**5. How urban environment determines the rise of NCD risk factors in African cities**

#### **5.1 Unhealthy diets in African cities**

There is evidence alluding to the link between diet and development of overweight, obesity and occurrence of NCDs [49]. However, the understanding of the nexus between urbanization and changes in dietary patterns and nutrient intakes in Africa remains limited. As African cities grow, the rise in urban population's increases pressure on arable land for farming, and coupled with rural urban migration, this reduces the ratio of food producers to food consumers [16]. This

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*Non-Communicable Diseases and Urbanization in African Cities: A Narrative Review*

sugary drinks, especially among children and young adults [55, 56].

Physical activity (PA) has many health-promoting effects and is associated with reduced risk of cardiovascular and metabolic diseases, obesity, and some cancers [57]. Insufficient physical activity is a leading risk factor for NCDs and has a negative effect on mental health and quality of life. Levels of physical activity in many African countries vary widely across geographic regions and population subgroups. For instance, country level prevalence of PA ranged from 46.8% in Mali to 96.0% in Mozambique [58]. While current data shows that SSA has the least prevalence of insufficient physical activity compared to the rest of the world [59], trend data shows decreasing levels of physical activity and increasing levels of sedentary lifestyles across all age groups [60]. Country-specific population-based data on physical activity prevalence show lower levels of PA in urban environments attributed to built-up environment leaving no green spaces for physical activity [61]. In addition, congestion in cities, availability of motorized transport and absence of paved walk-ways makes it impractical for physical activity to happen in African cities. In low income informal settlements in African cities, several physical barriers and insecurity limit physical activity [46]. In Kenya for instance, young adults in rural areas were found to be more physically active compared to those in urban areas. A study conducted by Mashili et al. (2018) in Tanzania also found that being employed, higher education and wealth status (mainly among urban residents)

The WHO considers tobacco use as the single leading cause of avoidable death and ill health, contributing to lung cancer, chronic respiratory disease and cardiovascular disease [63]. While the use of cigarette and other tobacco products has declined in high-income countries [64], cigarette use in LMICs including in SSA is rising [65]. Demographic Health Surveys (DHS) conducted in 16 African countries revealed that cigarette use was highest among urban dwellers, less educated, and lower socioeconomic status individuals [66]. Consistent with previous studies in Africa, urban residents are most at risk for cigarette use [67], and start smoking at a younger age [68]. A study by Williams et al., (2008) in Cape Town concluded

**5.2 Physical inactivity and sedentary lifestyles in cities**

were associated with less physically activity [62].

**5.3 Tobacco and alcohol use in African cities**

consequently leads to severe disruptions in healthy food availability, distribution, access and affordability [50, 51]. As healthy foods such as fresh vegetables and fruits, cereals and plant proteins diminish in urban settings, populations resort to the readily available which often unhealthy. A survey in major cities of Cape Verde, Ghana and Senegal reported an increased consumption of energy-dense foods such as candies, ice cream and sweetened beverages up to seven times as frequently as fruit and vegetables [50]. This finding affirms previous studies that showed rapid rise in fat intake across low income countries, including in Africa [52]. Proliferation of fast-food outlets, supermarkets, food vendors, and restaurants in cities have facilitated increased access to unhealthy diets, thus transforming urban settlements into highly obesogenic environments. Nevertheless, for individuals of higher socio-economic status, these changes may offer improved access to nutritious foods since they can afford more healthy foods [53]. While for the urban poor, choices for healthy foods are restricted and they easily resort to the most easily available and affordable diets that are largely unhealthy [54]. In the cities, there are aggressive powerful commercial and emotional advertisements and marketing through various media outlets, which greatly influence preferences and choices of fast-foods and

*DOI: http://dx.doi.org/10.5772/intechopen.89507*

#### *Non-Communicable Diseases and Urbanization in African Cities: A Narrative Review DOI: http://dx.doi.org/10.5772/intechopen.89507*

consequently leads to severe disruptions in healthy food availability, distribution, access and affordability [50, 51]. As healthy foods such as fresh vegetables and fruits, cereals and plant proteins diminish in urban settings, populations resort to the readily available which often unhealthy. A survey in major cities of Cape Verde, Ghana and Senegal reported an increased consumption of energy-dense foods such as candies, ice cream and sweetened beverages up to seven times as frequently as fruit and vegetables [50]. This finding affirms previous studies that showed rapid rise in fat intake across low income countries, including in Africa [52]. Proliferation of fast-food outlets, supermarkets, food vendors, and restaurants in cities have facilitated increased access to unhealthy diets, thus transforming urban settlements into highly obesogenic environments. Nevertheless, for individuals of higher socio-economic status, these changes may offer improved access to nutritious foods since they can afford more healthy foods [53]. While for the urban poor, choices for healthy foods are restricted and they easily resort to the most easily available and affordable diets that are largely unhealthy [54]. In the cities, there are aggressive powerful commercial and emotional advertisements and marketing through various media outlets, which greatly influence preferences and choices of fast-foods and sugary drinks, especially among children and young adults [55, 56].
