Author: Daniela Branco, John M Bryant, Shalom Kpetsu, Ann T. Nguyen, Gage H. Redler, Peter Allan Sandwall, Eman Suliman, Charles R. Thomas, Joseph Weygand 👨🔬
Affiliation: Department of Radiation Oncology and Applied Science, Dartmouth Health, University of South Florida Morsani College of Medicine, Alzahraa University Hospital, Dartmouth College, Moffitt Cancer Center, OhioHealth, Purdue University, University of California San Diego / California Protons, Department of Radiation Oncology, Moffitt Cancer Center 🌍
Purpose: Access to radiological health services in sub-Saharan Africa (sSA) remains extremely inadequate, with over 90% of the population in most countries lacking access to radiotherapy and facing similar deficits in diagnostic imaging. These disparities arise from a complex intersection of historical, socioeconomic, ethnic, and geopolitical influences. This study examines the impact of the European colonial legacy on contemporary access to radiological health services across sSA.
Methods: Sub-Saharan African countries were categorized by former colonizer (United Kingdom, France, Portugal, Belgium). Radiotherapy access was evaluated using megavoltage unit data from the IAEA's Directory of Radiotherapy Centers (DIRAC), while diagnostic imaging availability (MRI, CT, PET, nuclear medicine, and mammography) was obtained from the WHO's Global Atlas of Medical Devices. Population-normalized metrics and IAEA benchmarks were then used to estimate the percentage of populations with access to each service. Intergroup differences were analyzed to explore the impact of colonial legacy.
Results: Former British colonies exhibit markedly greater access to radiological health services compared to their French, Portuguese, and Belgian counterparts. For instance, 27.2% of the population in former British colonies has access to radiotherapy, compared to 8.2%, 6.0%, and 2.5% in former French, Portuguese, and Belgian colonies, respectively. A similar pattern is observed across multiple diagnostic imaging modalities; for example, access to CT is available to 47.3% of the population in former British colonies, contrasted with 33.7%, 25.8%, and 6.9% in French, Portuguese, and Belgian colonies, respectively.
Conclusion: The findings suggest that European colonial legacy continues to influence access to radiological health services in 2024 (six decades after independence), with former British colonies demonstrating greater availability compared to their French, Portuguese, and Belgian counterparts. Addressing these disparities requires targeted global health interventions, particularly in French- and Portuguese-speaking regions, focusing on infrastructure development, capacity-building, and language-specific outreach to promote equitable access to radiological healthcare.