Professor Ama de-Graft Aikins

Curing Our Ills: The Psychology of Chronic Disease Risk, Experience and Care in Africa

Prof Ama de-Graft Aikins


Millions of Ghanaians live with diabetes, hypertension, stroke, cancers and other major chronic diseases. For each Ghanaian living with a specific condition, at least two more Ghanaians are at risk. For example, the prevalence of diabetes ranges between 6% and 9%, and prevalence of impaired glucose tolerance, a marker for diabetes risk, ranges between 11% and 18%.
Individuals living with chronic conditions experience many disruptions, especially at the early stages of diagnosis and adjustment. The disruptions are physical (medical complications), psychological (depression), material (impoverishment), social (stigma) and spiritual (struggles with faith and trust). These experiences have an impact on family life and resources, with primary caregivers bearing similar disruptions to their chronically ill loved ones. While chronic conditions cannot be cured, many individuals hope for a cure. This hope drives healthcare seeking across different sectors of Ghana’s vibrant pluralistic health system. When ‘hope for a cure’ meets ‘claims to cure’ within the herbalist and faith healing sectors, the outcomes for individuals and their families can be catastrophic.
The Ghanaian situation is mirrored in many African countries. Currently, chronic non-communicable disease (NCD) deaths in adult men and women as a whole are higher in sub-Saharan African than in all other regions of the world. It is estimated that African NCD prevalence, morbidity and mortality rates will rise faster than rates in Asia and Latin America over the coming decades. The long term and costly nature of NCDs has major implications for individuals, communities, health systems and governments.
In this lecture I will discuss the psychology of chronic disease risk, experience and care in Africa. My lecture will be presented in three parts. In Part 1 I make a case for why the problem of NCDs needs to be examined through a psychological lens. I provide the conceptual background to the kind of psychology I do and how this informs the analysis that will follow. In Part 2 I will draw on four studies I have conducted independently and with collaborators, over the last 15 years, on diabetes representations and experiences among Ghanaians in Accra, Kintampo, Nkoranza, Kumasi, Obuasi and surrounding rural areas, as well as among Ghanaian migrants in London, Amsterdam and Berlin to highlight the complex multi-level context of chronic disease risk, experience and care. I will place the Ghanaian evidence within the African and global multidisciplinary literature and highlight where convergences and divergences occur. In Part 3, I will present a synthesis of the evidence through the lens of ‘curing our ills’. I treat ‘ills’ in terms of the physical as well as the ideological. 
I conceptualise ideological ills as the ways health experts (researchers, practitioners, policymakers, funders and development partners) define our problems and develop solutions to our problems, thereby setting the broader structural framework in which we manage our daily lives, in health, in illness, and in dying. I argue that the physical and ideological ills are interconnected and, as a result, must be addressed through critical interdisciplinary approaches.
To conclude, I offer practical solutions for reducing chronic disease risk and improving the quality of long-term experience and care, drawing from concrete responses within Ghana and from countries within and outside Africa that have implemented successful NCD interventions.