# 6.4: The Modern Sub-Saharan African Landscape

Today, Sub-Saharan Africa is comprised of 48 independent countries and is home to 800 million people. While colonialism transformed African politics and economics, the way of life for many Africans has changed relatively little. Only around one-third of people in Sub-Saharan Africans live in cities, and as of 2007, 72 percent of these city-dwellers lived in slums. Sub-Saharan Africa is still largely rural. Urbanization is increasing, however, as governments have invested in industries in an effort to strengthen economic development drawing impoverished farmers from rural communities. Relatively few Sub-Saharan Africans live in large cities; most live in urban areas with fewer than 200,000 people. A notable exception to this is Nigeria, which was 48 percent urbanized in 2015 and contains several cities with over one million residents including its former capital Lagos (Figure $$\PageIndex{1}$$). The metropolitan area of Lagos has a population estimated to be 21 million; it is the most populous city in Africa.

Sub-Saharan Africa’s population has been climbing rapidly with the highest fertility rates of any region in the world. In Angola, for example, on the southwest African coast, most women have around six children. This has created a very high dependency ratio across the region, referring to the ratio of people not in the labor force to the number of productive workers. Africa’s population is expected to double between 2010 and 2050. Nigeria, with 2017 population of over 190 million, is projected to surpass the population of the United States by 2050 to become the third-most populous country in the world.

In addition to rapid population growth, another significant challenge facing the governments of Sub-Saharan Africa is related to healthcare. Across the region, imbalances exist between the availability and quality of care. Furthermore, Sub-Saharan Africa’s tropical climate has contributed to the spread of a number of serious illnesses, and this fact, combined with often ineffective or under-funded post-colonial governments have made stopping the spread of disease difficult. In some areas, western aid workers have been viewed with suspicion by Africans fearful of western intervention given their colonial histories. In other countries, foreign aid meant to help the poorest in the region has instead financed corrupt governments and military spending.

There are a number of illnesses, like hepatitis and hookworm, that are endemic to Sub-Saharan Africa, meaning they are found within a population in relatively steady numbers. Before a vaccine was developed, chicken pox was endemic in the United States, existing in a relative state of equilibrium. When a disease outbreak occurs, it is known as an epidemic. Epidemic diseases often affect large numbers of people on a regional scale. The flu in the United States is an example of an epidemic disease, with increasing numbers of people affected during the winter months.

Malaria, a disease spread by mosquitos, is the deadliest disease in Sub-Saharan Africa and sudden epidemics can affect large populations. If left without proper treatment, the disease can also reemerge months later. 90 percent of all deaths from malaria worldwide occur in Africa and it is estimated that the disease costs $12 billion each year due to increased healthcare cost, lost economic productivity, and a negative impact on tourism. Other insect-borne diseases that have a significant clustering in Africa include Yellow fever, which is also spread by mosquitoes, and trypanosomiasis, better known as sleeping sickness, which is transmitted by the bite of the tsetse fly. When examining the geography of the global HIV/AIDS epidemic, Sub-Saharan Africa clearly stands out (Figure $$\PageIndex{2}$$). Around 70 percent of all people living with HIV/AIDS live in Sub-Saharan Africa and while a diagnosis with the disease might be met with long-term treatments in other regions, its fatality rate in Sub-Saharan Africa is much higher. In the hardest-hit countries, like Swaziland, Botswana, and Lesotho, more than one in five adults are infected. The disease is most often spread here by unsafe sexual practices, such as having sex unprotected with multiple partners even after marriage. Older adults in Africa are also deeply affected by HIV/AIDS, as they are often left to care for grandchildren orphaned by the disease. HIV/AIDS remains the leading cause of death in Africa. Still, there have been strides to try to slow the spread and assist those with the disease. Countries like Uganda have supported public awareness campaigns promoting monogamy in marriage and contraceptive use. They were able to slow the prevalence of HIV infections from 15 percent in the early 1990s to just 5 percent in 2001. In recent years, however, the infection rate in Uganda has once again climbed. Some say the government squandered aid money from the international community and did not keep up the public health initiative once rates decreased ultimately causing the infection rates to rise. There is also a concern that religious initiatives promoting abstinence have not had the desired effect. In a 2011 survey, around one-quarter of married men in Uganda reported having multiple sexual partners in the past year and just eight percent of them reported using a condom. Periodically, regions in Africa, particularly West Africa, have experienced epidemics of Ebola, a viral hemorrhagic fever. Although Ebola is relatively difficult to transmit from person-to-person – it cannot be spread through the air like the flu – a combination of lack of understanding about disease transmission, inadequate infrastructure, and a distrust of Western intervention has made the region particularly vulnerable to deadly outbreaks. An outbreak beginning in 2013 in the coastal West African country of Guinea spread across the surrounding area and killed 11,000 people over the course of two years (Figure $$\PageIndex{3}$$). The political issues and difficulties of dealing with Africa’s healthcare crises illustrate larger issues related to governance in the region. Corruption is a significant problem across Africa costing residents around$150 billion each year. Bribery, even to access some public services, is common in many areas. Several governments deteriorated to the point where they are no longer functional, which is referred to as a failed state. In fact, of the ten states most vulnerable to failure in the world, seven are located in Africa.

In some areas, political conflict has gone hand-in-hand with ethnic conflict. Where competing ethnic groups found themselves sharing the same territory after independence, civil wars sometimes erupted as one group vied for power. Some groups turned to genocide, the systematic elimination of a group of people, in order to gain territorial and political control. In Rwanda, which had been a Belgian colony following Germany’s defeat in World War I, the Belgian colonizers had given political power to the minority Tutsi. The Belgians perceived the Tutsi as closer to Caucasian, and this policy of granting power to minorities was a global colonial strategy aimed at suppressing the majority ethnic group.

After Rwanda gained independence in 1962 CE, the Hutu, who represented around 85 percent of the population, came to power and violent conflict between the Hutu and the Tutsi began almost immediately. Hundreds of thousands of Tutsi fled, becoming refugees, people who have been forced to leave their country. By the early 1990s, the Hutu began preparing for genocide, seeking to eliminate the Tutsi minority. Over the course of 100 days between April and July 1994, 800,000 Tutsis were killed – around 50 percent of the entire Tutsi population. By the time the United Nations admitted that “acts of genocide may have been committed,” 500,000 had already been killed, most murdered with machetes. Rape was also systematically used against the Tutsi women. The Rwandan Patriotic Front, formed by exiled Tutsi refugees, defeated the government’s forces and has governed Rwanda since the end of the genocide. Conflict between Tutsi and Hutu, particularly in neighboring Burundi, has continued, however.

In South Africa, the ruling party that came to power after independence was dominated not by an indigenous African group but by the descendants of Dutch settlers, known as Afrikaners. Africans in South Africa outnumbered non-Africans by 4 to 1 and the ruling Afrikaners instituted a policy of racial separation known as apartheid, aimed at maintaining minority rule. This system of segregation led to an entirely different system of education for non-white South Africans, limited their use of public spaces, and forced the relocation of millions into separate neighborhoods. The system ended in 1994 with the country’s first democratic elections, but inequality between white and non-white Africans persists, and has actually worsened according to some measures.

Some countries have tried to overcome political instability and the lack of colonial connectivity by creating interregional organizations aimed at economic and political cooperation. The largest of these organizations is the African Union, which formed in 2001 and consists of every African state, including Morocco which recently rejoined the AU in 2017. Among other objectives, the African Union seeks unity, integration, and sustainable development. Other regional organizations exist with narrower objectives, such as the Economic Community of West African States (ECOWAS) and the Common Market for Eastern and Southern Africa (COMESA), both of which aim to create free trade areas between member countries. Because of the diverse array of Africa’s cultural and linguistic groups, organizations have often found it helpful to have a lingua franca, a common language spoken between speakers of different languages. In some cases, the lingua franca is the language of a common colonizer, such as English or French. In other cases, the language is native the region, such as with Swahili, the lingua franca for much of Southeast Africa.

Endemic:

a disease found within a population in relatively steady numbers

Epidemic:

a disease outbreak

Failed state:

when a government deteriorates to the point where it is no longer functional

Genocide:

the systematic elimination of a group of people

Refugees:

people who have been forced to leave their country

Apartheid:

the ruling Dutch government’s policy of racial separation in South Africa

African Union:

an interregional organization in Africa that seeks unity, integration, and sustainable development

Lingua franca:

a common language spoken between speakers of different languages