Pressure of Life - Pressure of Blood : Local Illness Experiences related to Hypertension in a Lower Middle Class Society of Dar es Salaam, Tanzania

Hypertension or high blood pressure is a primary risk factor of the epidemic occurrence of cardio-vascular diseases currently proliferating in many urban centers of low-income countries such as Tanzania. In the face of a growing health impact on the population, first intervention programs on hypertension have been implemented in Dar es Salaam, Tanzania's most urbanized area. Yet, at the time of implementation, it remained unclear how local people perceived this new health issue. Focusing on the local idioms "BP" or "presha" commonly used for blood pressure, both high and low, the author examines how a lower middle-class society of Dar es Salaam interprets, perceives and experiences the relatively new health problem.

The study shows that people use the expressions "BP" or "presha" to refer to an illness that relates to, but is not identical, with the biomedical concept of hypertension. Apart from biomedical aspects of the illness, people understand the illness mainly as the result of a harsh life in the city, marked by economic degradation and the break-up of traditional family structures, resulting in social inse-curity. Both sides of the illness, the somatic and social sides, are integral parts of the local illness understanding and are not distinguished as two different illness concepts. This double sidedness of the illness results in ambivalences and contradictions in people's illness explanations and is a main factor of inadequate response in biomedical health advice. The results of the study call for a more comprehensive and interdisciplinary approach in combating newly emerging health problems.