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Analytical summary - Social determinants

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Understanding the significance of broad health determinants is essential, given the wide range of potential risk factors in African countries and the increasing numbers exposed to them. The population of Africa is likely to double by 2036. At present, life expectancy is below 50 years in many countries, while the population on average is increasing at around 2.5% annually. With 10% of the world’s population, Africa can claim almost 30% of the global poor, most of whom live in sub-Saharan Africa.

Percentage annual growth rate of population in the WHO African Region, 1989–1999 and 1999–2009

Urbanization has occurred very rapidly in the past 30 years, with projections that by 2025, 60% of the population of Africa will live in cities. However, due to natural, social and political phenomena, urbanization has been largely unplanned and has failed to contribute significantly to economic growth. Infrastructural deficiencies have also hampered economic development.

Confronting high levels of poverty, malnourishment and inequity, a large fraction of the population faces major health problems without the means to treat them. The poor face greater health risks and pass them on intergenerationally; they also have lower survival rates.

Breaking this vicious circle would require reducing economic and social inequalities, thereby serving the cause of justice as well as that of health and development. Removing the handicap of ill health from the poor offers the best potential for improving the health status of the population as a whole. In other words, health is a driver of poverty reduction, as well as vice versa.

To complement investment strategies in health, other measures have been understood as critical to development in Africa. These include gender equity in education and employment, enhanced educational completion rates for boys and girls alike, and addressing the environmental determinants of health which expose the poor relentlessly to both infectious and noncommunicable diseases. A higher level of investment by African countries in science and technology is also required – this averaged only 3% in sub-Saharan Africa in 2008.

Multiple internally and externally supported initiatives are currently under way in Africa, addressing the myriad health development problems and strengthening health systems so that they can deliver effective health programmes. Rapid advances are needed, but should not outpace the capacity of national and local systems and institutions to keep pace with innovation. Likewise, the role of health ministries and health governance should be strengthened, if effective policies and strategies created with understanding of the broader determinants of health are to be implemented as a contribution to economic and social development strategies in the WHO African Region.