Lancet Countdown to 2030: Where is Africa?

It’s not good news, but a paper highlighting the importance of African traditional diets might offer some comfort.

The Lancet is the oldest and most reputable medical journal in the world. It publishes what it calls the Lancet Countdown to 2030, a collaborative effort focused on monitoring progress towards the Sustainable Development Goals (SDGs).

The 2025 report was published this month, and it does not bring good news for Africa. While its conclusions about the continent may seem broad, they reflect a reality you may have experienced yourself–or that your neighbour, relative, or community has faced.

The report paints a sobering picture: "Sub-Saharan Africa, where over half of the population is younger than 20 years, has the greatest challenges on almost all fronts," it reads.

Although maternal, child, and adolescent mortality continues to decline across Africa, the pace of improvement has slowed sharply since 2015, falling far short of what is needed to achieve the 2030 SDGs. The continent, home to 72% of the world’s maternal deaths and 56% of child and adolescent deaths, is now the epicentre of the global struggle for health equity.

Between 2016 and 2023, undernutrition among children and women in Africa declined at a pace similar to that seen during the Millennium Development Goal (MDG) era.

However, the report highlights an alarming trend: rapid increases in obesity rates among adolescents and women across all regions, including Africa. Economic volatility, food insecurity, and the rise of cheap, ultra-processed foods have created an environment where a healthy diet is increasingly out of reach. By 2022, 72% of people in low-income countries–most of them in Africa–could not afford a nutritious diet.

This “nutrition transition” is worsening health outcomes and increasing the risk of non-communicable diseases. With food systems strained by climate change and conflict, many African families now face a cruel choice between hunger and unhealthy diets laden with empty calories.

The slowdown in health gains is stark. From 2000 to 2015, under-5 mortality rates and maternal deaths declined significantly across Africa. But during the SDG period (2016–22), the annual rate of reduction halved.

In West and Central Africa, the situation is particularly dire: mortality rates for individuals under 20 remain at 134.6 deaths per 1,000 births, the highest in the world. Stillbirths, neonatal deaths, and deaths among young children remain heartbreakingly common.

Meanwhile, improvements in maternal health have stagnated. The maternal mortality ratio–already unacceptably high–has shown little progress since 2015. In a region where access to emergency obstetric care is often limited and skilled health workers are scarce, the dream of safe motherhood remains elusive for millions of African women.

The health systems meant to protect women and children are buckling under pressure. Sub-Saharan Africa has just one-seventh the health workforce density–doctors, nurses, and midwives–of upper-middle-income countries. Fiscal constraints, driven by a mounting debt crisis, are undermining national budgets. Shockingly, by 2021, 25 out of 43 African countries spent more on servicing external debt than on healthcare.

The shortage of trained personnel is compounded by high rates of emigration among health workers, with many leaving for better opportunities abroad. Those who remain often work under immense strain, with few resources and limited opportunities for career progression. The result is predictable: large gaps in the quality of care, particularly in rural and conflict-affected areas.

Access to critical interventions–such as antenatal care, skilled birth attendance, immunizations, and adolescent health services–remains patchy. Although there has been modest progress in some areas, like skilled birth attendance reaching a median of 95.6% across low- and middle-income countries, coverage improvements have slowed sharply in Eastern and Southern Africa since 2016.

Adding to the burden is a relentless series of crises. Armed conflict has become a persistent feature across the continent, with nearly half of African countries affected. In 2022 alone, sub-Saharan Africa accounted for 29% of the world’s refugees and 45% of internally displaced persons.

Women and children, who make up the majority of those displaced, face heightened risks of malnutrition, disease, and violence. Conflict disrupts essential services, destroys health infrastructure, and forces families into precarious living conditions where clean water, sanitation, and health care are scarce.

Climate change looms as an even greater existential threat. Droughts, floods, and extreme heat events are becoming more frequent and severe, hitting Africa–already one of the most climate-vulnerable regions–hardest. Rain-fed agriculture, on which most African households depend, is increasingly unreliable.

Climate-related food insecurity is rising, and vector-borne diseases like malaria and dengue are expanding their reach. Yet, as the report starkly notes, “investments to increase resilience against climate consequences in sub-Saharan Africa have been small compared to most other regions of the world.”

VISUAL OF THE WEEK

The first three months of 2025 have been unusually warm, coming in in the top-three warmest on record across all the different scientific groups that report on global surface temperatures. Read a Carbon Brief story for more global details. 

QUOTE OF THE WEEK

“Floods in Kinshasa, which occur frequently and often result in high death tolls, highlight the urgent need to build resilience to heavy rainfall events. This urgency is further amplified by the city’s rapid growth: Kinshasa’s population is projected to double to nearly 40 million within the next 20 years,” World Weather Attributions on floods that killed more than 30 people in Kinshasa, the capital of Democratic Republic of Congo.

RESEARCH HIGHLIGHTS 

African traditional foods are better! A study in northern Tanzania found that switching from a traditional African diet to a Western-style diet increased inflammation and changed the body's metabolism in ways linked to chronic diseases like diabetes and heart problems. In contrast, returning to a traditional diet or drinking a local fermented banana beverage called Mbege had anti-inflammatory effects and supported better immune health. Some of these changes lasted even weeks after the diet switch, showing that eating habits can have a lasting impact. The study highlights the importance of protecting traditional African diets to help prevent rising health problems across sub-Saharan Africa. [Reference, Nature Medicine]

Africa’s infrastructure at risk from climate change: climate change is hitting Africa’s infrastructure hard. More frequent floods, storms, and heatwaves are damaging roads, bridges, power systems, and water networks that millions of people rely on every day. Yet, African countries often don't have strong plans to protect their infrastructure from these growing climate risks. Without urgent action, African nations could lose billions of dollars, and people’s lives and livelihoods will suffer even more. The report stresses that Africa must urgently make its infrastructure stronger and climate-smart–building roads that can withstand floods, energy grids that survive storms, and water systems that don’t fail during droughts–or risk being left dangerously exposed as climate disasters get worse. [Reference, Journal of Critical Infrastructure Policy]

New Mosquito Discovered in Tanzania: researchers in Tanzania have found a new type of malaria-carrying mosquito, called the Pwani form, living along the coast. Unlike other mosquitoes, this new type doesn’t seem to be resistant to insect sprays. They also found that familiar mosquitoes like Anopheles gambiae are changing depending on where they live — some groups are becoming more resistant to insecticides. Meanwhile, Anopheles arabiensis mosquitoes move freely across regions without much change. The study shows that to fight malaria better, we need to track how different mosquitoes are changing over time. [Reference, Journal of Molecular Biology]

Impact of land use on carbon storage in African drylands: A study which examined the impact of farming and wildlife conservation on carbon storage in African drylands found that land-use changes affect carbon in plants and soil differently. It showed that moderate disturbance levels, like those caused by farming or wildlife management, can sometimes increase soil carbon. In scrub savannas, shrubs lost significant carbon, while trees in woodland savannas were most affected by farming. The study emphasizes the importance of balancing land use with carbon storage goals for effective land management. [Reference, Global Change Biology]

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