Sub-Saharan Africa and the 2019 Global Burden of Disease Study: celebratory with a note of caution.

Blog 11 Dec 2020
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The recent Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) show positive trends for global life expectancy, healthy life expectancy, mortality, and universal health coverage in sub-Saharan Africa. It also highlights the need for a focused response to the growing burden of non-communicable diseases and injuries.

Between 2010 and 2019, the region showed a net increase in population growth of 2.6% (uncertainty interval [UI] 2.5-2.7). This was due to a combination of an increase in live births (23.7% (UI 23.3-24.1 in 1990 compared to 27.1% (UI 26.4-27.8) in 2019) and a reduction in deaths in children under five years (4% (UI 2.8- 5.3) reduction in deaths compared to estimates in 2010). In 2019, the life expectancy in the region was currently 64.5 (UI 62.8- 65.9) years with a healthy life expectancy of 57.4 (UI 54.8- 59.8) years. This progress is attributed to strong, long-term global policies and strategies focused on communicable diseases, maternal, neonatal, and nutritional health.

The study also highlights the rapid epidemiological transition in the profile of disease burden profile dominated by non-communicable diseases and injuries. The burden of disease due to NCDs and injuries, measured by proportion of total disability-adjusted life-years (DALYs), has increased from 37.8% in 1990 to 66.0% in 2019. Most countries are seeing an increase in numbers of years spent in poor health, even though both life expectancy at birth and healthy life expectancy has improved in the same period.

Health systems are struggling to cope with this shift as policies and health interventions do not reflect this transition. Despite an average of 2·6% [1·9–3·3] increase in effective universal health coverage index, per year since 2010, the performance of coverage indicators for non-communicable diseases consistently lag those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of the potential health gains in 2019.

While improvements in universal health coverage is welcome, focusing on effective coverage of interventions that address the evolving health needs is crucial. Research into integrated health systems for infectious and non-communicable diseases should be accelerated. The recent spate of epidemics, disasters and civil unrest will be an additional test of the resilience of global commitments to universal health coverage.