March 2001 Insights Health Issue #1

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Class divide: education and NCD risk factors in Cameroon

The burden of many NCDs, particularly cardiovascular disease, diabetes and lung cancer, tends to increase with economic development. However, in wealthier countries, the greatest burden of NCDs falls on the poor. Who is most at risk in developing countries - the rich or the poor?

One theory proposes that as countries become wealthier the burden of NCDs passes like a wave across socio-economic groups: starting with the richest and moving to the poorest. A study by the Universities of Yaoundé, Cameroon, and Newcastle Upon Tyne, UK, suggests that this view is over-simplistic and misleading. A team of epidemiologists and endocrinologists are studying the patterns of NCDs within the overall disease burden in Cameroon and the response of health services. They assessed a range of NCD risk factors:

• blood pressure

• height and weight

• waist and hip circumferences

• physical activity

• alcohol intake

• tobacco smoking (people 15+ years old)

• blood glucose after fasting (a subset of people 35+ years old).

They related these risk factors to measures of poverty and personal, household, and socio-economic status. They also recorded the incidence of diagnosed high blood pressure and diabetes and the level of care that patients receive. Preliminary results show a complex picture, particularly relating to education: some risk factors are more prevalent in the poor or illiterate; for others the reverse is true. For example:

• High blood pressure is strongly associated with illiteracy and fewer years of education in both men and women (Figure 1).

• Conversely, body mass index (BMI) and obesity are highest in those with most years of education (Figure 1).

• For women, elevated blood glucose levels (a sign of possible diabetes) are more common in the lowest education groupings.

• Alcohol consumption is highest in both men and women with more education; the reverse is true for smoking.

These preliminary data show that simplistic notions of NCDs as diseases of affluence are false. Risk factors exist across the socio-economic spectrum in urban areas and for some are highest among the poor and illiterate.

Jean-Claude Mbanya
Diabetes and Endocrine Unit
Department of Internal Medicine
Faculty of Medicine & Biomedical Sciences
University of Yaoundé I
BP 8046 Yaoundé
Cameroon
T: + 237 31 52 35
F: + 237 31 52 35
jean-claude.mbanya@camnet.cm