**3. Poverty in Africa**

Poverty is a multidimensional concept. According to the United Nations Development Programme (UNDP), poverty is not only the lack of income necessary to meet food and non-food needs (clothing, energy, housing) but also a lack of basic human capabilities (illiteracy, malnutrition, reduced life expectancy, poor maternal health, illness) [7]. Therefore poverty should not be considered only under the spectrum of financial income; as a result, the concept of poverty is difficult to quantify. But for a global assessment of poverty, a monetary scale has been developed as a common denominator between the different regions of the world in

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associated complications [12].

contributions [13].

*Lifestyle and Epidemiology: Poverty and Cardiovascular Diseases a Double Burden in African…*

order to be able to assess poverty. According to the World Bank, the poverty line is considered to be 1.90 dollars per day per inhabitant since 2011 [8]. In 2015, the rate of the world's population living in poverty was 10%, representing 736 million people, more than half of whom live in SSA, on less than US\$1 a day [8, 9]. The advent of industrialization in China and India tremendously decreased the poverty rate unlike in SSA where progress in poverty has been limited. Of these 736 million poverty stricken population living on earth in 2015, 80% resided in SSA [10]. According to the World Bank's estimates, the global poverty rate slightly dipped to 8.6% in 2018. No isolated figure was reported for SSA. But since 2018, the World Bank has repeatedly reported that SSA will consistently record a poverty rate of at least two figures till the year 2030 unless very drastic interventions are put into

In several SSA countries, the direct care costs, are high in relation to household income, a major factor in poverty. The cost of HIV/AIDS treatment for an adult, combined with the loss of income due to absence from work, can push an entire household below the poverty line. Therefore, just as good health can stimulate economic growth, poor health can lead to poverty from which it is very difficult to escape. The vicious cycle of poverty and poor health is observed in many African countries. About 76% of people in SSA have an income of less than US\$2 per day and 46.5% have an income of less than US\$1.08 per day [9]. While poverty has been declining in other parts of the world such as East and South Asia over the two decades the trend is clearly reversed in SSA. Between 1981 and 2001, the domestic product of SSA countries fell by 13% and the number of people in this region living on less than US\$1 per day doubled from 164 million to 314 million. While Africans accounted for only 16% of the world's poor population in the year 1985, the propor-

*DOI: http://dx.doi.org/10.5772/intechopen.95785*

place to address the problem of poverty in SSA [10].

tion rose to 31% by 1998, and this trend is expected to continue [9].

**4. Cost of management of cardiovascular disease in Africa**

In Africa, the cost of management is variable. With regard to hypertension, the overall average daily cost of drug treatment for uncomplicated hypertension is estimated at 368 ± 234.6 FCFA, i.e. 0.68 ± 0.44 dollars, representing more than a third of the daily income (1.90 dollars) [11]. In view of the cost of treatment, the absence of symptoms associated with hypertension is often the cause of non-adherence to treatment. Also, some patients who often reach the stages of complications of CVDs often experience the cost of treatment increased by the additional cost of treating the

In Africa, 60–70% of health expenditure is paid by households directly to health facilities, compared to a global average of 46%. This may be due to the preponderance of the informal sector (farmers, craftsmen,…) which groups together more than 70% of the African population who are not covered by health insurance. Contrary to those in the informal sector, some African governments are setting up compulsory health insurance systems for the formal sector, civil servants or employees of private companies, financed through employee and employer

**5. Poverty, malnutrition and cardiovascular disease: a vicious cycle**

Poverty is one of the socio-economic factors at the root of malnutrition in Africa. The prevalence of malnutrition in SSA rose from 181 million in 2010 to 222 million in 2016 [14]. Poverty and malnutrition are part of a vicious circle. Poverty

*Lifestyle and Epidemiology: Poverty and Cardiovascular Diseases a Double Burden in African… DOI: http://dx.doi.org/10.5772/intechopen.95785*

order to be able to assess poverty. According to the World Bank, the poverty line is considered to be 1.90 dollars per day per inhabitant since 2011 [8]. In 2015, the rate of the world's population living in poverty was 10%, representing 736 million people, more than half of whom live in SSA, on less than US\$1 a day [8, 9]. The advent of industrialization in China and India tremendously decreased the poverty rate unlike in SSA where progress in poverty has been limited. Of these 736 million poverty stricken population living on earth in 2015, 80% resided in SSA [10]. According to the World Bank's estimates, the global poverty rate slightly dipped to 8.6% in 2018. No isolated figure was reported for SSA. But since 2018, the World Bank has repeatedly reported that SSA will consistently record a poverty rate of at least two figures till the year 2030 unless very drastic interventions are put into place to address the problem of poverty in SSA [10].

In several SSA countries, the direct care costs, are high in relation to household income, a major factor in poverty. The cost of HIV/AIDS treatment for an adult, combined with the loss of income due to absence from work, can push an entire household below the poverty line. Therefore, just as good health can stimulate economic growth, poor health can lead to poverty from which it is very difficult to escape. The vicious cycle of poverty and poor health is observed in many African countries. About 76% of people in SSA have an income of less than US\$2 per day and 46.5% have an income of less than US\$1.08 per day [9]. While poverty has been declining in other parts of the world such as East and South Asia over the two decades the trend is clearly reversed in SSA. Between 1981 and 2001, the domestic product of SSA countries fell by 13% and the number of people in this region living on less than US\$1 per day doubled from 164 million to 314 million. While Africans accounted for only 16% of the world's poor population in the year 1985, the proportion rose to 31% by 1998, and this trend is expected to continue [9].
