Who Cares? Therapeutic Practices and the Making of Noncommunicable Diseases in Zanzibar

This article is an ethnographic study of emergent discourses and therapeutic practices that target rising rates of noncommunicable diseases (NCDs) in Zanzibar. It interrogates in what ways and by whom diseases such as diabetes and hypertension are made visible and produced as objects of investigation, expertise, and attention in political-economic contexts where chronic care infrastructure is only slowly emerging. It outlines the relevant care networks that enable NCDs to be understood as a pressing issue (here, new forms of collaboration between NCD experts and traditional healers) and further situates NCD management within Zanzibar’s pluralistic medical landscape. In terms of an anthropology of NCDs in regions with limited NCD-related infrastructure, my study suggests the need for a more nuanced picture of the impact of the growing global prevalence of NCDs amid biomedical “lifestyle” framings of NCDs that focus exclusively on health behaviors to the neglect of social context and environmental, political-economic, and structural determinants of health. This study thus contributes to current anthropological debates on the previously underacknowledged burden of ill health from NCDs in Africa.