Chronic Disease in Sub-Saharan Africa: a critical history of an 'epidemiological transition'. (360G-Wellcome-106534_Z_14_Z)

According to the WHO, Africa is the latest region of the world to be on the cusp of an epidemic of chronic disease, with rising rates of mortality and morbidity from cardiovascular disease, stroke, diabetes, chronic hepatic and renal diseases as well as cancer, mental illness and HIV/AIDS (now widely viewed as a chronic condition). It is projected that by 2015, a quarter of all deaths on the African continent will be caused by such diseases and their concurrence with infectious diseases. High-le vel meetings have produced a plethora of policy documents directed at the very significant challenges that this apparent epidemiological shift poses for already fragile health systems on the continent. A variant of modernisation theory, the historical framework of the epidemiological transition has been widely criticised, but its broad parameters remain at the heart of current policy-making. Accumulating evidence from different regions of Africa, as well as comparative work on India, China, Lati n America and the historical experience of Europe, suggest that this linear model of change may need more radical re-thinking. Recognising the real importance of these issues, this project has two central goals. Firstly, it will take a step back and ask some critical questions about the definitions and measurements of 'chronic' and 'non-communicable' diseases and examine the evidence for their longer history in sub-Saharan Africa. Secondly, through a set of case studies it will provide much-need ed in-depth research on the current situation in sub-Saharan Africa, paying particular attention to 'co-morbidities'.