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Health: African cities face the challenge of non-communicable diseases such as diabetes or hypertension
In early March 2024, more than 200 participants representing 52 cities from 40 countries gathered in Cape Town, South Africa, for the second annual Healthy Cities Partnership Summit. Health in urban areas in Africa, a subject on which RFI returns this March 29 through a report by Igor Strauss.
[Illustrative image] In South Africa diabetic patient consultation with lung breathing machine, lung health test or spirometry and hospital medical equipment technology. Getty Images - Kobus Louw
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One of the first challenges when we talk about health in cities is the fight against so-called “non-communicable” diseases, such as diabetes, hypertension or respiratory diseases. Diseases linked in part to urban lifestyle: junk food, physical inactivity, tobacco, air pollution, etc.
Today, these non-communicable diseases, which mainly affected the elderly in Western countries, are exploding all over the world and no longer spare young people.
According to the WHO, they cause 41 million deaths per year, 74% of all deaths worldwide.
And for cities, this is a major challenge to take up. Geordin Hill Lewis, the mayor of Cape Town, South Africa, explains: “
Our great public health victory was that we virtually defeated the HIV health crisis in the late 1990s. Now, people can have a good and long life, even if they are HIV positive. But today, we are facing a new health crisis with the emergence of non-communicable diseases, diseases linked to our lifestyle which represent an enormous cost for our public finances, since they are chronic diseases. It's really the equivalent of the crisis we experienced in the 1990s
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South Africa: the problem of HIV treatments which promote the emergence of diabetes and hypertension
South Africa has been one of the countries hardest hit by HIV/AIDS since the 1990s. According to UNAIDS, 7.7 million people carry the virus, or nearly 14% of the population. . But the mortality rate fell by 50% thanks to the arrival of ARV treatments, antiretrovirals. Today, we can therefore live well and for a long time with HIV.
But the increased lifespan of HIV-positive people favors the emergence of diseases such as diabetes or hypertension. A new challenge for the South African health system.
Natacha Berkowitz, epidemiologist, explains: “
We have seen an increase in non-communicable diseases among our patients who have HIV-tuberculosis co-infection. Not only because they live longer – which is a fantastic advance – but because certain treatments against HIV promote the emergence of pathologies such as diabetes or hypertension. »
Disease of debauchery, disease of shame: AIDS and tuberculosis have always been wrongly associated in different ways. This stigmatization of patients has led to the creation of care structures specialized in these diseases.
Natacha Berkowitz continues: “
The problem is that when it comes to access to care, everything is separate. There are clinics dedicated to tuberculosis, others to HIV, so we are constantly redirecting people to this or that clinic. We must now be able to treat HIV and a non-communicable disease in the same place.
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This is the new challenge for Cape Town and other African cities. Diabetes and hypertension progress silently over many years. Patients are therefore unaware of their status, which inevitably increases the mortality rate. Access to early diagnosis and then treatment are therefore essential. Otherwise some of the progress made in the fight against HIV will have been in vain.
Today, 4.4 billion people live in cities: that's more than half of humanity. In 2050, 70% of the world's population will live in cities. They are therefore on the front line and must act in different areas.
When we talk about the fight against non-communicable diseases, we are not only talking about health, but also about transport, pollution and education. And it is easier for a mayor to act and collaborate with these different sectors. A mayor is closer to his constituents and can strengthen national laws.
Also read: In Africa, the “double burden” of undernutrition and obesity
In the field of health, for example, many West African states have been pursuing a policy of decentralization of healthcare provision for several years. They rely on community health, which is managed by cities.
Since 2017, 74 cities around the world have created the city-health partnership to exchange, compare and help each other with the aim of improving the health of their inhabitants.
Burkina Faso: how Ouagadougou wants to rely on youth to change eating habits
Ouagadougou, Abidjan, Dakar and Freetown are uniting in the fight against junk food, which causes many diseases. Diabetes, hypertension, obesity: these pathologies are exploding on the continent.
The city of Ouagadougou therefore wishes to rely on young people to change eating habits. Fifteen primary schools in the city are affected.
Homère Ouédraogo, general director of social services in the city of Ouagadougou, explains: “
The first thing is to become aware of the dangers of sweet and salt. The second element is getting people to consume locally. At home, in Burkina Faso, we have other products praised for their merit, notably what we call in the local language soumbala, which is a product made from néré seed. We also have alternatives to industrial cube broths which are local spices. So, we are focusing on promoting these local dishes, and extending this to all schools in the city of Ouagadougou.
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Another avenue for reflection is the fight against preconceived ideas, which are sometimes stubborn. No, industrial food is not cheaper. Homere Ouédraogo warns those who think that good nutrition would be more expensive: “
In reality, it's an impression. In the long run, it's going to cost you more, because once you develop diseases like hypertension, like diabetes, it's for life. Given that our health systems do not have health insurance, it is not cheaper and in the long term, it causes a huge financial deficit for families.
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The trained children will then have the difficult task of educating parents and neighbors about the benefits of good nutrition. This is the bet that the city of Ouagadougou has made.
Now, young people easily get high blood pressure and kidney failure. Can you imagine young people who are sick? This is a truly uncertain future for the country. This is why Abidjan also decided to act in the school and student environment. We first carried out a diagnostic survey which revealed to us that indeed, in terms of our school canteens, there was room for criticism. We chose a secondary establishment which is typically female, and we made them understand that without imported broth and using only local produce, you can normally cook for your home and for your husband. The second establishment that we chose is an establishment of a religious nature, because you imagine an imam, a priest or even a pastor committed to your cause. We tell ourselves that by hitting this target in this way, we hope to be able to change things tomorrow.
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Doctor Stéphane Djadan, Head of planning and health monitoring in the autonomous district of Abidjan, presents a guide to good nutritional practices and an intervention program in four pilot schools to train cooks and canteen workers.
Igor Strauss
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