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Author: Marvellous Adeoye, Global health researcher, University of Essex
Original article: https://theconversation.com/heart-attacks-and-high-blood-pressure-are-on-the-rise-in-africa-what-does-air-pollution-have-to-do-with-it-243816
Air pollution has an alarming effect on global health. In 2019, it was responsible for 4.2 million global deaths. Inhaling air pollution harms health in many different ways beyond simply having effects on the lungs. Over 70% of air pollution deaths are due to cardiovascular diseases – diseases of the heart and blood vessels, such as heart attacks and strokes.
For many years, cardiovascular diseases were considered to be more of a problem of more prosperous countries, but this is not the case anymore.
In Africa cardiovascular diseases are now the second leading cause of death after respiratory infections and tuberculosis. The numbers of cardiovascular deaths are much higher in low-income countries where access to diagnosis and treatment is limited by resources available. But where does air pollution fit in?
Scientists Marvellous Adeoye, Mariachiara Di Cesare and Mark Miller explain what is known and what isn’t about air pollution and cardiovascular health in Africa.
How big is the burden of cardiovascular deaths in Africa?
While infectious diseases remain a major concern in Africa, cardiovascular disease cases are increasing, especially in urban areas. Between 1990 and 2019 cardiovascular diseases jumped from being the 6th leading cause of death in sub-Saharan Africa to the 2nd highest. The most recent figures show that in the same period the number of cardiovascular deaths in the region has increased from 650,000 to 1.2 million.
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Air pollution in fast-growing African cities presents a risk of premature death
Factors contributing to the increase in cardiovascular deaths include changes in lifestyle, a shift to living in urban settings, and a growing and increasingly older population.
An additional problem is that the region is not ready to address the increasing numbers of cardiovascular cases. Africa is experiencing a dramatic shortage of cardiovascular specialists. In 2018 the region had only around 2,000 cardiologists for the entire continent of 1.2 billion people.
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How bad is air pollution in Africa?
While air pollution is now beginning to decline at a global level, there are huge regional variations, with air quality still deteriorating in many low- and middle-income countries, including countries in Africa.
Estimates of levels of air pollution show that they are high in Africa and getting worse, especially in urban areas. Levels of air pollution are, on average, three times higher than those observed in high-income regions such as Europe. Overall, 60% of African countries experienced an increase in airborne pollution particles between 2010 and 2019.
Common sources of air pollution in Africa include vehicle emissions and industrial activities, as well as the burning of agricultural waste after harvesting. The use of solid fuels in homes like wood, charcoal and dried animal dung also releases pollutants into the atmosphere.
This mixture of air pollution can generate a range of air pollutants which can affect health in different ways. Pollutants include airborne particles of various sizes, and gases such as nitrogen dioxide, ozone, carbon monoxide and sulphur dioxide.
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What’s missing?
Research in other regions of the world clearly shows that air pollution has an impact on cardiovascular health. However, the evidence from Africa is limited due to both a lack of air quality data – just 24 of the 54 African nations are set up to measure air quality in some capacity – and studies that look at the health consequences.
Our research found only six academic studies exploring the impact of air pollution on cardiovascular diseases in the region. The majority focus on urban populations in South Africa.
This makes it difficult to determine the health impact of air pollution across Africa as a whole.
Still, our review identified studies showing clear associations between several air pollutants and increased cardiovascular hospitalisations and death.
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Air pollution and temperature: bad for your heart and blood vessels
What needs to be done?
There is a critical need to expand air quality monitoring across the continent, and then to use this data to assess the links between different air pollutants and cardiovascular disease.
We need data from different countries in Africa and both urban and rural locations. This will enable policymakers to target regulations and public health interventions.
Public health education is also essential to raise awareness about lifestyle risk factors and the health impacts of air pollution. It will allow individuals to take steps to reduce their exposure and improve their cardiovascular health.