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In recent decades, the WHO African Region has fallen behind world averages in respect of health and human development, with sobering effects on health status and trends. The heavy burden of infectious disease, particularly the HIV/AIDS pandemic, is without doubt a major factor accounting for lowered life expectancy at birth in recent decades, coupled with steadily increasing rates of noncommunicable diseases as countries make economic and social transitions to modern lifestyles.

With up to 62% of Africans living in slum conditions where traditional and modern lifestyle hazards intersect, it is hardly surprising that the WHO African Region leads the world not only in dropping life expectancy rates but also in mortality and burden of disease ratios.


The massive drop in life expectancy at birth in certain countries can certainly be explained by HIV/AIDS and related diseases. However, it has been possible for other countries to achieve a significant increase in life expectancy at birth since 1990, demonstrating that progress is feasible and possible. But with a regional average life expectancy of 53 years, African populations can expect about 15 fewer years of life than the global average.

The trend for women is only slightly greater than that of men, pointing to factors that affect women in particular. And measured according to the healthy life expectancy at birth method, the WHO African Region average drops by a further 7 years.

Mortality ratios remain the highest in the world, with spectacular leaps since 1990 experienced in a handful of countries hardest hit by health and political catastrophes. Progress has been made in lowering the mortality rates of children aged under 5 years (see figure), but this has been insufficient to meet the Millennium Development Goals target. The same is true for maternal mortality, although some countries have achieved a significant reduction since 1990.

Under-five mortality rate per 1000 live births, WHO Regions, 1990 and 2007

Burden of disease figures in the WHO African Region are also higher than in other WHO Regions (Regional Offices) by a considerable margin, with HIV/AIDS, lower respiratory tract infections, diarrhoeal disease and malaria responsible for most ill health. The rapidly increasing share of noncommunicable diseases in the Region poses an enormous challenge, as weak and overstretched health systems are now faced with the need to identify effective interventions and services to deliver on this double burden.

In these circumstances, learning lessons from countries that have achieved success despite the difficulties of the past two decades, and applying them elsewhere, will be crucial. Working closely with sectors responsible for the key determinants of health is paramount if the current health trends are to be positively influenced. Making the optimal choices in terms of budgeting and service delivery in order to meet the hugely disparate needs of Africa’s rural, urban and slum dwellers is fundamental to increasing the duration and quality of life across the continent.


With its population of over 730 million people spanning 46 countries, the WHO African Region accounts for approximately one seventh of the world’s population – a population growing annually at a rate of 2.5%. Nigeria, with its population of over 150 million, represents Africa on the list of the top 10 most populous countries in the world.

The WHO African Region lags behind other regions of the world in terms of health and human development. A powerful contributory reason for this is the very heavy burden of infectious disease experienced in African countries, particularly the interrelated group of HIV/AIDS, tuberculosis and malaria. Concomitantly, a rapid expansion of noncommunicable disease is taking place in many of these countries.

This double demand on often weak, underfunded and overstretched health services is shown in the health status and trends observed in many African countries.