Academic journal article Journal of Third World Studies

Rethinking Health Promotion and Disease Prevention in Africa: The Quest for an Integrated Model

Academic journal article Journal of Third World Studies

Rethinking Health Promotion and Disease Prevention in Africa: The Quest for an Integrated Model

Article excerpt


It is a well established fact that Sub-Saharan Africa is a region of the world weighed down with the heaviest burden of disease. Although this region comprises only a little over 10 per cent of the world's population, over two thirds (67%) of all people living with HIV globally lived in Sub-Saharan Africa in 2008--that is an estimated 22.4 million people. (1) But the HIV/AIDS pandemic is only part of the story of the heavy burden of disease although, without a doubt, it is the deadliest. Malaria, tuberculosis, respiratory tract infections, diarrheal diseases and a myriad of other communicable as well as non-communicable diseases comprise major causes of morbidity and mortality in the region.

Until recently, much of the discourse on disease in Sub-Saharan Africa had focused primarily on communicable diseases. Today that is no longer the case. There is a growing threat from non-communicable (chronic) diseases such as heart disease, diabetes, stroke, obesity, cancer, and high blood pressure--health conditions that have, until now, been dubbed diseases of "affluence" or "diseases of progress", an apparent reference to the rich industrialized societies.

However, Africa has achieved neither widespread affluence nor enough progress to be counted in the company of the rich industrialized countries. The Global Burden of Disease Report (2) asserts that more than 50% of adult disease burden in low and middle income countries is caused by non- communicable diseases. Africa suffers from 25% of the world's burden of diseases. The rising health threat from non-communicable diseases on top of the communicable diseases that have for the most part proved to be pervasive and intractable is creating a "double burden of disease." (3)

This in a way represents a truncation of the conventional epidemiological transition of disease. The epidemiological transition of disease represents a shift from one set of diseases (such as acute infectious diseases) to a different set of diseases (such as chronic and degenerative conditions) as the primary causes of morbidity and mortality within a population. Most industrialized countries, such as the United States, have, by and large, achieved the epidemiological transition as the result of their economic, technological, and medical development. In much of the developing world, the "premature" epidemiological transition is occurring as the result of the rapid globalization process. The epidemiological transition in the developing world appears to have been replaced by another transition known as the "nutritional transition" which is characterized by the increase in the consumption of foods high in fats (trans-fatty acids), sweeteners and processed foods. (4) This, in turn, has led to a rapid rise in obesity, heart disease, diabetes, and cancer. Now people in developing countries are dying from diet-related chronic diseases as well as from the already widely prevalent acute and infectious diseases, again, creating the double burden or double jeopardy of disease.

The problem of bringing under control the burden of disease and improving health continues to be one of the major challenges in Africa. Not surprisingly, the dominant reigning disease control paradigms are the biomedical and life- style change (behavior modification) models. However, these models have had very little success, to date, in the promotion of public health and prevention of disease as will be clear in the section on theories of disease. Why have these models been met with only limited success? Given the expense and relative ineffectiveness of these intervention strategies, what is to be done? Is there a better alternative disease prevention model that addresses the challenges of the double burden of disease facing Sub-Saharan African countries today?


The purpose of this study is twofold: First, it attempts to provide a critical assessment of three existing models of health promotion and disease prevention, namely, the bio-medical model, life-style change model, and the political economy model. …

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