Report warns cardiovascular disease in Africa is a “time bomb waiting to explode”

More air pollution monitoring and research across Africa is urgently needed to avoid cardiovascular diseases (CVDs) overtaking infectious diseases as the leading cause of death on the continent according to a new report.

Experts from the Universities of Edinburgh and Essex, working in collaboration with the World Heart Federation (WHF), warn that a lack of monitoring and research is preventing evidence-based policies and interventions, tailored to African communities, that could save lives.

The paper, published in the Journal of the American College of Cardiology: Advances, was led by Professor Mariachiara Di Cesare and Marvellous Adeoye from the Institute of Public Health and Wellbeing at the University of Essex and Dr Mark Miller from the University of Edinburgh.

Their paper reviewed existing research on the links between air pollution and CVDs in Africa to establish what is currently understood and identify gaps requiring further study.

They found that only six academic studies have been completed on the impact of air pollution on CVDs for the continent, with the majority focusing on urban populations in South Africa, making it difficult to determine the true health impact of air pollution.

Their paper also reveals that just 24 of the 54 African nations are set up to measure air quality in some capacity.

The study comes on the back of the WHF’s 2024 global report, published in May, which highlighted that only 30 per cent of countries in Africa are legally required to monitor air quality and only 18 per cent are obliged to report on their findings.

The scarce monitoring and research that does exist has shown that air pollution and CVDs across Africa are rising, meaning understanding the role of air pollution is vital for reducing its harm. In a single year (2019) there were more than a million deaths from CVDs in Sub-Saharan Africa alone, a figure this report’s authors warn is likely to be an underestimate given the lack of monitoring.

Professor Di Cesare, who is a member of the WHF's World Heart Observatory expert group, added: “This is a time bomb waiting to explode. With a population of over one billion, an increasing burden of cardiovascular diseases, and with half of the population expected to live in urban settings in just a decade from now, the region is at high risk of experiencing an unfair burden of cardiovascular mortality and morbidity due to the exposure to air pollution.”

The publication is especially timely as world leaders meet for the COP29 conference in Azerbaijan.

“We need to act now to avert global environmental crises such as climate change and air pollution. Health needs to be at the forefront of strategies. Political commitment needs to be greater and have more urgency, with significantly greater support for low and middle income countries,” added Professor Di Cesare.

Dr Miller, who is Chair of Air Pollution and Climate Change Expert Group at the WHF, said: “Air pollution damages health all across the world. However, low- and middle-income countries face some of the highest air pollution, in addition to many other stresses on health and a lack of access to good medical care. Africa in particular is likely facing major air pollution challenges which will have a huge toll on cardiovascular health.

“To save lives we need better data, so that different sectors, policymakers and communities can come together to identify more effective methods to improve air quality in those regions and put support in place to improve cardiovascular health and protect those who are particularly vulnerable.”

The authors recommend:

• Better monitoring in different regions and with more detailed characterisation of the sources of air pollution.
• Examining exposure to air pollutants in different settings, both urban and rural, as well as risk variations in different communities.
• Measuring out-of-hospital ill-health events as well as clinical outcomes and understanding both short- and long-term connections between air pollution and cardiovascular health.
• Establishing the efficacy of different mitigation strategies to reduce emissions and exposure, and tailored advice guidelines.

The report was funded by the Clean Air Fund.

Read the report: The Impact of Air Pollution on Cardiovascular Health Outcomes in African Populations: A Scoping Review.