Non-communicable diseases (NCDs) pose a major global public health problem in the 21st century, substantially affecting illness, death, disability, and quality of life.
Between 2011 and 2030, it is projected that NCDs will lead to an economic loss of $47 trillion worldwide, more than $30 trillion of which can be attributed to cardiovascular illnesses, cancer, chronic lung diseases, and diabetes.
The majority of NCD-related mortality, around 77% to 80%, occurs in low-income and middle-income countries, such as those in Africa, which has been described as “the social justice issue of our time”.
In addition to the ongoing burden of communicable, maternal, and child health issues, African countries are undergoing rapid transitions in epidemiological, socioeconomic, and demographic contexts.
These transitions are projected to shift the profile of disease burden, with NCDs progressively emerging as the primary health concern, overtaking communicable diseases. To address the increasing burden of NCDs, there has been a coordinated global and regional endeavour to create and execute methods with the goal of decreasing the incidence and consequences of these illnesses.
The political declaration on NCDs by the UN General Assembly in 2011 was a crucial event that resulted in the creation of the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020.
The WHO Global Action Plan outlines a comprehensive monitoring framework for NCDs and sets a target to be achieved by 2025. One key goal is a 25% reduction in premature deaths from the four main NCDs and their associated metabolic and behavioural risk factors.
Furthermore, in 2015, the UN established the Sustainable Development Goals (SDGs), which include a target to decrease premature mortality caused by NCDs by a third by the year 2030 (SDG target 3.4). The African Union, aligned with global commitments towards NCDs as outlined in the SDGs, also recognises the profound impact of NCDs on Africa’s development. NCDs have been prioritised as a key area of focus within the Agenda 2063 framework, which aims to ensure that citizens are “healthy, well-nourished and have long life spans”.
Previous Global Burden of Diseases, Injuries, and Risk Factors Study (GBD)-based regional analyses have focused on sub-Saharan Africa or specific subsets, including a 2019 study quantifying the non-communicable disease (NCD) burden in sub-Saharan Africa using GBD 2017 data; however, no study has synthesised GBD data for all 54 African countries for NCD burden and attributable risk factors simultaneously.
This study provides the first comprehensive, sex-disaggregated analysis of NCD burden and its attributable risk factors across all 54 African countries, using GBD 2023 data. Our findings reveal a paradoxical epidemiological trajectory: despite modest declines in age-standardised disability-adjusted life-year (DALY) and death rates of approximately 6% and 9%, respectively, over three decades, the absolute burden has more than doubled, with total NCD deaths and DALYs increasing by 122% and 118%, respectively, between 1990 and 2023.
These increases were driven predominantly by rapid population growth. In 2023, NCDs accounted for around 45% of all deaths across Africa, with cardiovascular diseases, neoplasms, diabetes, chronic kidney disease, and digestive diseases representing the leading causes of NCD mortality, while mental health disorders and musculoskeletal conditions were the principal drivers of years lived with disability.
More than half of all NCD deaths and over a third of NCD-related DALYs were attributable to modifiable risk factors—mainly high systolic blood pressure, dietary risks, and ambient air pollution—and rising age-standardised death and DALY rates were largely attributable to high BMI, high fasting plasma glucose, and drug use as emergent and escalating public health threats across Africa.
Evidence shows a marked epidemiological transition in Africa for the past three decades, with NCDs rising sharply and diverging from progress made globally and in regions with high Socio-demographic Index (SDI). This study, the first major assessment since the COVID-19 pandemic, highlights patterns in Africa: dietary risks rank as the second leading attributable risk factor for DALYs and deaths, compared with fourth globally, underscoring inequities in exposure and control. Digestive diseases, mental health disorders, and musculoskeletal conditions remain under-prioritised in policy, despite their substantial contribution to mortality and disability.
Meanwhile, high BMI and elevated fasting plasma glucose have risen steadily since 1990, threatening to accelerate cardiovascular, metabolic, and renal disease burdens, and indicating insufficient prevention and control strategies. These findings call for region-specific strategies that integrate WHO’s Global Action Plan, the UN Sustainable Development Goals, and Lancet NCDI poverty Commission recommendations into African health agendas. Strengthening surveillance, expanding preventive interventions, improving access to treatment, and addressing social determinants of health are crucial. Without urgent action, Africa risks widening inequities in NCD outcomes compared with high-SDI regions.
A Guest editorial