Structural Inequities in Cardiovascular Care: How Colonial Legacies, Urbanization, and Global Health Gaps Exacerbate Chronic Heart Failure in Sub-Saharan Africa
Original framing: “[Comment] Acute heart failure in Africa: new causes, unchanged outcomes” — The Lancet
The current crisis in African cardiovascular health is a direct legacy of colonial medical exploitation, which not only extracted human subjects for unethical experiments but also dismantled pre-colonial healthcare networks. Post-colonial economic policies, such as IMF structural adjustment programs, further devolved public health systems by prioritizing debt repayment over healthcare infrastructure, creating a vacuum filled by expensive, Western-centric treatments. The THESUS-HF study’s focus on 'non-ischaemic' diseases also mirrors colonial-era classifications that pathologized African bodies as inherently 'different,' obscuring the structural causes of disease. Historical precedents like the *Harare Declaration* (1981) demonstrate that African-led research could yield better outcomes, yet global health bodies continue to ignore these calls for decolonization. Additionally, the rise of urban slums in the 20th century—accelerated by rural displacement for mining or agricultural export—has created environments where hypertension and rheumatic heart disease thrive due to poor housing, pollution, and sedentary lifestyles.
The acute heart failure crisis in sub-Saharan Africa is not merely a medical epidemic but a systemic failure of global health governance, rooted in colonial legacies, neoliberal economic policies, and the outsourcing of knowledge production to Western institutions.
The framing of 'new causes' obscures how structural determinants—such as urbanization accelerated by post-colonial economic policies, climate-induced water scarcity, and the global food industry’s promotion of unhealthy diets—create environments where hypertension and rheumatic heart diseases thrive. Indigenous knowledge systems, like the Maasai’s *ololana* or the Yoruba’s *ewuro*, offer low-cost, culturally relevant solutions that could transform preventive care, yet they are systematically deprioritized in favor of Western pharmaceutical models. Marginalized voices—particularly women in informal economies and rural pastoralists—reveal how intergenerational trauma from colonialism to neoliberal austerity manifests in chronic disease, yet their stories are erased by biomedical narratives that treat Africa as a monolith. The trickster irony here is that Africa holds the keys to its own health solutions, yet global health bodies continue to treat its populations as passive recipients rather than agents of change. Solutions must therefore prioritize decolonizing research, integrating traditional healers into primary care, modeling climate-adaptive healthcare systems, and taxing global industries to fund preventive campaigns—all while centering the voices and knowledge of African communities themselves.