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THE CONTINUING
EPIDEMIOLOGICAL TRANSITION
IN SUB-SAHARAN AFRICA
A Workshop Summary
Thomas J. Plewes and Kevin Kinsella, Rapporteurs
Committee on Population
Division of Behavioral and Social Sciences and Education
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the
Steering Committee for the workshop were chosen for their special competences and with regard for
appropriate balance.
This study was supported by the National Institutes of Health Award N01-OD-4-2139, Task Order 227 to
the National Academy of Sciences. Any opinions, findings, conclusions, or recommendations expressed in
this publication are those of the author(s) and do not necessarily reflect the views of the organizations or
agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-26648-2
International Standard Book Number-10: 0-309-26648-3
Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW,
Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Research Council. (2012). The Continuing Epidemiological Transition in sub-
Saharan Africa: A Workshop Summary. Thomas J. Plewes and Kevin Kinsella, Rapporteurs. Committee on
National Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The
National Academies Press.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged
in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the
general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate
that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president
of the National Academy of Sciences.
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Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection
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The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs,
encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is
president of the National Academy of Engineering.
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eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public.
The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be
an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and
education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad
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providing services to the government, the public, and the scientific and engineering communities. The Council is
administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest
are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
.
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STEERING COMMITTEE ON THE CONTINUING
EPIDEMIOLOGICAL TRANSITION IN SUB-SAHARAN AFRICA
BARTHÉLÉMY KUATE DEFO (Chair), University of Montreal
AYAGA A. BAWAH, INDEPTH Network, Accra, Ghana
LISA F. BERKMAN, Harvard University School of Public Health
ALAN D. LOPEZ, School of Population Health, University of Queensland, Australia
JANE MENKEN, Institute of Behavioral Science, University of Colorado
JULIE KNOLL RAJARATNAM, Institute for Health Metrics and Evaluation,
University of Washington
STEPHEN TOLLMAN, University of the Witwatersrand, Johannesburg, Republic of
South Africa
STIG WALL, Umeå University, Umeå, Sweden
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COMMITTEE ON POPULATION
LINDA J. WAITE (Chair), The University of Chicago
CHRISTINE BACHRACH, Duke University
JERE R. BEHRMAN, University of Pennsylvania
PETER J. DONALDSON, The Population Council
KATHLEEN MULLAN HARRIS, The University of North Carolina at Chapel Hill
MARK D. HAYWARD, University of Texas at Austin
CHARLES HIRSCHMAN, University of Washington
WOLFGANG LUTZ, International Institute for Applied Systems Analysis
ROBERT D. MARE, University of California, Los Angeles
SARA S. McLANAHAN, Princeton University
BARBARA BOYLE TORREY, Independent Consultant
MAXINE WEINSTEIN, Georgetown University
DAVID R. WEIR, University of Michigan
JOHN R. WILMOTH, University of California, Berkeley
Staff
BARNEY COHEN, Director (until August 15, 2012)
THOMAS J. PLEWES, Interim Director
KEVIN KINSELLA, Senior Program Officer
BARBARA BOYD, Administrative Associate
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Contents
Acknowledgments
1 Introduction 1
2 The Changing Context of the Transition in sub-Saharan Africa 4
3 Mortality and Causes of Death 6
4 Risk Factor Transitions: Exposures and Comparative Risk Assessment 8
5 The Role of Migration 10
6 Health Financing in sub-Saharan Africa 12
7 Data Collection and Validation in Resource-Poor Settings 14
8 The Epidemiological Transition in Africa: Are There Lessons from Asia? 17
9 Future Research Directions 19
References 22
Appendixes
A Workshop Agenda 25
B Participant List 30
C Biographical Sketches of Steering Committee Members and Presenters 34
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Acknowledgments
This report summarizes the presentations and discussions from a workshop
convened in October 2011 that featured invited speakers on the topic of epidemiological
transition in sub-Saharan Africa. The workshop was organized by a National Research
Council (NRC) panel of experts in various aspects of the study of epidemiological
transition and of sub-Saharan data sources. The panel provided invaluable guidance in
developing the workshop, in securing expert presentations, and in conducting the
workshop. Although the panel members played a central role in designing and conducting
the workshop, they did not actively participate in writing this workshop summary.
A special acknowledgement is owed to Richard Suzman, director of the Division
of Behavioral and Social Research of the U.S. National Institute on Aging, who not only
played an important role in developing and refining the workshop but also actively
participated in discussions that helped frame the issues and enhance the general
understanding of the subject matter.
The staff of the University of Witwatersrand, which hosted the conference, played
an important role in preparing for and conducting the workshop. In particular we would
like to acknowledge Stephen Tollman both for his work during workshop preparations
and for his contributions during the workshop itself, when the information and comments
he offered greatly enhanced the value of the event.
The task of describing the overall changing context for these issues was taken on
by the chair of the panel, Barthélémy Kuate Defo. Dr. Defo and the other presenters
played a critical role in the workshop, identifying the key issues in the area and laying the
basis for the robust discussions that were to follow; these discussions were also facilitated
by a series of discussants. Peter Byass, Mark Collinson, Riku Elovainio, Majid Ezzati,
Gilles Pison, and Stephen Tollman served as presenters, and their presentations were ably
discussed by Ayaga Bawah, Hosen Coovadia, Karen Hofman, Alan Lopez, Moffat
Nyirenda, Thomas Rehle, and Eric Udjo.
The panel also acknowledges the excellent work of the staff of the Committee on
Population (CPOP) and the NRC for support in developing and organizing the workshop
and providing rapporteur services for this report. The workshop was carried out under the
direction of Barney Cohen, who served as director of the Committee on Population until
August 2012. Tom Plewes and Kevin Kinsella served as rapporteurs. The panel was ably
assisted by Barbara Boyd, who handled much of the administrative load in organizing the
meeting and Danielle Johnson, who prepared the report for final production.
This workshop summary was reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise in accordance with procedures approved
by the Report Review Committee of the NRC. The purpose of this independent review is
to provide candid and critical comments that assist the institution in making its report as
sound as possible and to ensure that the report meets institutional standards for
objectivity, evidence, and responsiveness to the study charge. The review comments and
draft manuscript remain confidential to protect the integrity of the deliberative process.
The panel thanks the following individuals for their review of this report:
Chodziwadziwa Whiteson Kabudula, MRC/Wits Rural Public Health and Health
Transitions Research Unit (Agincourt), South Africa, and W. Henry Mosley, Department
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of Population (emeritus), Family and Reproductive Health, Johns Hopkins Bloomberg
School of Public Health.
Although the reviewers listed above have provided many constructive comments
and suggestions, they were not asked to endorse the conclusions or recommendations, nor
did they see the final draft of the report before its release. The review of this report was
overseen by Mark D. Hayward, Population Research Center, University of Texas at
Austin. Appointed by the NRC, he was responsible for making certain that the
independent examination of this report was carried out in accordance with institutional
procedures and that all review comments were carefully considered.
The purpose of this report is to serve as a factual summary of what occurred at the
workshop. The steering committee's role was limited to planning and convening the
workshop. The views contained in this report are those of individual workshop
participants and do not necessarily represent the views of all workshop participants, the
committee, or the NRC. Responsibility for the final content of the report rests entirely
with the rapporteurs and the NRC.
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