Abstract
Africa and most of the global south continue to experience a striking burden of communicable diseases, neglected tropical diseases, and high rates of maternal and child mortality, as well as disastrous internecine conflicts and floods. While Africa has been making steady progress in addressing communicable diseases, it now faces new threats from highly infectious pathogens, specifically those with a human-to-animal interface such as the 2014 Ebola virus disease outbreak in West Africa. Moreover, with weak health systems in many of its countries, Africa is the only continent where poverty rates remain high at around 48% according to the Millennium Development Goals progress report (United Nations Development Programme, 2015; World Health Organization [WHO], 2008). The emergence of noncommunicable diseases (NCDs) in Africa threatens to retard the social and economic gains that have been made to date.
Of the 57 million deaths that occurred globally in 2008, 36 million deaths (63%) were due to NCDs—mainly cardiovascular diseases (48%), cancers (21%), chronic respiratory diseases (12%), and diabetes (3.5%). The African region attributed 2.8 million deaths to NCDs and is projected to increase by 27% over the next 10 years (WHO, 2008). In addition, a third of the NCDs occur in people under the age of 70 years, which are the most productive years of life and therefore have a negative impact on economic development. WHO (2008) estimates that by 2030, NCD-related deaths globally will increase to 55 million, with low- and middle-income countries in Africa and the global south bearing the largest burden.
NCD Risk Factors
The four major modifiable behavioral risk factors for NCDs are tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet. In addition, the four key metabolic risk factors known to increase the risk of NCDs are hypertension, overweight/obesity, hyperglycemia (high blood glucose levels), and hyperlipidemia (high levels of fat in the blood). Of these, the leading metabolic risk factor is elevated blood pressure, followed by overweight and obesity and elevated blood glucose. The fastest rise in overweight young children is in low- and middle-income countries, including those in Africa, a development that has prompted the WHO to set up the Commission on Ending Childhood Obesity (WHO, 2015a) with a mandate to gather the evidence on the status of childhood obesity and recommend actions required for intervening.
The Key Determinants of NCDs
The four major NCD risk factors are driven by multiple determinants that have the potential to influence health outcomes positively or negatively. The level of income, power, resources, age, and gender shape overall health outcomes, including NCDs. The health system, a key determinant of health in its own right, has strong bearing on implementation and enforcement of policies, legislation, and regulations; human resource capacity; evidence gathering; and multisectoral actions for NCD control and prevention.
In Africa, good governance for health remains an elusive goal due, in part, to industry interference in policy development and implementation (WHO, 2014). African governments will be expected to show good will and commitment to intervene. Civil society and citizen juries are also critical in the empowerment of communities to demand health promoting services. The WHO recommends three key cost-effective strategies: (a) regulating marketing (advertising and sponsorship), (b) limiting availability, (c) and regulating prices through taxation. The WHO FCTC (Framework Convention for Tobacco Control) Treaty has been an effective advocacy instrument for countries in Africa in tobacco control (WHO, 2003).
Implications for NCD Control and Prevention in Africa
The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. In low-resource settings, health care costs for cardiovascular diseases, cancers, diabetes, or chronic lung diseases can quickly drain household resources and driving families into poverty. Also, the loss of breadwinners affects national development negatively.
The WHO African Region’s five Strategic Priorities for 2015-2020 identifies Universal Health Coverage; Health Systems Strengthening; and Addressing Social Determinants of Health as central to ensuring programmatic strategic thinking and financial resource alignment for the NCD Cluster. Reducing out-of-pocket expenditures for NCD-related conditions is the primary target. However, reducing these costs requires engagement of individuals, households, and communities; a responsive health system in terms of access, availability, and affordability; and a functional partnership between government and other agencies to address the determinants of NCDs that exist outside the health sector.
Actions Required
In 2013, member states agreed on nine voluntary global targets that are contained in the Global Action Plan for Prevention and Control of NCDs 2013-2020 (WHO, 2013). These targets, although voluntary, should guide all the actions aimed at addressing NCDs in Africa and the global south. The Global Action Plan seeks to reduce preventable and avoidable burden of morbidity, mortality, and disability due to NCDs. Africa and the global south would require decisive leadership to coordinate the collective action at national, regional, and global levels. The specific actions required include the following:
Safeguarding the participation of individuals, households, and communities in the development and implementation of NCD prevention and control policies and programs in order to ensure empowerment, ownership, and ultimately community action.
Establishing and enforcing policies, legislation, and regulatory frameworks that aim at protecting the population from risks by ensuring stronger health systems and equity in access to key services such as financial resources; building essential health infrastructure for prevention, treatment, and care; and intervening to curb practices of industry known to harm health.
Engaging civil society organizations, research and academic institutions, and community-based groups, including women, youth, and the media, in creating public awareness on NCD risk factors and their determinants and to ensure the long-term benefits of investments in prevention activities seeking to positively influence social, cultural, and behavioral aspects on NCDs.
Making a strong investment in research designed to build a strong evidence base on how to modify social, cultural, and behavioral aspects related to the different populations in the global south.
Advocating for both governments and other stakeholders to mobilize additional resources to fund infrastructure, health workforce training and development, health information systems, essential medicines, and basic technologies required in NCD control and prevention. Increasing domestic funding for prevention and control of NCDs by government is both a social good and justifiable public investment. Therefore, it is prudent that government consider a (dedicated) special tax on tobacco, alcohol, sugar, sodium, or other substances, and in turn use the funds for health promotion activities as has been done, for example, in the case of the Thai Health Promotion Foundation (WHO, 2015b).
Reinforcing the leadership and stewardship role of Ministry of Health to facilitate social dialogue on NCD determinants and risk factors among key sectors such as agriculture, commerce, education, finance, health, local municipal government, social services, and trade, as well as the integration of NCD prevention and control in urban planning and environmental initiatives and the policies of these and other sectors.
Each country setting up a Monitoring and Accountability Framework to measure progress in achieving the targets set in the Global Action Plan for Prevention and Control of NCDs 2013-2020 (WHO, 2013).
Conclusion
The threat from NCDs is real and calls for decisive leadership to bring about urgent actions. In addition, strategic thinking, new approaches, and advocacy for good governance at national, regional, and global levels are needed to address the growing threat. The WHO African Region is transforming into a responsive and results-driven organization (WHO, 2015c). Our leadership has placed NCDs high on the agenda, and we believe the time has come to take action to mitigate the threat of NCDs not only in Africa but throughout the global south as well.
Footnotes
Authors’ Note
The views expressed here do not represent the views if the World Health Organization but are solely those of the authors.
Supplement Issue Note
This article is part of a Health Education & Behavior supplement, “Noncommunicable Diseases in Africa and the Global South,” which was supported by SAGE Publishing, with additional support from the National Heart, Lung, and Blood Institute Contract No. HHSN268201500073P. The entire supplemental issue is available open access for one year at 
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