African Studies: Health 283
Table 3 Life expectancies and average increases for the major regions of Africa, 1950–2000
Life expectancy at birth (years)
West Africa Middle Africa East Africa
1950–55 36 36 36
1960–65 40 40 41
1970–75 43 44 45
1980–85 46 48 47
1990–95 49 51 45
1995–2000 50 50 45
Source: As for Table 1.
disease affecting that age group, poor weaning practices, and
unsatisfactory foods available for weaning.
Why Did Health Improve?
It seems likely that life expectancy climbed by about 15 years
between the 1880s and the early 1950s, and then by another 11
years in the next three decades. The reasons are complex, and
the use of modern medicine is only part of the story.
Much of the explanation for mortality decline in the first
period was probably the organization brought about by
colonial governments. Inter-ethnic and individual violence
probably declined. People were separated from others when
plague struck, and from wild animals to curb sleeping sick-
ness. Roads and railways helped to usher in a market economy
which distributed food, and medicine, more widely. Capi-
talism and education increased individualism and made it
likely that greater initiatives would be taken to prevent or cure
illness. Immunization, led by smallpox vaccination, eventu-
ally brought the great epidemic diseases under control. Yellow
fever has almost vanished, and cholera levels have declined.
Digging drains and oiling stagnant water reduced malaria in
towns, and mosquito nets partly protected colonial and local
elites.
There was a slow spread of government and missionary
hospitals. Although there is debate about the impact of modern
medicine on poor, predominantly rural societies, a comparison
of two areas of similar socioeconomic levels in Nigeria showed
that the one which had possessed for a generation a small,
adequately staffed and supplied hospital offering free services
was characterized by a life expectancy 12 years greater than the
area with no facilities (Orubuloye and Caldwell, 1975). The
treatment of water supplies, usually in urban areas and often
inadequate, has improved, but is still often woefully bad. Better
sanitation and hygiene practices have doubtless also reduced
mortality. By the 1990s, Demographic and Health Surveys were
reporting that about half of all countries had a majority of
children immunized against tetanus, diphtheria, and pertussis
(whooping cough), while the coverage against measles (a
major killer in the region) was increasing and the incidence of
poliomyelitis was declining steeply. But morbidity and
mortality from diarrhea and pneumonia were still high.
Malaria was almost as bad as ever, although many lives were
saved by the use of drugs, and HIV/AIDS was presenting
a horrific challenge.
Average annual increase in life expectancy since
previous period (years)
Southern Africa West Africa Middle Africa East Africa Southern Africa
44 – – – –
49 0.4 0.4 0.4 0.5
53 0.3 0.4 0.4 0.4
56 0.3 0.4 0.2 0.3
59 0.2 0.3 –0.2 0.3
54 0.2 –0.1 –0.2 –0.9
Health at the Dawn of the AIDS Era
By the early 1980s sub-Saharan African life expectancy was 48
years, having increased by seven years in the previous decade,
and seeming to promise similar gains to come. This was not to
be so, because of problems in funding the health system and
the emergence of the AIDS epidemic. In contrast to most of Asia
and North Africa, female child mortality was as low as that of
males. There were significant mortality differentials by region
(with mortality lowest in Southern Africa), ethnic group (even
when neighbors), parental education (with mother’s education
being more important for child survival than father’s educa-
tion), by occupation (with farmers’ death rates highest), and by
residence (with urban health better). Mortality was highest in
countries like Ethiopia and Mozambique where civil unrest and
war had disorganized the health and other systems. It was also
higher in the drought-prone savanna countries, but no higher
than would be expected from their relatively low income and
educational levels, which were in turn the product of impov-
erished agricultural resources. Drought still visited these lands
regularly but evidence accumulated that, although it caused
much distress and livestock loss, excess human mortality was
less than might have been anticipated because of the scale of
migration to better-off areas and towns.
Information on the nature of illness and the causes of death
is still meager because so few people are seen by doctors or
die in hospitals. By the 1980s the great epidemic diseases
were largely under control. Campaigns, which mostly proved
successful, aimed at eradicating onchocerciasis (river blindness),
and some progress was being made against schistosomiasis
(bilharziasis). Malaria, particularly its worst form, falciparum
malaria, was almost universal, moderated only in the highest
parts of East and Southern Africa by lower temperatures and in
South Africa by a more temperate climate and successful
eradication. A Gambian study revealed malaria to be the
dominant cause of illness, except among children under 3
months of age, who were relatively free of it. Research in
Tanzania showed that 31% of the sick were suffering from
malaria, 13% respiratory infections and 7% diarrhea.
A major World Bank/Harvard University study (Murray and
Lopez, 1997) of global mortality estimated that 65% of
the region’s mortality was still attributed to communicable,
congenital, maternal, and nutritional causes (compared with
51% in India, 42% in all developing countries, and 6% in
developed countries), 23% by non- communicable disease,
mostly cardiovascular and cancer (compared with 40%