The views expressed are those of the writer.
by Elsabé Brits
Last year the South African Medical Research Council published its Second Comparative Risk Assessment study, which outlined the trends and risk factors associated with disease and death in the country.
Although unsafe sex and interpersonal violence remain high on South Africa’s risk profile, key results from the study suggest that non-communicable diseases combined are at an all-time high and are highly likely to overtake unsafe sex and interpersonal violence.
The study looked at risks and changes which occurred between 2000 and 2012.
According to the study, unsafe sex dominates South Africa’s risk factor profile and accounts for the largest proportion (27%) of the 20.6 million disability-adjusted life years (DALYs) lost in 2012.
The other high-risk factors are in order of rank: high body mass index, alcohol consumption; high blood pressure; high fasting plasma glucose; smoking; childhood undernutrition; water, sanitation and hygiene; ambient air pollution; low fruit intake; high cholesterol; iron deficiency; low physical activity; household pollution; low vegetable intake, high sodium intake and high ambient pollution (ozone).
An estimated 33% of child deaths in South Africa were attributable to undernutrition. Addressing undernutrition must include measures that address household poverty and food security to ensure nutrition is a basic human right. The health system response also needs to be strengthened.
Experts wrote in the South African Medical Journal that ensuring the health system’s resilience post the COVID-19 pandemic to attain universal health coverage constitutes an important first step.
However, it is a common cause that disease prevention is, and will continue to be, a key platform for health improvement and reducing the burden on the healthcare system and communities. As it is currently envisaged, the preparations for NHI do not adequately address the need for health promotion and disease prevention. To the extent that the NHI Bill mentions health promotion, commentators have argued that the approach is very narrow and the vision, in scope and likely funding, falls far short of what is to impact population health.
It is hard to see how this could be accomplished without establishing an equipped and resourced entity for evidence-based health promotion and protection.
An influential Lancet Series in 2009 on Health in South Africa provided recommendations for priority diseases, structural reforms in health financing, disease surveillance and research and innovation. South Africa’s health challenges were framed at the time as colliding infectious disease, non-communicable disease, and injury epidemics.
Evidence is critical.
To know the population’s health and risks, scientists need access to data. No informed decisions can be made without proper research by the health sector. Without this, policies would be a guessing game.
A limitation of the study is that the results reflect the 2012 status, as this is the latest year for which burden of disease estimates are available for SA.
This is no fault of the researchers nor the Burden of Disease Unit, which does excellent work. The country has very limited epidemiological data on the non-fatal burden of disease, making it necessary to estimate this from the relationship of non-fatal to fatal burden from The Global Burden of Disease, Injuries, and Risk Factors study, which provides country estimates up to 2019.
Without contemporary data, it is impossible to know how different the current risk factor profile might be or the impact that COVID-19 would have had. In addition, a critical gap in the South African health system is the lack of integrated care for mental disorders at the primary level, a highly-specific, evidence-based, best-buy intervention.
The National Public Health Institutes of South Africa (NAPHISA) Bill, enacted in 2020, aims to provide health surveillance to guide health policy and planning; however, this has yet to be established and funded. This aims to provide integrated and coordinated diseases and injury surveillance research, monitoring and evaluation of services and interventions for the major public health problems affecting the South African population. Without it, the country is falling further behind with health surveillance. We need to know what diseases are affecting us, what changes have occurred, and what to focus on. Without it, health services cannot be targeted – and this will affect each of us if it has not already.