There is a shift happening across Africa that we are not fully talking about. Non-communicable diseases are rising fast. The World Health Organization estimates they now account for about 35 percent of all deaths in the African region, up from just over 20 percent in 2000. By 2030, they are expected to become the leading cause of death in sub-Saharan Africa. This is not a small trend. It is a change in how illness looks and feels in everyday life.

But our conversations have not caught up. We still understand infectious diseases better than chronic ones. We know how to talk about HIV, malaria, and tuberculosis. There has been years of education, campaigns, and public messaging. People understand risk, testing, and treatment pathways. With diabetes, epilepsy, and hypertension, the language is weaker. The understanding is patchy. The tone is often judgmental.

This gap is not just about information. It is about emotion.

People living with chronic conditions are more likely to experience depression and anxiety. In diabetes, rates of depression are around two to three times higher than in the general population. At the same time, alcohol is a known risk factor for worsening many of these conditions. These two realities are often discussed separately. In real life, they overlap.

In Zambia and across the diaspora, many people are diagnosed late. Some are not diagnosed at all. Others are given a diagnosis but not enough explanation. They are told what to take, but not always how to live with it. Mental health support is rarely part of the conversation. So people are left managing a condition and their emotions at the same time. And that pressure builds.

When people feel overwhelmed, they look for relief. Alcohol is one of the easiest options. It is available. It is social. It does not require explanation. Research shows that people under psychological stress are more likely to drink as a coping mechanism. In chronic illness, this is often linked to burnout. People get tired of managing something that does not go away.

In diabetes care, this is called diabetes distress. It reflects the mental load of constant decisions. What to eat. When to take medication. When to check levels. When that load becomes too much, people disengage. They stop checking. They delay treatment. They avoid thinking about it. Alcohol can sit in that space. It gives a short break from the constant thinking. From the outside, this can look like poor discipline. From the inside, it often feels like relief.

Stigma makes this worse. When people do not understand a condition, they simplify it. Diabetes becomes about food choices. Epilepsy becomes something to hide. Hypertension becomes something people ignore until it is serious. These simplified views create blame and fear. Over time, people absorb that. They stop saying, I have a condition. They start feeling, I am the problem.

This shift creates shame, and shame changes behaviour. People speak less, they ask fewer questions, and sometimes they avoid going to the clinic. They manage things alone. Isolation grows, and isolation increases the likelihood of unhealthy coping, including alcohol use. This is not just culture. It is a systems issue, because when support is limited, people create their own ways to cope.

If we compare this to infectious diseases, the difference is clear. HIV and tuberculosis still carry stigma, but there has been sustained effort to address it. There are support groups, counselling services, and clear public messages. People have the language for it so they know what is happening and what to do next. Whereas with non-communicable diseases, we are behind. The conditions are increasing, but the support systems are not growing at the same pace. People are living with lifelong conditions without the same level of guidance or emotional support, which creates a huge gap that shows up in people’s behaviour.

Alcohol is not just a lifestyle issue in this context. It can be a signal. It can point to confusion, stress, or fatigue that has not been addressed. If we only focus on the drinking, we miss the root of the cause. This does not mean alcohol-use should be excused. Alcohol worsens many conditions. It affects the liver, the heart, and blood sugar control. It can increase complications and reduce treatment effectiveness. But telling people to stop drinking without addressing why they are drinking is not enough.

If someone is overwhelmed, unsupported, and confused about their condition, removing alcohol does not remove the problem. It only removes the coping tool. The underlying issue remains. So the question becomes practical. What needs to change? How can we create ways or support structures to foster healthier coping mechanisms?

Chronic disease care cannot be only clinical. It has to include emotional and mental support. People need clear explanations, not just instructions so that they can understand what is happening in their body and what they can do about it. They need to feel capable, not blamed.

We also need to normalise honest conversations. Saying this is difficult should not feel like failure. Managing a lifelong condition is not simple. It requires daily effort. That effort needs to be acknowledged. And this is where community matters here. Whether in Lusaka or in the diaspora, people need spaces where they can talk without being judged. When people feel understood, they are more likely to stay engaged in their care. When they stay engaged, they make better decisions.

Africa is moving from a health system focused on acute illness to one that must manage long-term conditions. That requires a different approach. It requires consistency, education, and emotional awareness. If we do not build that, people will continue to cope in the ways that are more easily available to them.

And sometimes, what looks like a drinking problem is actually a coping problem that no one has taken the time to understand.

Kaajal Vaghela is a sportswear designer and diabetes wellness consultant with over three decades of lived experience managing Type 1 diabetes. Having previously served as Chairperson of the Lusaka branch of the Diabetes Association of Zambia, she remains a passionate advocate for breaking down myths and building awareness about diabetes. For more personalised coaching or corporate wellness workshops, visit: www.kaajalvaghela.com and for any feedback: [email protected])