Intended for healthcare professionals


No more disease silos for sub-Saharan Africa

BMJ 2012; 345 doi: (Published 31 August 2012) Cite this as: BMJ 2012;345:e5812
  1. Patricio V Marquez, lead health specialist, Eastern and Southern Africa Region1,
  2. Jill L Farrington, honorary senior lecturer2
  1. 1World Bank, Washington, DC, USA
  2. 2Nuffield Centre for International Health and Development, Leeds, UK
  1. Correspondence to: P V Marquez pmarquez{at}
  • Accepted 24 August 2012

Countries in sub-Saharan Africa are facing a double burden of communicable and non-communicable disease. Patricio Marquez and Jill Farrington argue that knowledge of their common determinants and the links between diseases should be used to spur development of coordinated programmes to prevent and treat both

While much of the health focus in sub-Saharan Africa, has been directed at communicable diseases (particularly HIV/AIDS, tuberculosis, and malaria), non-communicable diseases are a growing problem for the region, causing almost one third of total deaths.1 The May 2012 World Health Assembly resolution on setting a global target for reducing non-communicable diseases2 and the pronouncements made at the 19th International AIDS Conference in July remind us of the similar challenges faced by these two sets of disease and the potential shared solutions. The theme of the AIDS conference “turning the tide together” seems apt and should give pause for thought in the lead-up to further debate about non-communicable diseases at the UN and other international forums.

The approach to preventing and treating HIV/AIDS—exemplified by an intention to build on lessons learnt, take account of recent scientific advances, and demonstrable ability to scale-up key interventions—seems particularly relevant to non-communicable diseases. But how should sub-Saharan Africa, well represented at the AIDS conference, gear up to the challenge of non-communicable diseases in a way that avoids creating new vertical programmes in competition for scarce resources?

What is the essence of the problem?

Although communicable diseases have traditionally been leading causes of disease and mortality in sub-Saharan Africa, rapid urbanisation, changes in dietary patterns, behavioural and biological factors, and major improvements in the prevention and treatment of communicable diseases, particularly AIDS, that are helping raise life expectancy, are all contributing to a shift in disease patterns. For some countries, such as Mauritius and Seychelles, and some populations, such as people aged over 45 years, …

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