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

26 The Challenge of Non-communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa
major assets for a nation’s development – the 40
percent of Africa’s population that now lives in cities
produces 80 percent of its GDP – but if not properly
or fairly steered they can lead to major social and
economic challenges [108]. SSA follows South and
East Asia in having the third largest number of slum
dwellers worldwide, with slum conditions, such as
lack of access to basic services, impacting most negatively
on the poorest people, particularly women
and children [109-110]. As people move away from
villages, traditional family- or community-based
safety nets are breaking down, and governments
are recognizing the need to set up or extend social
protection systems to protect vulnerable households
from sudden shocks to offset poverty [111].
Living in an urban environment is associated with
raised blood pressure, blood sugar, and BMI, particularly
for recent settlers, with increased blood
pressure becoming apparent within months of migrating
from rural to urban areas [40, 104]. Urban
residents have a 1.5- to fourfold higher prevalence of
diabetes than their rural counterparts, and have increased
cardiovascular risk [34, 112]. Urbanization,
income, sedentary lifestyles, and alcohol consumption
independently contribute to higher BMI [113],
and changes in dietary habits, stress, and uptake of
smoking among women raise cardiovascular risk
[114-115].
Pollution is an emerging issue in urban centers. It
is caused by emissions from industry, motor vehicles,
and households, and exacerbated by the use of
trucks for long-distance transportation in the presence
of poor railway systems [116]. The use of obsolete
vehicles is a major contributor to air pollution,
and poor maintenance of vehicles and monitoring
and enforcement systems also contribute to crashes
[63, 117]. Urbanization is associated with increased
asthma prevalence in South Africa and other parts
of SSA. Unsafe working conditions, out-of-date
technology, and poor regulation contribute to occupational
lung diseases [118].
The Contribution of Demographic Change
Africa is undergoing rapid population growth and
it is likely to double within the coming generation.
Projections are for a population increase from 1.02
billion in 2010 to 1.56 billion in 2030, with around
85 percent of his population living in SSA [119]. Figure
12 shows the population distribution by age for
the region in 2010.
FIGURE 12: Population of SSA, 2010
Age (years)
80 - 84
70 - 74
60 - 64
50 - 54
40 - 44
30 - 34
20 - 24
10 - 14
0 - 4
10 8 6 4 2 0 2 4 6 8 10
% population (Male = blue; female = red)
Source: [119] (medium variant)
All SSA countries but one (Mauritius) are considered
either high- or medium-fertility countries;
nearly half have an estimated fertility level above
five children per woman. There are signs of a fertility
transition to lower rates but this is fairly unpredictable
in SSA countries, and depend on the level of
development, socio-economic factors such as levels
of education, female employment, and urbanization,
as well as more ‘proximate’ determinants such as
contraceptive use [120]. Countries with the highest
population growth rates struggle to meet the social,
economic, and health needs of their people, and face
increasing environmental stress and competition for
land and water resources [109].
Africa is the ‘youngest’ region in the world. A demographic
shift which sees half of the increase in
world population over the next 40 years in Africa
could be favorable in economic terms, while populations
age elsewhere in the world [1]. However,
youth already comprise up to 60 percent of the unemployed
in the region. Investments in education
and health are needed to provide skills for jobs, and
to enhance protection against preventable diseases
that affect productivity and the negative impact of
unemployment on health [121].