Smaller Ugandan cities already familiar with obese, diabetic, or hypertense bodies; yet diverse interpretations of contributing socio-environmental causes

For the attention of: Urban planners and urban health managers

The problem: The rising burden of non-communicable disease in urban Africa, with differential impacts on men and women as a critical issue. This problem has links to poverty, inequality and low dietary diversity, rather than earlier understandings of these as ‘diseases of wealth or excess’.

What we did and why:  I used in-depth interviews to explore local experiences and understandings of overweight, obesity, diabetes and hypertension in two secondary Ugandan cities: Mbale and Mbarara. I conducted twenty-two in-depth biographic interviews with interviewees from a range of circumstances, including those described, ‘the missing people’, or hard to reach. I discussed with participants how urban life was affecting their experience regarding these diseases and their responses to them.

What our study adds: The work provides insight into barriers to healthy urban living in the current socio-economic context of Ugandan, and potentially other sub-Saharan African, cities. Our in-depth analysis of local understandings of non-communicable diseases: 

  • Does not support behavioural causal claims
  • Supports significance of socio-economic and cultural determinants of health
  • Explores claims of body-enhancement and transactional relationships as livelihood strategies, with gendered and classed dimensions

It also shows how women’s roles go unrecognised and they can be ‘blamed’ for ill health, when the realities of insecure access to income and food, and inability to balance calorific-activity intakes in cities play a significant role

Implications for city policy and practice: We see food and diets as a useful entry-point to creating healthier, more just, cities.

  • Initiatives to prevent non-communicable diseases will not succeed if we do not understand the breadth of experience and explanation from people on-the-ground
  • Body-size beliefs and attitudes can create conflicting desires and hinder NCD prevention – work with rather than against these in health messages

Links to other resources:

Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases, WHO, 2017.

Social and Economic Determinants of Health, WHO AFRO, webpage

Full research article: Of fatness, fitness and finesse: Experiences and interpretations of non-communicable diseases in urban Uganda

Authors: Heather Mackay

Editor: Marcus Grant (@MarcusxGrant)