ABSTRACT

This paper examined the direction of causality among urbanisation, carbon emissions and infectious diseases in heavily indebted poor countries in Africa. The analysis was motivated by the rising health burden associated with HIV prevalence, tuberculosis incidence and malaria incidence in countries where rapid urban growth, weak infrastructure, environmental degradation and limited fiscal capacity continue to shape public health outcomes. The article was derived from a panel of 28 heavily indebted poor African countries over the period 1990 to 2023. Infectious diseases were captured through three indicators: prevalence of HIV among the population aged 15-49, incidence of tuberculosis per 100,000 people and incidence of malaria per 1,000 people at risk. Urbanisation was measured as urban population as a percentage of total population, while carbon emissions were measured as CO? emissions in metric tonnes per capita. The study was anchored on the epidemiological transition theory and the environmental Kuznets curve hypothesis, with additional insights from environmental determinants and urban health perspectives. The Dumitrescu-Hurlin panel Granger non-causality test was employed to determine the direction of causality across the panel. The findings revealed bidirectional causality between HIV prevalence and carbon emissions, as well as between HIV prevalence and urbanisation. The results further showed that carbon emissions Granger-caused tuberculosis incidence, while tuberculosis and urbanisation exhibited bidirectional causality. For malaria, the findings showed feedback relationships between malaria incidence and carbon emissions and between malaria incidence and urbanisation. These results indicate that infectious diseases, urban development and environmental degradation reinforce one another in heavily indebted poor African countries. The article concludes that disease control in these countries should not be treated as a purely health-sector issue but as a combined public health, urban planning and environmental governance challenge. It recommends integrated disease surveillance, sustainable urban planning, improved sanitation, cleaner energy use and health-sensitive environmental policy as coordinated strategies for reducing infectious disease vulnerability.