Top Health Challenge: Cardiovascular Disease

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Standing in the lobby of the Sheraton Times Square Hotel at the Clinton Global Initiative’s 10th annual meeting, Kenyan physician Dr. Allan Pamba excitedly tells me about a new initiative to train African scientists in non-communicable disease (NCD) research. This $8.1 million NCD Open Lab is the brainchild of GlaxoSmithkline (GSK), where he is now vice president of pharmaceuticals for East Africa, but I first met him when he was an intern at a rural hospital in the foothills of Mount Kenya nearly 15 years ago. He explains to me that he now thinks of non-communicable diseases with the same urgency as he did infectious diseases back then.Like Pamba, for as long as I can remember, working as a doctor in sub-Saharan Africa, the three big catchwords were: malaria, tuberculosis, and HIV/AIDS. These diseases ravaged the sub-continent and, rightfully so, received the most funding. But while donors have poured resources into fighting infectious diseases, non-communicable, chronic diseases have quietly but rapidly ascended the morbidity and mortality ladders, especially high blood pressure, or hypertension.

Today, cardiovascular disease is the number-one cause of death in sub-Saharan Africa in adults over the age of 30. Globally, low- and middle-income countries bear 80 percent of the world’s death burden from cardiovascular disease. One of the strongest drivers is undiagnosed and untreated hypertension, which affects nearly one in two Africans over the age of 25—the highest rate of any continent in the world.

But current funding spins a different narrative. In November 2010, a Center for Global development working paper on global development assistance for health (DAH) revealed that after controlling for burden of disease, 30 times more DAH money was allocated to malaria, tuberculosis, and HIV, compared to all NCDs combined. Astonished by these numbers, I called development economist Rachel Nugent, the lead author of that study, who is now director of the Disease Control Priorities Network, funded by the Bill and Melinda Gates Foundation.

Though Nugent has not officially updated the numbers since her 2007 calculations, she has insight into current trends, and says that assistance for NCDs is increasing, but slowly. Nugent agrees with Pamba that sub-Saharan African countries recognize that hypertension and cardiovascular disease are priorities, but the lack of funding is a major barrier. “Without a doubt the perception of what causes and who gets chronic disease is a barrier to donor investment,” Nugent says. “Donors don’t say it, but I am quite convinced that in the backs of the minds of those in wealthier countries is that NCDs are for rich, fat white men. It’s not something poor children and adults get—but that’s wrong. That perception that it’s people’s own fault and that you can’t change behavior may seem believable, but that doesn’t accord with the facts.”As Nugent insinuated, hypertension in this population is not exclusively a lifestyle issue; studies have shown that sub-Saharan Africans may be genetically predisposed as well. One hypothesis is that certain African populations may be more vulnerable to salt retention, resulting in more drug-resistant hypertension that strikes at a younger age. This idea is not new. Pamba shares a personal story from his youth: “I’m from western Kenya. My father had hypertension. He came home one day with an article showing hypertension is increased in our population because of a certain gene. When I reflect on that now, it means someone was thinking about this all the way back in the 1980s!”

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