Men's Health in Africa. Part 2: Non-communicable diseases, malignancies and socio-economic determinants of health
While recognizing that the geographic designation 'Africa' does not imply a homogeneous race or population, and that the concept 'men's health' is not clearly defined, the aim of this paper is to review the non-communicable diseases and socio-economic determinants affecting the health of African men. It is clear that Africa bears a disproportionate burden of disease in relation to health care funding, with the highest disease burden (measured in disability-adjusted life years) being in sub-Saharan Africa (21.4% of the global total). Many parts of Africa are exposed to a wide range of disasters, such as drought, desertification, infectious disease epidemics and armed conflicts, leading to poverty, malnutrition, environmental degradation, lack of economic development, and large refugee populations. Although malignant neoplasms do not form a major portion of the disease burden in Africa, certain types of cancer (primary hepatocellular and esophageal carcinoma) are much more common than in other parts of the world, most probably due to dietary carcinogens. With the advent of the human immunodeficiency virus (HIV) epidemic there has been a dramatic increase in the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma. Penile carcinoma is relatively more common, but testicular germ tumors are much less common in Africa than in other parts of the world. In many of the large urban centers there is an increasing mortality among young males due to road traffic accidents and the use of firearms, with a male:female ratio as high as 10:1 in some cities. Armed conflicts in several parts of Africa have left a legacy of physically and psychologically traumatized survivors, with a high prevalence of post-traumatic stress disorder and depression, leading to alcohol and drug abuse. Refugee and migrant populations in sub-Saharan Africa have increased dramatically, due to the partisan nature of African politics in many countries, and the incapacity to manage ecological degradation. In the USA, African-American men bear a greater burden of diet and lifestyle-associated conditions such as diabetes mellitus, hypertension, obesity and cardiovascular disease. There is an increasing prevalence of hypertension among urban black men in sub-Saharan Africa, probably related to dietary factors such as increased salt intake and obesity. Many developing countries in Africa are experiencing a transition from diseases of poverty, such as malnutrition, infective and parasitic diseases, towards chronic conditions, such as hypertension, diabetes mellitus, obesity, ischemic heart disease, stroke, chronic obstructive lung disease and lung cancer, which increasingly contribute to premature mortality in men. © 2008 WPMH GmbH.