Populations in Africa range from the truly rural to the urban sophisticate. In some African countries, urban dwellers constitute only a small proportion of the total population, but in others, such as South Africa, about half the people live in cities. Not so long ago, rural populations living traditionally had little obesity, hypertension, and diabetes. In gross contrast, today in Soweto, a city of 3–4 million black Africans, the prevalences of hypertension and diabetes (but not of obesity in men) exceed those in whites in nearby Johannesburg, a city with about half a million whites. Intriguingly, coronary heart disease (CHD), while absent in rural dwellers, is still rare in cities. At the public Baragwanath Hospital (3200 beds), which serves Soweto, 55 cases of myocardial infarction were detected in local residents in 1994. Because of widespread poverty few patients will have attended private hospitals. Even if all 55 patients died CHD would explain only 0.3% of total mortality in Soweto, a huge contrast with the proportion in southern Europe (6%), northern Europe (16–20%), and the USA where CHD mortality rates in African Americans and in white Americans are the same. In other African cities CHD rates are low too.CHD risk factors such as raised serum cholesterol are common in Soweto (mean 5·0–5·4 mmol/L), and since hypertension and diabetes and smoking (in men) are common, why is CHD not more frequent? Part of the explanation may be that atheromatous lesions are much less severe in South African blacks than whites. The picture in Nauruans, in the central Pacific, is similar. Obesity and diabetes are even more common there than in Soweto yet there is negligible CHD.Most African populations are impoverished; numbers are rising faster than food production; and debt entrapment is increasing. Prosperity beckons for only a tiny minority, and CHD is unlikely to increase significantly. But if it did—as it has in the Maori of New Zealand and the Aboriginal population of Australia, whose mortality rates from CHD exceed those in whites—there would be an impossible burden on urban African hospitals already near-overwhelmed with tuberculosis and AIDS. Holding back a rise of CHD by urging a “more prudent lifestyle” is a non-starter in Africa, as in most western populations.1Walker ARP Sareli P Coronary heart disease: outlook for Africa.J Roy Soc Med. 1997; 90: 23-27Crossref PubMed Scopus (55) Google Scholar Populations in Africa range from the truly rural to the urban sophisticate. In some African countries, urban dwellers constitute only a small proportion of the total population, but in others, such as South Africa, about half the people live in cities. Not so long ago, rural populations living traditionally had little obesity, hypertension, and diabetes. In gross contrast, today in Soweto, a city of 3–4 million black Africans, the prevalences of hypertension and diabetes (but not of obesity in men) exceed those in whites in nearby Johannesburg, a city with about half a million whites. Intriguingly, coronary heart disease (CHD), while absent in rural dwellers, is still rare in cities. At the public Baragwanath Hospital (3200 beds), which serves Soweto, 55 cases of myocardial infarction were detected in local residents in 1994. Because of widespread poverty few patients will have attended private hospitals. Even if all 55 patients died CHD would explain only 0.3% of total mortality in Soweto, a huge contrast with the proportion in southern Europe (6%), northern Europe (16–20%), and the USA where CHD mortality rates in African Americans and in white Americans are the same. In other African cities CHD rates are low too. CHD risk factors such as raised serum cholesterol are common in Soweto (mean 5·0–5·4 mmol/L), and since hypertension and diabetes and smoking (in men) are common, why is CHD not more frequent? Part of the explanation may be that atheromatous lesions are much less severe in South African blacks than whites. The picture in Nauruans, in the central Pacific, is similar. Obesity and diabetes are even more common there than in Soweto yet there is negligible CHD. Most African populations are impoverished; numbers are rising faster than food production; and debt entrapment is increasing. Prosperity beckons for only a tiny minority, and CHD is unlikely to increase significantly. But if it did—as it has in the Maori of New Zealand and the Aboriginal population of Australia, whose mortality rates from CHD exceed those in whites—there would be an impossible burden on urban African hospitals already near-overwhelmed with tuberculosis and AIDS. Holding back a rise of CHD by urging a “more prudent lifestyle” is a non-starter in Africa, as in most western populations.1Walker ARP Sareli P Coronary heart disease: outlook for Africa.J Roy Soc Med. 1997; 90: 23-27Crossref PubMed Scopus (55) Google Scholar
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Apr 21, 2024
Charalambos Fotakis + 6
Open Access
