For decades, public health efforts across Africa focused primarily on combating infectious diseases and addressing widespread malnutrition. Yet in recent years, a rapid epidemiological transition has emerged. Driven by urbanisation, globalisation, economic growth, and shifts in dietary habits, traditional lifestyles are being replaced by patterns that increase vulnerability to non-communicable diseases (NCDs) such as obesity, type 2 diabetes, and cardiovascular disease.

This transformation has created a “triple burden” of malnutrition, where communities face undernutrition (stunting and wasting), micronutrient deficiencies (named hidden hunger) and overnutrition (overweight and obesity). As health systems grapple with this evolving crisis, it’s clear that strategies designed for high-income countries must be adapted to meet the complex realities of African populations, where chronic illness and nutritional deprivation now coexist.

The Rise of NCDs and Triple Burden

Obesity plays a central role in the development of insulin resistance and other metabolic disorders. As the body’s ability to regulate blood sugar declines, type 2 diabetes often follows, bringing with it a heightened risk of cardiovascular complications such as hypertension, coronary artery disease, and stroke. These interlinked conditions form a waterfall effect of health challenges, placing immense strain on already overstretched and underfunded healthcare systems.

Over the last couple of decades there has been a health shift across Africa. Between 200 and 2019, there was a drastic increase in NCDs from 24.2% to 37.1% (a 53% relative increase). NCDs are now the leading cause of mortality on the continent. Once considered diseases of wealth, they are increasingly prevalent in urban African settings, driven by rapid nutrition transitions, increased consumption of ultra-processed, calorie-dense foods, and increasingly sedentary lifestyles.

This shift is unfolding alongside a triple burden of malnutrition, defined as persistent undernutrition, widespread micronutrient deficiencies, and rising rates of overweight and obesity. A 2021 study profiling households across sub-Saharan Africa found that this triple burden is influenced by factors such as household wealth, education, and urban residence showing the need for targeted, equity-driven interventions.

Globally, the World Health Organization reported that NCDs were responsible for approximately 71% of all deaths in 2025 amounting to over 41 million lives lost, with cardiovascular diseases accounting for most NCD deaths. Notably, 77% of NCD deaths now occur in low- and middle-income countries, underscoring the urgent need for integrated, context-sensitive public health strategies that address both the root causes and systemic consequences of this rising tide.

Africa’s Triple Burden of Malnutrition

The coexistence of undernutrition, micronutrient deficiencies, and overnutrition within the same communities and often within the same households, underscores the complexity of Africa’s evolving nutritional challenges. While urban areas are witnessing an increase in overweight, obesity, and related NCDs, many rural and peri-urban populations continue to grapple with chronic undernutrition and hidden hunger.

This triple burden of malnutrition is shaped by overlapping factors such as poverty, rapid urbanisation, food system transitions, and unequal access to nutritious, affordable foods. In many households, some members may face stunting or anaemia, while others consume energy-dense but nutrient-poor diets that increase the risk of obesity and metabolic disease.

Influential Factors

This complex coexistence is shaped by overlapping structural, economic, and cultural factors:

• Rapid Urban Growth: Urbanisation has led to reduced physical activity, increased reliance on motorised transport, and limited access to safe spaces for movement. Urban living often promotes sedentary lifestyles, contributing to obesity and NCD risk.

• Dietary Transition: Traditional diets rich in fibre and plant-based nutrients are increasingly replaced by ultra-processed foods high in sugar, salt, and unhealthy fats. This shift fuels both micronutrient deficiencies and overnutrition.

• Income Changes: While economic development can improve overall living standards, it may also lead to consumption patterns that favour convenience over nutrition. With increased disposable income fast food and sugary beverages become more affordable leading to higher consumption.

• Cultural Shifts: In some African societies, larger body sizes are associated with prosperity and health. These norms can hinder obesity prevention and complicate messaging around NCD risk and healthy weight.

• Limited Preventive Measures: Health systems remain focused on infectious diseases, with limited capacity for routine screening, early detection, and management of chronic conditions. This gap delays interventions for both micronutrient deficiencies and NCDs.

• Resource Constraints: Inadequate funding, lack of trained personnel, and limited educational campaigns on lifestyle and nutrition contribute to delays in diagnosis and treatment.

Africa within the Global Context

Globally, the rise in obesity, type 2 diabetes, and cardiovascular disease (CVD) is driven by shared structural factors: urbanisation, dietary transitions, reduced physical activity, and socioeconomic shifts. However, the pace, context, and consequences of these trends vary significantly across regions.

In high-income regions such as North America and Europe, obesity and related chronic conditions have been occurring for decades. Rising income levels often correlate with increased consumption of calorie-dense, ultra-processed foods, while aggressive marketing by global food industries continues to shape dietary behaviours. Worldwide, the shift from rural to urban living is associated with reduced physical activity and increased reliance on processed foods contributing to an estimated 1.86 million deaths annually from high sodium intake and 830,000 deaths linked to physical inactivity.

According to the NCD Risk Factor Collaboration, global average body mass index (BMI) has steadily increased across all regions. In 2022, approximately 2.5 billion adults (aged 18 and older) were overweight, including 890 million living with obesity, the equivalent to 1 in 8 adults globally. These trends are no longer confined to high-income countries. In Africa, the nutrition transition is accelerating, with urban populations increasingly affected by overnutrition and diet-related NCDs, while rural and peri-urban communities continue to face undernutrition and micronutrient deficiencies. This duality reinforces the need for region-specific, equity-driven interventions that address both the structural determinants and the underliers of poor health. 

What Global Interventions Can Teach Africa

There remains significant inequality in health outcomes between high-income countries and many African nations, particularly in cancer survival. For example, only about 50% of women diagnosed with breast cancer in sub-Saharan Africa survive beyond five years, largely due to late-stage diagnosis and limited access to timely treatment. In contrast, five-year survival rates exceed 90% in many high-income countries, where early detection and comprehensive care are more accessible.

Countries such as Kenya, Zimbabwe, and Côte d’Ivoire are beginning to close this gap by investing in screening programs, early diagnosis, and improved treatment infrastructure. However, there is urgent need for more African countries need to be following in their footsteps.

Globally, high- and middle-income countries have implemented a range of population-level interventions which could offer valuable lessons for Africa’s evolving NCD challenges, including:

• Taxation on sugary beverages to reduce sugar consumption and prevent obesity and diabetes.

• Front-of-pack nutrition labelling to guide healthier food choices.

• Urban planning that promotes physical activity through walkable cities and green spaces.

• Community-based education campaigns tailored to local cultures and languages.

• School and workplace wellness programs that integrate nutrition, movement, and mental health.

These interventions are part of the WHO’s “Best Buys” for NCD prevention and have shown measurable impact in reducing risk factors when adapted to local contexts.

However, it’s important to note that even in high-income countries, the NCD burden remains high, due in part to persistent commercial determinants (i.e. marketing) of health, socioeconomic inequalities, and lifestyle factors. This underscores the need for sustained, multisectoral action, not only to replicate successful interventions but to adapt them in ways that address Africa’s unique structural and cultural realities.

Some initiatives implemented across Africa

A wonderful example of the implementation of one of these interventions has been in Malawi, which over the last year have scaled up its free school meals programme, reaching over 60,000 children aged 3–6, across 1,260 Early Childhood Development centres. Spearheaded by World Vision and supported by the Malawian government, this initiative has improved school attendance, learning outcomes, and child nutrition. According to World Vision, every $1 invested in school meals sees a return of up to $20 through improved education, health, and local economic development.

South Africa has implemented front-of-pack nutrition labelling and sugar-sweetened beverage taxes, which have shown early signs of reducing sugary drink consumption and raising public awareness.

Ghana has piloted community-based health planning and services (CHPS) to bring preventive care and health education closer to rural populations.

Rwanda has integrated NCD screening into primary care and invested in digital health tools to track hypertension and diabetes.

Nigeria has launched school-based health clubs and nutrition education campaigns to promote healthy behaviours among youth.

These interventions mirror global strategies that have shown promise in reducing NCD risk factors. However, even in high-income countries, the NCD burden remains high, underscoring the need for sustained, multisectoral action that addresses both structural and commercial determinants of health.

Addressing the Challenge

Addressing this multifaceted crisis requires a systems-level approach that confronts structural inequities, reshapes food environments, and strengthens public health infrastructure.

Governments and organisations must implement policies that improve access to diverse, nutrient-rich foods while tackling the underlying drivers of poverty and food insecurity. Educational campaigns can promote culturally relevant, healthful dietary practices, while interventions such as fortifying staple foods with essential micronutrients can help reduce deficiencies. Equally important is addressing the broader determinants of health ensuring access to clean water, sanitation, healthcare, and social protection.

To mitigate the rising tide of NCDs across Africa, a multipronged strategy is essential:

• Policy and Regulation: Governments can curb the availability and marketing of ultra-processed foods through taxation, advertising restrictions, and front-of-pack labelling. Simultaneously, they must promote access to affordable, nutritious alternatives especially for low-income households.

• Community and School-Based Programs: Educational campaigns embedded in schools and communities can foster lifelong habits around balanced diets and physical activity. Malawi is a great example of this.

• Healthcare Strengthening: Expanding routine NCD screening, training health workers to manage obesity-related complications, and integrating chronic disease care into primary health systems are critical steps. Countries like Rwanda and Kenya are leading with digital health tools and decentralised screening models.

• Research and Data Collection: Ongoing research is vital to monitor trends, evaluate interventions, and tailor solutions to local cultural and socioeconomic contexts. Strengthening national health information systems and investing in community-based data collection can drive more responsive policymaking.

• Cross-Sector Collaboration: Tackling the triple burden demands coordinated action across agriculture, education, urban planning, and health. Partnerships between governments, civil society, researchers, and the private sector are key to building resilient, equitable food and health systems.

The rise of obesity, diabetes, and cardiovascular disease in Africa signals a turning point. These interlinked epidemics demand comprehensive, cross-sectoral solutions, spanning urban planning, agriculture, education, and healthcare. As the continent urbanises and integrates with global food systems, holistic strategies can improve quality of life, strengthen economies, and empower communities.

With the right policies, community engagement, and investment in prevention, the trajectory of these diseases can be reversed. Regional innovations and tailored interventions offer scalable models. The time to act is now, inaction will cost lives and futures.