The relevance of the community in reducing the impact of NCD’s on life expectancy is because they are rooted in unhealthy lifestyles, adverse physical and social environments [23] . A well crafted community based program could significantly help to positively address these risk factors. When population is targeted as a whole, even a modest risk factor change will translate to a huge public health impact [23] . A sustained and effective commu- nity level risk reduction such as decrease in fat and salt intake, increase in potassium intake from fruits and veg- etables, regular blood pressure and lipid checks, could lead to substantial reduction of mortality in middle ages. The advice is that such efforts should commence at early stages, early secondary school age or even while in primary school, because the risk factors for NCD’s commences in early life [24] (see Figure 4).

In Africa, a good community program is based on low-cost lifestyle modification and effective community participation [23] [25] given cultural, political, psychological and economic factors that may hinder positive re- sults [23] . Community nutrition education should emphasize the benefits of nutrition in redressing NCD’s. Non- governmental organizations can play prominent roles here and such groups include, house wives organization, lay opinion leaders [26] and spiritual bodies such as churches and mosques. The government’s role here is con- ceptualization of nutrition policy and education and their implementation. The media should be enlisted for educating the community on proper nutrition, need for regular blood pressure, blood lipids and glucose checks, and other schemes necessary to curtail NCD’s prevalence. They should emphasize the role of primary health care worker in achieving success in this agenda [23] .

Major lifestyle changes that impact negatively on life expectancy are adoption of westernized diet and sedentary habit. Diets high in saturated fats and salt, but low in carbohydrate, fruits and vegetables, are implicated in in- creasing emergence of chronic diseases. The ongoing nutrition transition in Africa is characterized by large consumption of fat and sugar, marked increases in animal products and declining intake of fibers due to reduced consumption of cereals [27] . In most urban areas in developing countries, income increase due to improved economy, is associated with changes in diet preference. This change is satisfied by increase in supply and varie- ties of food products in such communities [28] . The combination of pro-NCD’s diet and poor physical exercise couple with increasing urbanization, growing private/public transportation and less physical employments, is driving the rising cases of NCD’s [29] with consequent impact on life expectancy.

Ability to afford pro-NCD’s meals in developing countries and use of cars for personal transportation is usually for those at the upper bracket of the socio-economic structures in most of Africa. For example, high se- niority civil servants with higher household income have been found to have lower levels of physical activity than their junior counterparts and greater energy consumption. Hence they have higher BMI, waist-to-hip-ratio, blood pressure, insulin levels and dyslipidemia [15] [30] . It appears that higher education and income contri- butes to NCD’s risk in this region. To address this, there is the need for nutrition education with emphasis on traditional diets. This should be inculcated into school curricula, even at higher education levels. Such efforts should be tied with increased encouragement to engage in physical exercise. Encouragements should include providing safe neighborhoods for safe walking and modification of built environment in a manner that increases energy expenditure in the community.

Studies in developed countries shows that the present obesity pandemic has a root in issues in physical environ- ment that supports obesity [31] [32] . Addressing built environment contribution to NCD’s could help in reduc- ing its prevalence in Africa. The relevance of built environment to health was first recognized during the indus- trial revolution, when insanitary condition and overcrowding facilitated the spread of infection [32] . At the time, built environment manipulations such as installation of comprehensive sewer systems, design of buildings that allowed inflow of light and fresh air and relocation residential quarters from noxious industrial facilities, were responsible for bringing infections under control [33] .

Present threat is from chronic NCD’s and built environment still has a role in its control. The observation is that sprawling nature of neighborhoods [31] , lack of safe open spaces for exercise, poor access to nutritious food, promotion of use of alcohol and tobacco products through outdoor advertisements [33] promotes NCD’s. A spread out residential design encourages use of automobile transportation rather than walking thus encouraging sedentary living. When “open spaces” in the community are left unattended to, they end up becoming dumping sites for garbage, habitats for vermin and favored spots for criminal activities [34] . They thus discourage physi- cal activities in and around such locations. Items that should be addressed in the community include, the present pattern of sprawling neighborhoods, availability of safe parks, neighborhood safety through adequate lighting, access to nutritious food market, reduced availability and access to alcohol and cigarette, and construction of safe and widely inter-connected walk ways. Added to educating people, healthy behavior should be encouraged through the provision of appropriate physical space [33] .

Due to increasing control of tobacco use in developed countries, the tobacco industry has shifted its marketing to middle and low income countries. This shift is encouraged by the inadequate tobacco-control and large prospec- tive consumer size in these poorer countries [35] . The targeting of young persons in low income countries [36] is worrisome giving that early exposure to tobacco use in the face of poor dietary choices will increase the risk for developing NCD’s in affected individuals. In Sub-Saharan Africa, men are found to presently use more cigarette than women [35] and this has made females to become the new target by tobacco advertisements [37] . Apart from increased NCD’s in women who use cigarette, there is the added issue of high prevalence of low birth weight babies by women who consumed tobacco during pregnancy. The already high cases of low birth weight babies in Africa and similarly poor regions will increase further with the use of tobacco products among women. Therefore the projection of substantial increase in number of children with NCD’s risk in the 21^st century [35] , as a result of fetal programming for such diseases, can only come true in Africa.

A substantial increase in price of tobacco products will discourage its regular use [38] and this should be coupled with restriction of tobacco advertisement in developing countries low income countries should be as- sisted in implementing tobacco control policies and educating their subjects on the dangers of tobacco use. Such education should be extended to hand-rolled cigarette, pipe smoking and use of snuff which is a common mode of tobacco use among women in Africa [39] . These measures have been well encapsulated in the WHO Frame- work Convention on Tobacco Control (WHO FCTC) to which most African and South East Asia countries have signed to [40] . It is therefore imperative that countries must be pressured by academia, professional groupings and civil society to implement the measures contained in such convention to which they have signed. The rise in prevalence of NCD’s due to tobacco use in adults, coupled with the risk in offspring’s of pregnant tobacco users, constitutes a big threat to improved life expectancy in Africa.

Epidemiological evidence suggests that hypertension, insulin resistance and dyslipidemia leading to cardiovas- cular diseases and type 2 diabetes mellitus in adulthood, originate in early life [41] . The preparatory mechanism for such later life NCD’s is related to fetal malnutrition. This fact is supported by the findings that low birth weight due to inadequate maternal nutrition is associated with chronic NCD’s emergence in later life [42] -[44] . Therefore, the present high prevalence of low birth weight in some Africa states will lead to higher prevalence of NCD’s in the region [45] . Some workers are of the opinion that the present high prevalence of NCD’s in Africa could be related to food shortages in parts of the region decades ago, and now [35] . The following are suggested measures to reduce increase in NCDs due to low birth weight/fetal programming.

1) Affected regions should consider malnutrition in pregnancy as an emergency situation. Women of child bearing age should be well educated on the impact of nutrition on materno-fetal well being. A good suggestion is establishment of a “pregnant woman meal” similar to previous school child meal programs. A similar venture has recorded success in a part of Africa thus suggesting its practicality [46] .

2) Primary health care workers should be adequately trained in nutrition education in a sustainable scheme that will guarantee continued education in the community. In particular, women should be taught how to source and utilize locally available health food materials.

3) In places that utilizes Traditional Birth Attendants are still common, they should be trained in nutrition education so as to pass it on to their clients.

Since it is possible that many subjects are already genetically primed to develop NCD’s in poor regions of the world, it is again important that the WHO NCD Draft Action for 2008-2013 [47] be not only adopted by region- al governments, but they should be assisted to make and drive anti-tobacco policies in their regions. This is a prime factor in the implementation of the WHO FCTC to cut down consumption of tobacco in different societies.

The model of health service in most of Africa is one that focuses on acute illnesses and immediate need of the patients. The pattern of operation is episodic interaction between the patient and the health services, and this is usually denominated in a “cash and carry” service. In this model, an ill patient who comes to the clinic or hos- pital is treated and payment is made for services rendered. Even in chronic disease clinics, compliance with clinic attendance could be influenced by the ability to pay for the service offered. Such a pattern of care does not allow for effective monitoring of chronic diseases in Africa. Hence a WHO report [23] emphasize the need to move away from Acute Care Model to a Patient-Centered Care type, which can be efficiently co-ordinate. In the patient-centered care model, a continuous relationship between the patient and health care provider is cultivated and maintained. The health care provider goes beyond the premises of the clinic or health facility to ensure the patient’s health is better managed. Information, education and other personal personal/community tools are re- cruited to enhance the patient’s well being [48] . The bedrock of this system of health care is that the patient rela- tionship with the system goes beyond mere understanding of ill health, but to creating a platform for prevention and management of chronic diseases and associated risk factors [49] .

The system of spending a large chunk of public health expenditure on tertiary-level hospitals should be recon- sidered [50] . It does not remove from the importance of tertiary hospitals which have immense regional and education roles, rather it makes them even more efficient. The point is that health needs are usually country- wide and centralized services as represented by tertiary hospitals can not address the roots of these chronic dis- eases. There need to be a change of tactics in order to improve life expectancy which is threatened by chronic non-communicable diseases. An expansion of primary health care is advised, in a manner that de-emphasizes centralization of health authority. Such an expansion will form the platform that will allow it effectively manage risk factors of NCD’s in the community. While ensuring this relocation of health responsibility to the periphery (primary health care centers), the central health authority can still maintain its hold on regulatory and infrastruc- tural interventions [50] . Closely linked to health system review is the issue of health insurance as a means of improving funding of health care services. Health insurance is grossly absent in most of Africa, especially in Sub-Saharan Africa. Even in South Africa, talk about public health insurance as the way to go in health funding, has barely moved beyond discussion documents. Governments should muster the political will to overcome public sector unpreparedness [50] in allowing the establishment of health insurance. This can only add to the advice of the World Bank [51] that Sub-Saharan African countries to employ the simultaneous solutions of en- gaging in public wide prevention and promotion activities, and effective management of those subjects already affected by NCD’s. The expansion of public health care with well trained staff that takes health care to the door steps of the patients, coupled with a properly positioned health regulatory organ, will assist greatly in improving health care delivery in Africa in a manner that increases the quality of life and life expectancy. The price of poor preparedness of public health sector in developing regions of the world including Africa will attract the expen- sive cost of compromised life expectancy which is now in the horizon. This is the point we recently emphasized during an ageing conference in Barcelona, Spain [52] and to which we continue to bring attention. Supporting our alarm is a study done in Oman in which the authors concluded that chronic diseases threatens the past four decades of advancements in health and longevity [53] .