The rise of non-communicable disease (NCDs) in Mozambique: decolonising gender and global health

Abstract

Health and gender are two significant areas of the global development system. They share entangled epistemological histories typically drawn from the global North. We examine how these global entanglements of gender in global health act to veil local epistemologies and explanatory systems of understanding of disease, simultaneously advancing and complicating local responses to the changing epidemiological burdens in Mozambique. This paper draws on research from Mozambique conducted as part of a large three-country study of the double burden of disease. We focus in this paper on the connected conditions of hypertension and stroke. The research was conducted in areas that have faced a double burden of disease: the persistence of diseases that attract international intervention, where community-based health centres are sometimes referred to as ‘Global Fund’ clinics, and a new burden of non-communicable disease (NCDs). The reach and penetration of particular sets of knowledge derived somewhat from the global North have been accompanied by particular renderings of gender that have brought with them social constructivist theorising that eschews non-Western configurations of sex and gender in the context of illness, disease, and well-being. Drawing on critical African gender studies, we begin to re-examine global health and its epistemological assumptions about disease presentation and explanatory models. Such discussion is necessary to engage in calls to de-colonise global health, as well as the mainstreaming of gender in global health. Reflecting on measures to decolonise feminisms and ensuring that African feminisms inform future gendered understanding and programming around NCDs should be central to responses to the new onslaught and double burden of NCDs across Mozambique and sub-Saharan Africa more widely.