LONG VALLEY, New Jersey — Over one billion people in the world suffer from high blood pressure, one of the leading risk factors for non-communicable diseases such as stroke and heart disease. It is most prevalent in sub-Saharan Africa, where one in two residents over 25 are affected by hypertension.
Though hypertension has been a hidden killer for years, the hypertensive percentage of the population continues to increase and doctors predict that the death toll from chronic diseases like diabetes, cancer and especially hypertension will exceed the death toll from HIV and malaria combined in the next 15 years.
According to Dr. Catherine Kyobutungi, health director for the African Population Health Research Centre in Nairobi, high blood pressure in the African population is attributable to many factors. In the western world, blood pressure raises with aging, along with decreased exercise, increased weight and increased salt-intake. As Africans earn more income, move from fields to cities and spend more money on food, their risk factors begin to mirror that of the western population.
These problems are felt more acutely in the continent’s urban areas, including Lagos where the rapidly expanding population has reached 10 million inhabitants. The Lagos State Commissioner for Health, Dr. Jide Idris, claims that urbanization brings risks in addition to sedentary lifestyles and unhealthy diets. “City life has implications for levels of stress and loss of family cohesion as well. It is not just a rich man’s problem. Hypertension cuts across gender and socioeconomic status,” he says.
But the problem in Africa is not so much dangerously high blood pressure as it is that people are not aware of the necessity for or are unable to afford regular blood pressure checks. Kyobutungi says that in any given African hospital, you are more likely to find out your HIV status and get tested for malaria than have your blood pressure measured. Non-communicable diseases, such as hypertension, do not receive the money, supplies and training from donors that are poured into malaria and HIV/AIDS.
In the Nigerian health system, diagnosis and treatment for hypertension are only offered to those who are willing to pay for it. For a patient to have their blood pressure checked, it costs approximately $6.36, a fee that often deters people from finding out their blood pressure status. In addition, fewer than four percent of Nigerians are covered for basic and essential health services by insurance.
Kyobutungi executed a simple plan to solve this problem. In 2008, she sent a team of health workers to visit the inhabitants of Korogochu and screen them, explain their blood pressure results and offer medication if needed. Although the screening was completely free, only three percent of the 1,000 hypertensive patients accepted the free treatment.
People are simply unaware of the health consequences or indifferent to the risks of untreated hypertension in the developing world. Raising public awareness of high blood pressure is critical in order to convince the population to be tested, monitored and treated. In light of this discovery, Kyobutungi altered her plan. In collaboration with the Health Research Center, Kyobutungi promised to pay community health workers an extra 100 shillings, or about a dollar, for every patient screened that came to the clinic for treatment. If the patient came back a second time, the Health Research Center paid them an extra 50 cents.
Another reason that this epidemic is considered “silent” is because Africans associate non-communicable diseases, such as high blood pressure, with high-income countries and affluence. But according to Harvard professor Dr. Thomas Gaziano, “in some of the countries, it is no longer silent, they’re waking to it. Others are still not sure that this is the problem they need to be dealing with.”
While very little has been done to address hypertension in the developing world and throughout Africa, the hidden killer has begun to reveal itself as awareness and responsiveness to high blood pressure gradually increases.
– Abby Bauer
Sources: NPR, Global Post, WHO