A theme issue “by, for, and about” Africa

2005, it seems, is the year of Africa.¹,² As world leaders gathered in Davos to discuss debt relief and pop stars re-released their poverty anthem, the world's attention is drawn to magnificent Africa—a continent of vast cultural and regional diversity and potential but plagued by extreme poverty and disease.

The Roll Back Malaria campaign reports that of the 300 million acute cases of malaria each year around the world (which result in 1 million deaths), over 90% occur in Africa. These mostly affect children under the age of 5.³ A new UN report estimates that more than 80 million Africans will die of AIDS by 2025, and another 90 million—more than one in 10 people on the continent—will become infected.⁴ Tuberculosis, maternal mortality, domestic violence, and undernutrition pose further health challenges.

Undoubtedly, these are problems of poverty. Despite substantial growth in the global economy over the past half century, most of Africa remains poor, with living conditions not conducive to good health and without access to cheap and effective medicines. Seventy five million more Africans are in poverty than a decade ago, and the depth of that poverty is brutal and widespread. Thirty four of the world's 49 least developed countries are in Africa. Nearly half the region's population lives on $1 a day or less. Women are disproportionately affected.⁵

Africa's health challenges and solutions are complex, deeply rooted in political, socioeconomic, and cultural issues. Unfortunately, this complexity is rarely reflected in the current discourse on health. Instead, Africa is often inadequately portrayed in the broader world as a “basket case”: run by corrupt leaders, vulnerable to terrorist extremes, lacking infrastructure, unable to look after itself. Recently, efforts to help countries in the region to achieve the millennium development goals have taken centre stage, propelled by Tony Blair's call to arms that Africa “remains a scar on the conscience of the world.”⁶,⁷

But the millennium development goals have their problems. The gains of the specific goals for health will not necessarily flow to the poor and in fact may exacerbate inequalities between the rich and poor.⁸ Few countries are anywhere near honouring their financial commitment to the goals—a paltry 0.7% of their national income. Moreover, conservatism, including America's reluctance to support the importance of women's sexual and reproductive rights—a long acknowledged essential component of development—will threaten advances. And some Africans have already rejected Blair's international commission for Africa as a public relations gimmick.

Still, new and innovative leadership within Africa and among countries around the world is emerging, and there's perhaps no better time than now to harness and inspire global responsibility, accountability, and strategy for change in Africa.

The BMJ plans a theme issue for September 2005 “by, for, and about” Africa, to deal exclusively with the region's problems and, more importantly, offer solutions. Following the model of our South Asian issue last year,⁹ we will discuss a wide range of health challenges such as HIV/AIDS, tuberculosis, malaria, violence against women, and maternal and child health, as well as emerging challenges such as cardiovascular disease and diabetes. We will consider the political economy of health, including progress toward achieving the millennium development goals; health systems issues such as human resources development and retention; and the contributions made by traditional health systems and approaches.

We hope the theme issue will be a diverse mix of papers, debate pieces, editorials, and reviews (these might include art, literature, and popular media). We are particularly interested in original research conducted in Africa. The deadline for submissions of original research is 30 April 2005.

Our aim is to bring together health professionals in the region to discuss issues that are common to all. But we want to encourage submissions that tackle the historical, political, social, economic, and cultural dimensions of health. We need stories of Africa's problems, but also of its potential: “Stories are important because we read a lot about how Africa is dying and despairing but not about how Africa is living and developing.”¹⁰