Chronicity and control: framing ‘noncommunicable diseases’ in Africa

Abstract

This paper proposes a way of framing the study of ‘noncommunicable diseases’ within the more general area of chronic conditions. Focusing on Africa, it takes as points of departure the situation in Uganda, and the approach to health issues developed by a group of European and African colleagues over the years. It suggests a pragmatic analysis that places people's perceptions and practices within a field of possibilities shaped by policy, health care systems, and life conditions. In this field, the dimensions of chronicity and control are the distinctive analytical issues. They lead on to consideration of patterns of sociality related to chronic conditions and their treatment.

Keywords:

• chronicity
• noncommunicable disease
• chronic disease
• Africa
• Uganda
• AIDS
• diabetes
• disability
• medical anthropology

Acknowledgements

Thanks to the editors for suggestions and to the reviewer who wrote several pages of useful comments.

Conflict of interest: none.

The paper was presented at the conference ‘Medical Anthropology in Europe’ funded by the Wellcome Trust and Royal Anthropological Institute.

Notes

1. The WHO uses both concepts seemingly as complements to one another. It emphasizes structural determinants: ‘negative effects of globalization, for example, unfair trade and irresponsible marketing, rapid and unplanned urbanization and increasingly sedentary lives’ as well as poverty (WHO 2011, 33). And it stresses population-level structural interventions such as regulation. But it also recommends health education and raising public awareness about diet and physical activity, interventions that assume that knowledge will motivate people to change their lifestyles (WHO 2011, 56)

2. Chronic illness is itself a ’technical term’ that came into biomedical discourse as a category in the inter-war years (Armstrong 1990).

3. PEPFAR (the US President's Emergency Plan for AIDS Relief) initially committed 15 billion dollars to fight AIDS over five years (2003–2008) and was renewed and expanded in 2008. The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2002, is another prominent funder of AIDS interventions.

4. ‘Prescribing by Numbers’ was the term Jeremy Greene (2006) adopted for the pattern of starting medication when test values reach a certain established (and adjustable) threshold.

5. The Uganda Diabetes and Hypertension Association, the Uganda Heart Research Foundation, and the Uganda Cancer Society are currently receiving support from Danida to form an NCD alliance in the country.