The Tragedy of the 21st Century?

A child born between 2010 and 2015 in Nigeria can expect to live 30 years less than a child born in Italy. 33 countries have a life expectancy of greater than 80 years of age. The life expectancy for the 40 worst performing countries ranges from 49 years (Swaziland) to 63 years (Ethiopia). On which continent are 39 of the 40 lowest ranked countries? You guessed it – Africa!

Most people still think that the infectious diseases are the major cause of death worldwide. In fact, for nearly two decades now the so called non-transmissible diseases have been responsible for the majority of deaths globally – that is more than deaths from malaria, HIV, TB, meningitis, hepatitis and all the other infectious (or transmissible) diseases combined. The shocking statistics seen in Figure 1 show that throughout the whole of Central, West and East Africa – the traditional domain of the infectious diseases – over 60% or even 70% of people WHO die under the age of 70 years die from non-transmissible diseases.

What are the non-transmissible diseases?

They include cardiovascular diseases such as heart attack, heart failure and stroke as well as diabetes, hypertension, high cholesterol levels. All these “diseases of civilisation” are thought to be patterns of the same disease and have a common origin in obesity and inactivity. Indeed, diabetes is thought to be a vascular disease and diabetes units are often part of the cardiovascular centre in many of the major medical centres around the world. The other major non-transmissible diseases include cancer and chronic respiratory disease from cigarette smoking. Many cancers are themselves driven by obesity and estimates suggest that between 11-40% of cancers are causally related to obesity.

What is driving this growth in the non-transmissible diseases?

Ever since early human history, mankind in general has had to suffer calorie restriction or under-nutrition. Very few societies had freely available and unlimited food supplies. It is thought that as a result we developed certain genetic and adaptive characteristics that were of survival value. These characteristics allowed us to store energy very efficiently and to expend energy in a very thrifty and efficient way. Of course, these characteristics were invaluable when we were hunters and gatherers expending a great deal of energy in return for a relatively limited nutrient reward.

However, these adaptations continue within us despite the avalanche of food coming at us from all directions in recent decades, food that makes us obese because we continue to store it very efficiently. Much of this food is of poor quality. Thus fast foods and processed foods are eaten in excessive quantities, accompanied by carbonated beverages and other high-calorie drinks containing large amounts of added sugar of no nutritional value.

When all this is added to our increasingly sedentary lifestyles, we have created the perfect setting for the exploding prevalence of obesity, diabetes, hypertension, hyper-cholesterolaemia, cancer and heart disease. The whole of the developing world including Central and South America, the Middle East and Far East including India, China and Southeast Asia is caught up in this explosion of disease. However, you will see from Figure 2 it is Africa that has the fastest growing rate of “DIABESITY” in the world and the prevalence of diabetes in the African continent is expected to rise by 110% in the next decade.

In the developed world the higher socio-economic and educated groups in society are more aware of these issues and are able to afford better nutrition and exercise. Thus obesity and unhealthy lifestyles in these countries are increasingly being seen in the poorer groups in society. In the developing countries such as in Africa, the opposite is often the case as the free availability of food can be a sign of affluence. The high consumption of carbohydrate-rich foods such as maize, yam, manioc, rice, bread and cassava etc. that form the staple diet of native Africans is also driving the increasing levels of obesity.

The tragedy of the 21st Century?

Diabetes is the commonest cause of blindness in adults of working age, the commonest cause of kidney failure and haemodialysis and the commonest cause of lower limb amputation. However, the majority of people (80%) with diabetes die prematurely from heart disease.

Much of the impact of this can be prevented by blood pressure, cholesterol and diabetes control by medications or treatment of established disease by angioplasty or coronary bypass surgery. Unfortunately, these expensive treatments are clearly not an option in poorer countries where many people cannot afford even the most basic of treatment such as antibiotics etc.

As a result, this epidemic of obesity and its consequences is shaping-up to be potentially the tragedy of this century.

What can be done to prevent this from happening?

I have visited West Africa on eight occasions now to work in diabetes in a voluntary capacity. At first I thought that I may be able to make some impact, in a small way, by drawing the attention of people to this rising tide of obesity. However it soon became clear on my first visit that it was already too late for prevention – the growing prevalence of obesity is everywhere to be observed, even in the young.

There is no magic cure. It is going to take a great deal of education, legislation and concerted efforts on behalf of governments and health agencies over many years to make a significant impact. However, education of the population is key.

One recognises that replacing some carbohydrate with more protein and some healthy fats is expensive. However, simply eating less and walking more and taking part in other forms of exercise are very important.   This is especially important in the case of children and I would urge parents not to overfeed their children and not to give them carbonated beverages with added sugar and sweetened fruit juices. Drinks containing artificial sweeteners instead of sugar have not been shown to be damaging but water is the best drink.

What should we be looking for? :

  1. Diabetes – demand to be screened by your doctor or nurse with a finger-prick blood test, especially if you are over 40, overweight, have a family history of diabetes, have high blood pressure or have had diabetes during pregnancy.
  2. Have your blood pressure checked if you are over 40 years. It should be less than 140/80. High blood pressure is very common in African people. You should be aware of your own blood pressure readings.
  3. Have your cholesterol levels checked and be aware of what it is.

Remember that diabetes, blood pressure and cholesterol are generally controlled and not cured. So the tablets need to be taken for the rest of one’s life. People with these conditions generally have no symptoms so they are not motivated to spend their scarce funds on medication. However, I promise you that if you do these things you will make a major difference to your future health and life expectancy!

I have grown very fond of the African countries and the people I have visited and I am distressed at what is unfolding. I have found the people attending public meetings to be very receptive to my message – they were simply unaware that there is this developing problem. Therefore I hope that this article written for The African Bulletin will be widely read and would ask those who have read this to circulate this article to others and distribute it as widely as possible.

Thank you for taking the time to read it. Who knows? Perhaps we can close the life-expectancy gap between the rich and the poor countries.

*Professor Richard GR Firth, a Consultant Physician/Endocrinologist is a former National Programme Director for Diabetes and the former President Irish Endocrine Society.