About the project

This project is funded through a five year Wellcome Trust Investigator Award held by Megan Vaughan at the Institute for Advanced Studies, UCL. We work in an interdisciplinary mode, combining anthropological, historical and social science methods, in dialogue with our colleagues in medicine and biological sciences. The work is inherently collaborative with colleagues in Ghana, South Africa and Malawi, in universities and beyond. We welcome enquiries from colleagues and health activists working in the field of non-communicable and chronic disease in sub-Saharan Africa.

We tend to think of Sub-Saharan Africa as a region dominated by infectious disease as a cause of mortality and illness – the HIV/AIDS epidemic, the Ebola ‘emergency’, the ongoing scourge of malaria. But recently the global health community has been drawing attention to the increasing burden to chronic and non-communicable conditions on the sub-continent. Thanks to the greater availability of treatment, AIDS is now often thought of as a chronic, lifelong condition.

Meanwhile non-communicable diseases such as cardiovascular disease, cancers, diabetes, chronic respiratory disease and mental illness are apparently rapidly increasing and are projected to be the leading cause of death by 2030. In colonial terminology these used to be called the ‘diseases of Western civilisation’, associated with increased longevity, urban diets and ‘stress’. With high infant and child mortality rates, low life expectancy and largely rural lifestyles, African populations were thought to have little experience of these conditions.

Our project aims to investigate more closely the changes taking place in disease patterns and the lived experience of illness in Africa.

In recent decades these conditions previously seen as characterising the ‘West’ have collectively become the leading cause of death worldwide. South Asia, China, and Latin America all seem to have moved swiftly through the so-called ‘epidemiological transition’ from a landscape dominated by infectious disease to one dominated by chronic and noncommunicable conditions. Increasing life expectancy, effective measures against infectious disease, and massive urbanisation have contributed to ‘epidemics’ of obesity and diabetes mellitus, and increasing rates of cancer and heart disease.

The African continent appeared to be the last region of the world to move through this ‘transition’ and was fast catching up. As many observers noted, the growing burden of often long-term chronic conditions places an enormous strain on already fragile health services and threatens to impede the attainment of social development goals.

Our project aims to contribute to a growing literature that seeks to problematise the idea of ‘transition’ and to investigate more closely, and with a historical perspective, the changes taking place in disease patterns, and the lived experience of illness in Africa. Though ageing populations, urbanisation and the globalisation of the food industry affect African populations in many of the same ways as they affect other parts of the world, we also need to pay attention to local conditions and histories. In addition, we need to think critically about the dominant models of change which determine how data is collected and analysed and how health information is translated into policy.

We aim to interrogate what is often called the ‘double burden’ of disease in Africa. This refers to the co-existence of infectious and non-communicable disease burdens. We argue that these are not simply co-existent, but interact in important ways which are often lost when we separate them into two different categories or consign them to different ‘stages’ of history.

We aim to interrogate what is often called the ‘double burden’ of disease in Africa.

We also aim to explore the experience of illness through engagement with health care providers and patient groups. What does it mean to be told that you have diabetes mellitus when you are already a person living with HIV/AIDS? How do families manage the consequences of stroke in rural areas? What meanings attach to “pressure” (hypertension) in African contexts? The project is multi-disciplinary and collaborative with our colleagues in African institutions.