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

An Overview 27
Life expectancy has stagnated or gone down in
many African countries, reflecting worsening social
and economic conditions, and the impacts of
AIDS and related diseases especially in Southern
Africa [109]. Nevertheless, large gains in life expectancy
have occurred since 1990 in some SSA countries;
most notably, increases of 12-15 years for
men and women in Angola, Ethiopia, Niger, and
Rwanda are due to HIV-control strategies and a reduction
of childhood diseases [122]. All four SSA
regions had at least a 10 percent decline in adult
mortality from 2004 to 2010, particularly in Eastern
and Southern SSA.
Global healthy life expectancy (HALE) increased
over the period 1990-2010, mainly
through reductions of child and adult mortality
rather than through reductions in disability [123].
For similar reasons, overall HALE also rose in the
SSA regions (East, West, and Central), with the
FIGURE 13: Projected Age-Specific Increase in Male
and Female Populations in SSA, 2010 to 2030
85+
80-84
75-79
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
female
0-4
male
0.0 0.5 1.0 1.5 2.0 2.5 3.0
Source: Authors from [119] (medium variant)
Factor increase in population size 2010 to 2030
exception of Southern SSA due to adult mortality
from HIV/AIDS.
Chronic conditions occur in younger age groups
more commonly in SSA than in developed countries
[83]. High burdens of CVD are attributable not just
to the epidemiological transition, but also to the relatively
early age at which CVD manifests in combination
with the large population of individuals who
are young or middle aged [34].
The number of elderly persons in SSA is projected
to double between 2000 and 2030 (Figure
13). Advancing age is associated with increased risk
of a number of chronic diseases [124], more so for
people living with HIV and AIDS (PLWH) [125].
Population growth and ageing alone are driving a
substantial part of the projected increases in cancer
by 2030. Nevertheless, health and wellbeing in older
age is determined more by chronic disease status
and co-morbidity than by age [126].
3.3. Socio-Economic Determinants
and Distributions
Increased prevalence of both communicable and
NCDs in disadvantaged populations is caused by
the same social conditions [127-128]. Poverty and
the challenges of poverty, such as overcrowding,
insanitary environments, malnutrition, infections,
and psychosocial stress, play a critical role in the rise
of NCDs in poor and rural communities [114, 129].
Differential exposures throughout a person’s lifetime
result in a range of consequences and outcomes
(Figure 14) – Africa may have some specific insights
to contribute on these linkages.
As noted before, Africa’s growth has been robust
(averaging 5-6 percent GDP growth a year) since
the turn of the new century, making important contributions
to poverty reduction. Income inequality,
however, remains high and SSA has some of the
highest income inequalities in the world. Nevertheless,
there has been a trend toward improvement in
several countries [82, 131]
Wealthy communities experience a higher risk of
chronic diseases, while poor communities experience
a higher risk of communicable diseases and a
double burden of communicable diseases and NCDs