PR O GRE S S I N C ARDI O VAS CU L AR D I S EAS E S 5 6 ( 2 0 13 ) 23 2–2 33
Available online at www.sciencedirect.com
ScienceDirect www.onlinepcd.com
Editorial
Introduction: Progress in Cardiovascular Diseases and Diabetes in Africa By most measures of economic prosperity examined by the Africa Progress Panel, Africa is making substantive progress and stands today “on the edge of enormous opportunity”.1 However, the Africa Progress Panel's 2013 report also points out that a decade of highly impressive economic growth has not brought comparable improvements in health, education, and nutrition to many African countries.1 In fact, as a former president of Nigeria astutely commented, “Prosperity is bringing to our nation many benefits, but there are some changes that are not positive. As our diets and habits are changing, so are our waist-lines. Already, more than 35% of women in Nigeria are overweight….”2 The nutrition transition in sub-Saharan Africa, coupled with modest population growth, aging, and progress in the treatment and control of communicable diseases, is ushering in a rising burden of chronic non-communicable diseases (NCD) such as diabetes, cardiovascular diseases (CVD), and their risk factors.2 These chronic NCDs now constitute a major cause of death and disability worldwide and pose prominent economic and developmental challenges in low- and middle-income countries including those in sub-Saharan Africa.3–5 But how prominent are diabetes, CVD, and their related risk factors in sub-Saharan Africa? What has been the trend in the past decade and to what extent do these trends mirror epidemiologic observations in other regions of the world? How have global events and policies influenced behavioral and lifestyle changes in this region? Is sub-Saharan Africa facing an impending tsunami of CVD and diabetes? What objective data exist and how reliable are they as quantitative descriptors of these diseases and their risk factors? Where data exist, are they directly enumerated local primary data or secondary estimates and imputations from non-ideal epidemiologic sources? Most importantly, what progress has been made in the prevention, detection, diagnostic evaluation, treatment, and control of these chronic diseases and their risk factors; and are local health systems and workforce adequate to tackle these challenges?
Disclaimer: The views expressed in this article do not necessarily represent the views of the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services or any other government entity.
These questions prompted the series of papers that make up this special issue of Progress in Cardiovascular Diseases with a focus on sub-Saharan Africa. I was very fortunate to have the opportunity to work with a broad spectrum of internationally recognized experts from the fields of clinical cardiology, diabetes, and primary care; public health; genetic epidemiology; health metrics and evaluation; health promotion and education; telemedicine and distance learning; and globalization, trade, and health policy. Their diverse expertise permitted the scholarly discussions that range from the genetic epidemiology of diabetes to the complex influences that rapid urbanization, globalization, trade liberalization, and foreign direct investments all have on lifestyle and behavioral changes and their related distal impact on CVD and diabetes. The 12 articles in this issue could not have been produced at a more opportune time in the context of clinical and public health practice in sub-Saharan Africa. Some of the articles tackle the continuing challenge of extremely limited quantity and quality of locally enumerated empirical data on measures of health and causes of death in Africa. The urgent call for a global collaborative effort to strategically strengthen local African educational institutions and governmental agencies to address data needs is inescapable. An in-depth analysis highlights the substantial impact that urbanization, globalization, and international trade policies have on the determinants of cardiovascular health and diabetes in Africa. Other papers call attention to the value of investing in “best buys” or cost-effective health care and population-wide prevention interventions that are evidence-based and prioritized on the basis of affordability, feasibility and high health impact. The importance of health promotion and education strategies built on a foundation of primary care and the crucial role that the private sector can play in incentivizing or “nudging” patients and their families to make healthful choices are also highlighted. As the World Health Organization's Regional Office for Africa has stated, the double burden of communicable diseases and NCDs, including diabetes and CVDs, is too heavy for the public sector to address alone.6 I am very grateful for the zeal and commitment with which these experts addressed their tasks. I am also deeply honored to have had the chance to work with our Editor-in-Chief,
PR O G RE S S I N C ARDI O V A S CU L A R D I S EA S E S 5 6 (2 0 1 3) 23 2–2 3 3
Dr. Henry Greenberg, on what turns out to be the last issue in his illustrious 5 years leading this journal. His thoughtful and insightful comments during editorial review of the manuscripts in this issue were only surpassed by his patience and diligence in assuring another high-quality journal issue. As guest editor, it gives me great pleasure to invite all of you to explore the progress made and remaining challenges described in the accompanying articles. These papers provide a path forward on the journey to tackle diabetes and cardiovascular diseases, an important part of the double burden of diseases in sub-Saharan Africa. George A. Mensah National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, MD E-mail address: [email protected]
REFERENCES
1. Annan K. Africa progress report 2013: foreword. Africa Progress Panel. 2013. [Available at: URL: http://africaprogresspanel.org/
2. 3.
4.
5.
6.
233
index.php/download_file/view/3091/. Last accessed on September 22, 2013.]. World Health Organization. Preventing chronic diseases: a vital investment. Geneva: World Health Organization. 2005. Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time: the challenge of cardiovascular disease in developing countries. New York, NY: Earth Institute, Columbia University. 2004. Kirigia JM, Sambo HB, Sambo LG, Barry SP. Economic burden of diabetes mellitus in the WHO African region. BMC Int Health Hum Rights. 2009;9:6 http://dx.doi.org/10.1186/1472698X-9-6.:6-9. Institute of Medicine. Preventing the global epidemic of cardiovascular disease: meeting the challenges in developing countries. Washington, DC: National Academies Press. 2010. Sambo LG, Kirigia JM. Africa's health: could the private sector accelerate the progress towards health MDGs? Int Arch Med. 2011;4:39 http://dx.doi.org/10.1186/1755-7682-4-39.
0033-0620/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.pcad.2013.10.013
Available online at www.sciencedirect.com
ScienceDirect www.onlinepcd.com
Editorial
Introduction: Progress in Cardiovascular Diseases and Diabetes in Africa By most measures of economic prosperity examined by the Africa Progress Panel, Africa is making substantive progress and stands today “on the edge of enormous opportunity”.1 However, the Africa Progress Panel's 2013 report also points out that a decade of highly impressive economic growth has not brought comparable improvements in health, education, and nutrition to many African countries.1 In fact, as a former president of Nigeria astutely commented, “Prosperity is bringing to our nation many benefits, but there are some changes that are not positive. As our diets and habits are changing, so are our waist-lines. Already, more than 35% of women in Nigeria are overweight….”2 The nutrition transition in sub-Saharan Africa, coupled with modest population growth, aging, and progress in the treatment and control of communicable diseases, is ushering in a rising burden of chronic non-communicable diseases (NCD) such as diabetes, cardiovascular diseases (CVD), and their risk factors.2 These chronic NCDs now constitute a major cause of death and disability worldwide and pose prominent economic and developmental challenges in low- and middle-income countries including those in sub-Saharan Africa.3–5 But how prominent are diabetes, CVD, and their related risk factors in sub-Saharan Africa? What has been the trend in the past decade and to what extent do these trends mirror epidemiologic observations in other regions of the world? How have global events and policies influenced behavioral and lifestyle changes in this region? Is sub-Saharan Africa facing an impending tsunami of CVD and diabetes? What objective data exist and how reliable are they as quantitative descriptors of these diseases and their risk factors? Where data exist, are they directly enumerated local primary data or secondary estimates and imputations from non-ideal epidemiologic sources? Most importantly, what progress has been made in the prevention, detection, diagnostic evaluation, treatment, and control of these chronic diseases and their risk factors; and are local health systems and workforce adequate to tackle these challenges?
Disclaimer: The views expressed in this article do not necessarily represent the views of the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services or any other government entity.
These questions prompted the series of papers that make up this special issue of Progress in Cardiovascular Diseases with a focus on sub-Saharan Africa. I was very fortunate to have the opportunity to work with a broad spectrum of internationally recognized experts from the fields of clinical cardiology, diabetes, and primary care; public health; genetic epidemiology; health metrics and evaluation; health promotion and education; telemedicine and distance learning; and globalization, trade, and health policy. Their diverse expertise permitted the scholarly discussions that range from the genetic epidemiology of diabetes to the complex influences that rapid urbanization, globalization, trade liberalization, and foreign direct investments all have on lifestyle and behavioral changes and their related distal impact on CVD and diabetes. The 12 articles in this issue could not have been produced at a more opportune time in the context of clinical and public health practice in sub-Saharan Africa. Some of the articles tackle the continuing challenge of extremely limited quantity and quality of locally enumerated empirical data on measures of health and causes of death in Africa. The urgent call for a global collaborative effort to strategically strengthen local African educational institutions and governmental agencies to address data needs is inescapable. An in-depth analysis highlights the substantial impact that urbanization, globalization, and international trade policies have on the determinants of cardiovascular health and diabetes in Africa. Other papers call attention to the value of investing in “best buys” or cost-effective health care and population-wide prevention interventions that are evidence-based and prioritized on the basis of affordability, feasibility and high health impact. The importance of health promotion and education strategies built on a foundation of primary care and the crucial role that the private sector can play in incentivizing or “nudging” patients and their families to make healthful choices are also highlighted. As the World Health Organization's Regional Office for Africa has stated, the double burden of communicable diseases and NCDs, including diabetes and CVDs, is too heavy for the public sector to address alone.6 I am very grateful for the zeal and commitment with which these experts addressed their tasks. I am also deeply honored to have had the chance to work with our Editor-in-Chief,
PR O G RE S S I N C ARDI O V A S CU L A R D I S EA S E S 5 6 (2 0 1 3) 23 2–2 3 3
Dr. Henry Greenberg, on what turns out to be the last issue in his illustrious 5 years leading this journal. His thoughtful and insightful comments during editorial review of the manuscripts in this issue were only surpassed by his patience and diligence in assuring another high-quality journal issue. As guest editor, it gives me great pleasure to invite all of you to explore the progress made and remaining challenges described in the accompanying articles. These papers provide a path forward on the journey to tackle diabetes and cardiovascular diseases, an important part of the double burden of diseases in sub-Saharan Africa. George A. Mensah National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, MD E-mail address: [email protected]
REFERENCES
1. Annan K. Africa progress report 2013: foreword. Africa Progress Panel. 2013. [Available at: URL: http://africaprogresspanel.org/
2. 3.
4.
5.
6.
233
index.php/download_file/view/3091/. Last accessed on September 22, 2013.]. World Health Organization. Preventing chronic diseases: a vital investment. Geneva: World Health Organization. 2005. Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time: the challenge of cardiovascular disease in developing countries. New York, NY: Earth Institute, Columbia University. 2004. Kirigia JM, Sambo HB, Sambo LG, Barry SP. Economic burden of diabetes mellitus in the WHO African region. BMC Int Health Hum Rights. 2009;9:6 http://dx.doi.org/10.1186/1472698X-9-6.:6-9. Institute of Medicine. Preventing the global epidemic of cardiovascular disease: meeting the challenges in developing countries. Washington, DC: National Academies Press. 2010. Sambo LG, Kirigia JM. Africa's health: could the private sector accelerate the progress towards health MDGs? Int Arch Med. 2011;4:39 http://dx.doi.org/10.1186/1755-7682-4-39.
0033-0620/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.pcad.2013.10.013
