of Speaker of the Parliament and Head of State, respectively. However, the latter’s postmortem results from Milpark Hospital in RSA are NOT yet out although the diagnosis and cause of death by the Malawian Doctors at Kamuzu Central Hospital had certified NCD as the leading cause.

In this article, I shall dwell much on societal and structural determinants of obesity that lead to NCDs because individual behavior is a subset of both through upstreaming factors.

Societal factors in African countries include shortage of healthy low-fat food and little fresh fruit and vegetables in the townships; the majority of local shops and street vendors’ stalls sell fatty foods in forms of fatty meat and sausages that are NOT regulated; unavailability and low promotion of “low-fat milk”; and high stigma over losing weight exercises as narrated in RSA research: “I am scared of exercising because I will lose weight and people may think that I have HIV/AIDS” (Chopra M, Puoane T. Diabetes Voice 2003; 48: 24–6).

Structural factors include rapid growth of supermarkets that share more than 50% of food sales in semi-urban and rural areas in most African countries. Most of these foods are unhealthy and not regulated at production or importation in African countries. The study done in RSA showed that supermarkets now share at least 50-60% of food sales in South Africa and nearly two-thirds of households in a rural area in South Africa are now buying their food at supermarkets (Source: D’Haese, Marijke, and Guido Van Huylenbroeck. “The rise of supermarkets and changing expenditure patterns of poor rural households case study in the Transkei area, South Africa.” Food Policy 30 (2005): 97-113).

In the same study, it was noted that healthier foods typically cost between 10% and 60% more when compared on a weight basis (Rand per 100g) and between 30% and 110% more when compared based on the cost of food energy (Rand per 100 kJ).

The following are my personal and health professional probable global, continental, regional and national solutions to the unchecked diseases (NCDs) of rich people in African countries with emphasis on prevention:

  1. Factoring in unhealthy foods internalization or externalization externality cost of “unhealthy foods-external” in Trade Agreements and Trade Policies.
  2. Strict policies on importing unhealthy foods through internalization or externalization the externality cost of “unhealthy foods-external”.
  3. Legislative policies aligned in line with public health act on NCDs
  4. Health promotion of NCDs to all people at all levels.
  5. Punitive measures in Health Insurance schemes (MASM, social insurance etc) to internalize the externality cost of “unhealthy foods-external” and “overweight”.

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