**3. Discussion**

The difference in lifestyle between rural and urban areas in SSA is a sociological reality known to all; however, the impact on the burden of CVRFs in these two settings has not yet been sufficiently studied. This is mainly due to the high cost of epidemiological surveys in the general population. Nevertheless, the few studies carried out in these two environments and mentioned in this chapter, although small in scope, have been able to provide some information tending to confirm the difference between these two environments.

The rural environment is characterized by its still strong attachment to the customs and mores of traditional African society where individuals are physically active, most often consuming natural foods and less exposed to stress related to the vagaries of modern society. There is therefore a low exposure to CVDFs and hence to CVDs. Conversely, progress in the fight against infections is less noticeable there, which would explain an infectious mortality even more marked than in urban areas, a residue of the era of major pandemics. All of this deserves to be documented by solid epidemiological investigations that can inform health and policy decisions. On the basis of current plot data related to CVDs and CVRFs in rural areas, it could be said that rural areas in SSA are still between the 1st and 2nd stage of the epidemiological transition following the subdivision described by Meslé and Vallin in 2007 [18], while the urban environment could be considered to be already in the middle of the 2nd stage, in view of the real decline of the infectious risk to the benefit of NCDs and their RFs.

As a reminder, the concept of epidemiological transition was launched by Omran in 1971 [19] and subdivided into three stages below by Meslé and Vallin in 2007:

• the stage of high infectious morbidity and mortality, with low life expectancy;

*Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population… DOI: http://dx.doi.org/10.5772/intechopen.96881*


This concept was supplemented by that of health transition [20], which is more global, encompassing not only the epidemiological situation but also the different responses from society to health issues.

Conversely, the urban and peri-urban environment in SSA are characterized by a tendency to sedentary lifestyle, a diet rich in sodium and calories, excessive alcohol consumption, socio-professional stress, all this in a context of poverty or social insecurity. Linked in particular to an uncontrolled rural exodus. This results in an increase in biological or physiological RFs [15, 21, 22] and a vicious circle between NCDs which exacerbate poverty and vice versa, poverty which promotes NCDs [23], poverty understood in the classic World Bank sense, namely an income of less than \$ 1.9 per day per person or the inability to afford basic minimum services.

There is growing evidence that poverty promotes NCDs, particularly through poor accessibility to treatment [24] and other health services; in low-income countries, the high prevalence of RDF of NCDs, the early onset of their complications [25–29] as well as the excess mortality associated with these diseases constitute strong arguments in favor of this link between poverty and NCDs. The following statement by Ambassador Taonga Mushayavanhu, Permanent Representative of the Republic of Zimbabwe to the United Nations Office at Geneva, within the framework of the "Dialogue on NCDs, Poverty and Development Cooperation" forum is sufficiently enlightening on the question:

"In developed countries, the population often takes advantage of multisectoral policies and plans put in place by the government to reduce exposure to risk factors and empower health systems", explains the Ambassador, who adds: "Developing countries have little capacity to fight NCDs, which leads to premature death, reduces productivity, slows economic growth and locks the most destitute in chronic poverty. In a report published in April 2013, the African Union pointed out that the exorbitant costs associated with NCDs push 100 million people into poverty each year, hampering development. Yet the tools, knowledge and strategies available today can prevent most of these diseases" [23].

It should be recalled that NCDs have already been the subject of three high-level meetings at the United Nations, in 2011, 2014 and 2018, each time bringing together the various member states of the world organization at the highest level of representation. World leaders have recognized that NCDs pose the greatest threat to health and development worldwide, especially in the developing countries. To this end, a political declaration on NCDs was adopted at the first high-level meeting.

At the Sixty-sixth World Health Assembly held in May 2013 and as part of the follow-up to the Political Declaration of the First High-Level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases, States approved the Global Plan of Action for the Control of Noncommunicable Diseases for 2013–2020 [17], whose objectives and voluntary global targets are as follows.

#### **3.1 Objectives**

1.To raise the priority accorded to the prevention and control of noncommunicable diseases in global, regional and national agendas and

activities have not been modernized, they are essentially carried out by hand and thus require their providers to have a high, regular and permanent level of physical activity. In addition, the diet contains fewer processed products than in urban areas. All this could explain the low prevalence of CVRFs in comparison to the urban environment where we find the following characteristics: tendency to sedentary lifestyle, insufficient physical activity, diet high in sugar, fat and salt, stress psy-

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases…*

Hence the interest of general measures among populations as recommended by the WHO, including reducing salt consumption. In fact, in the 2013–2020 global action plan to combat NCDs [17] adopted in 2013, one of the targets to be achieved by 2025 was the 30% reduction in average salt consumption by populations to reduce the prevalence of hypertension. The effective implementation of this recommendation requires general measures, among the populations, aimed at reducing salt consumption, in particular by discouraging the use of added salt during food

It is also useful to mention that locking rural populations in an environment dominated by traditional mores and mentalities can constitute a handicap to understanding and adopting new behaviors necessary for the fight against NCDs. This can make rural populations fragile once they are exposed to NCD RFs. This is precisely what is observed among populations from rural areas and living in periurban areas, mentally close to their traditional areas but confronted with a Westerntype society that exposes them to the RFs of NCDs. An awareness-raising effort for the fight against NCDs, adapted to each environment and each social category,

The difference in lifestyle between rural and urban areas in SSA is a sociological reality known to all; however, the impact on the burden of CVRFs in these two settings has not yet been sufficiently studied. This is mainly due to the high cost of epidemiological surveys in the general population. Nevertheless, the few studies carried out in these two environments and mentioned in this chapter, although small in scope, have been able to provide some information tending to confirm the

The rural environment is characterized by its still strong attachment to the customs and mores of traditional African society where individuals are physically active, most often consuming natural foods and less exposed to stress related to the vagaries of modern society. There is therefore a low exposure to CVDFs and hence to CVDs. Conversely, progress in the fight against infections is less noticeable there, which would explain an infectious mortality even more marked than in urban areas, a residue of the era of major pandemics. All of this deserves to be documented by solid epidemiological investigations that can inform health and policy decisions. On the basis of current plot data related to CVDs and CVRFs in rural areas, it could be said that rural areas in SSA are still between the 1st and 2nd stage of the epidemiological transition following the subdivision described by Meslé and Vallin in 2007 [18], while the urban environment could be considered to be already in the middle of the 2nd stage, in view of the real decline of the infectious risk to the benefit of

As a reminder, the concept of epidemiological transition was launched by Omran in 1971 [19] and subdivided into three stages below by Meslé and Vallin in 2007:

• the stage of high infectious morbidity and mortality, with low life expectancy;

chosocial etc.

preparation or at the table.

deserves to be encouraged.

difference between these two environments.

**3. Discussion**

NCDs and their RFs.

**170**

internationally agreed development goals, through strengthened international cooperation and advocacy;

To this end, seven main obstacles to the implementation of these commitments

*Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population…*

6. Insufficient funding (internal and international) to transpose scaling up

This explains, in most states in SSA, a situation of inertia in the implementation of the recommendations and commitments made by the leaders of these states, with multiple consequences: absence of administrative and legal reforms to support the fight against NCDs, lack of support for national programs, where they exist, scarcity of basic epidemiological data on NCDs, lack of support for healthcare

In this context, it is understandable why in SSA states, there are no national registers of NCDs, nor large-scale general population data on NCDRFs or CVRFs, and even less on CVDs; healthcare establishments are not equipped for the correct management of NCDs or CVDs. These states for the most part do not have structures for universal health coverage to promote accessibility for all to quality care. Comparative information on NCDs and their RFs between rural and urban areas is

In view of this gloomy picture of CVDs in SSA, one of the priority actions should concern the carrying out of large national surveys of the prevalence of CVRFs so as to make basic epidemiological data available. This would make it possible to identify evidence on the possible differences between the different environments, urban and rural, and to draw the necessary consequences in terms of prospects for the

CVDs are one of the major current public health problems in SSA and globally. They are among the main causes of morbidity and mortality in SSA, but data on their geographical and sociological distribution, especially in rural and urban areas, are still incomplete. The first existing epidemiological surveys seem to indicate that they are more firmly established in urban areas than in rural areas, probably linked to the difference in lifestyles between these two areas. SSA states need to take the option of launching vast epidemiological and clinical research programs aimed at making basic epidemiological data available, taking into account the sociological specificities of African society. This knowledge, documented in the form of scientific evidence, would make it possible to

consider with relevance and effectiveness measures to combat this new epidemic in

1.lack of political will, mobilization, capacity and action;

4.impact of economic, business and market factors;

5.insufficient technical and operational capacities;

have been identified, namely:

2.lack of policies and plans for NCDs;

3.difficulties in setting priorities;

*DOI: http://dx.doi.org/10.5772/intechopen.96881*

measures to combat NCDs; and.

establishments for the management of NCDs, etc.

not sufficiently documented, apart from a few small series.

7.lack of accountability.

control of CVDs.

**4. Conclusion**

developing countries.

**173**

