When human beings first left Africa around 70,000 years ago they left behind a conundrum that to this day has not been cleared up. The human species, Homo sapiens to which we all belong evolved in Africa.
The oldest well-dated fossils of modern humans place them near Kibish, Ethiopia around 200,000 years ago. The archaeological records found in the area indicate that there was a shallow freshwater lake jam-packed with crocodiles, catfish, and hippopotamus, which provided food for these early humans.
Among the human fossil remains a hippopotamus skull found had clear-cut marks made by stone tools, though it was not possible to tell if the early humans were hunters or scavengers. Technology was advancing.
The tools found indicate that these humans had begun to develop stone made tools moving away from earlier hand axes made of wood and bone.
It seemed like an ideal life, however a possible climate change, a cooling during the last ice age, may have drastically reduced the population and caused the first migration out of Africa.
Within 20,000 years humans had expanded along the coast of India, South East Asia and reached Australia. It would take another 30,000 years for them to cross to what is now the North American continent.
In the last 10,000 years the growth of agriculture has fuelled an explosion in human population and now in the last 150 years the growth of science and medicine means that these many human beings can now live a long life.
The oceans separate continents and humans identify themselves racially, socially as distinct groups, but DNA studies say that we are all one.
So each country organises its own healthcare but we also talk of global health. The question is as a Kenyan, when you hear the term ‘global health’ do you think they are talking about ‘us’ or talking about ‘us’?
One of the major problems we all face when we want to make any decision about our individual or family health is where to find information. We could listen to any FM radio station and pick up on the topic of the day. If it is October then it will be breast cancer month and so the fact that cancer is rampant will be obvious to everyone.
If it is August, Kenya has a well-known curse about August, and so grisly road accidents happen then and we must do something about it. Police reshuffles usually sort out the problem until it rears its head again.
Why police do not just do the shuffle in the first place is a mystery. Alternatively family news has great bearing on how we perceive things.
A family friend or relative being diagnosed with a disease brings it to the fore and naturally with our antenna up we realise that a particular condition is more common than we previously thought.
The main bias is that when something is not on our personal agenda we do not think it important. At this point we ‘Google’ for information.
Search for ‘breast cancer’ and 407,000,000 results immediately come up. Nobody has time to read through such masses of information. There is also question of what is true? Most importantly there is the question of does it apply to me?
One way to decide this is to assume several things.
The first is that there is nothing special about being a Kenyan health-wise.
Secondly, unhealthy trends that occur in other parts of the world given the same opportunity will occur here.
Third, on the flip side, across the world there are certain health interventions that work in improving health status and will work here too. If we make these assumptions then we can use global comparisons to rank ourselves. The Global Burden of Disease study uses disability-adjusted life years (Dalys) to measure disease burden.
A Daly is the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability. So a disease that kills a one-year old child like diarrhoea, leads to many Dalys being lost but so does a disease like diabetes that does not kill straight away but the patient does not ever function at full capacity for the many years that it drags on.
Globally a shift is occurring with the Daly contribution of children under five years declining as child health improves, while non-communicable diseases rises. Ischaemic heart disease, caused mainly by high blood pressure, is the leading cause of Dalys worldwide.
But sub-Saharan Africa does not follow the worldwide trend. Communicable diseases, maternal, neonatal, and nutritional disorders continue to be the dominant causes of disease burden.
Improving overall health status is about reducing those risk factors that contribute the most health loss for a given population. In Kenya it is still the same diseases we faced off with at independence with the addition of HIV/AIDS and road traffic crashes.
The non-communicable conditions are on the rise too and are felt particularly by those families that have escaped communicable diseases.
After all they are the ones that are alive to suffer these conditions. And so the confusion continues.
Are we part of the global family? Or was the movement 70,000 years ago a separation that created a difference we must continue to emphasize at every opportunity?