Cancer and Africa
The demographic and epidemiological transitions sweeping across Africa are vast and unique in human history.
The continent is facing or experiencing a quadruple disease burden – infectious disease / maternal health, non-communicable diseases, interpersonal violence and HIV/AIDS – across all age cohorts and all socio-economic classes.
The Economist’s‘Health and Africa’conference (http://cemea.economistconferences.com/event/healthcare-africa) then could not have come at a more opportune moment, bringing together national health leaders – the Health Ministers of South Africa, Zambia and Ethiopia, with global health, Sir Richard Feachem and Dr. Unni Karunakara ,President of Medicin San Fronitiers (MSF) and key stakeholders across the professional and political spectrum.
The conference was clear on the problems, huge disease burden set against weak capacity and infrastructure in national health systems, where indeed these existed, but the solutions to these challenges were hotly debated.
The mosaic of systems and health cultures was a major issue to delivering a pan African vision of health reform. African countries (including North Africa) span the Human Development Index from the bottom, DR Congo at 187 all way through to 64, and with between 2300 and 3000 linguistically different communities the debate had to pull along way out to provide realistic generalities to the disease burden.
One of the critical changes being felt was the impact of downturns in donor funding (and general aid) going into healthcare systems through such organizations as MSF.
Few African countries had reached a self-sufficiency level to absorb such funding cuts. There were exceptions, notably South Africa that is currently starting on an ambitious set of healthcare reforms (Health National Insurance) based on social solidarity principles, but from the HIV/AIDS, TB and Malaria communities there was serious fear of major reversals occurring to gains that had been made.
The debate also went much further addressing the impact of the current and future burden of non-communicable diseases. Whilst the percentage of mortality in economically active populations due to NCD might be small compared to established economies (around 10-15% compared to 80% in say Europe), rates are very high and this coupled with the expanding demographics (population size) and increasing exposure to modifiable risk factors (tobacco, obesogenic environments etc.) make this a clear and present additional threat and challenge to systems design.
The conference also took a welcome perspective through Prof Derek Yach on what prevention meant for Africa. The view was clearly African solutions to African problems and there was a much greater need for research and implementable policy around intelligence (disease registries) and development, societal engineering to reduce disease burden.
The size and complexity of the health problems could be almost overwhelming, and in some parts of Africa they are, however, there was a very real sense of solidarity and a recognition that healthy development was absolutely key to many of Africa’s long term challenges.