Santé et sociétés en Afrique de l’Ouest ed. by Boëtsch Gilles, et al. (review)

This collective work is the fruit of an ambitious programme bringing together researchers from many disciplines, including biologists, medical epidemiologists, ecology specialists, geographers, sociologists and anthropologists; a multidisciplinary team engaged in both North-South and South-South collaborative projects. The methodological choice to work with local populations rather than merely on them is instrumental to understanding how international health programmes are appropriated at the local level, specifically in connection with family and social organization and symbolic conceptions of the body and illness. The studies presented here were conducted in three West African cities: Dakar, Bamako and Ouagadougou (a greater number of chapters on Dakar). The first of the five issues discussed is the health impacts of pollution (especially in terms of allergies); the second, the combined effect of the environment and societal changes on non-transmissible chronic pathologies in the context of a globalized food system (rises in obesity, high blood pressure, diabetes). Here we see the impact these emerging pathologies are having in West Africa and how Southern countries with little in the way of local treatment facilities are “catching up” with Northern ones for prevalence. The other three issues are transmissible infections (particularly malaria and schistosomiasis or bilharzia), health services in West Africa (a renewal of approaches and methods), and lifestyle changes in the region and their health impacts.

The book’s main contribution is surely its focus on contemporary changes and the fact that it discusses health issues in the context of globalization; i.e., of circulating images, representations, knowledge and bodily practices. The book recalls that Africa will have new challenges to cope with in the coming years, a major one being caring for older persons. Until recently the aged were treated with consideration and respect in accordance with traditional values. They are now often perceived as a useless burden by new generations caught up in an individualization process due in large degree to urbanization.

While the book shows the persistence of older representations (the traditional values of modesty, self-control, what may be considered an overweight body), West African societies are not treated as static or isolated but rather situated in the global context. The book helps to combat received ideas, recalling, for example, that high blood pressure is just as widespread in Western societies as in African cities, though there is much more cause for concern in the latter because the population knows little about this pathology, meaning that monitoring and treatment rates are low. The book also discusses how sexuality is socially organized and operates in urban contexts, stressing how new means of communication open the way to new gender relations. West African societies, especially cities, are currently undergoing lifestyle changes related to particular housing and economic situations as well as social transformations facilitated by development of the media (television, radio and internet) and considerable North-South and South-South migration, which mixes populations and works to circulate ideas.