South Africa’s looming public health crisis …

Understanding the depth of the NCD burden.
Image: Bloomberg

The number of South Africans suffering from diabetes increased by 257% in the decade to 2019, while cancer and cardiovascular illnesses are responsible for 55% of claims against critical illness policies. South Africa is facing an unprecedented public health emergency driven by a growing prevalence of non-communicable diseases (NCDs) like diabetes, cardiovascular disease, cancer, asthma and mental health conditions.

The country’s looming public health crisis is likely to be compounded by the large number of South Africans living with HIV as well as the arrival of Covid-19, which impacts most severely on people with NCDs.

Understanding the depth of the NCD burden

Concerned about the impact that NCDs are having on the country’s public healthcare system, especially as the country moves towards a system of universal health coverage, Percept, a South African multi-disciplinary consultancy, joined forces with public health specialist, Dr Beth Vale, the Actuarial Society of South Africa (ASSA), the Board of Healthcare Funders (BHF) and RGA Reinsurance Company of South Africa to conduct deep dive research into the growing burden of NCDs.
The research was conducted by Percept and Dr Vale, and was funded by ASSA, BHF and RGA. The findings were recently published in a series of 14 briefs, each exploring a different aspect of managing NCDs in the South African context.The ASSA Public Interest function initiates and funds research that has the potential to influence public policy. According to Lusani Mulaudzi, ASSA’s public policy actuary, the general prevalence of NCDs has never been quantified making it almost impossible to project the impact on healthcare costs in South Africa. “This research work done by Percept will help to enhance the understanding and management of NCDs in South Africa and ASSA is honoured to be part of this initiative.”
The research on NCDs in South Africa is much more than just a set of quantitative data, what makes these briefs incredibly relevant is the qualitative data gathered by Dr Beth Vale through in-depth ethnographic research in a community situated in the heartland of the Karoo.
NCDs and socio-economic factors

The Karoo community became the focus of the research because, despite being removed from the country’s key urban centres, it has some of the highest rates of NCDs in the country. This highlights the link between NCDs and socio-economic factors. Previously considered “diseases of lifestyle” that afflicted high-income countries, the rate of NCDs is increasing rapidly in low- and middle-income countries where healthy food options are either not available or unaffordable. Eighty-six percent of the world’s NCD-related premature deaths occur in low- and middle-income countries, with sub-Saharan Africa facing the highest NCD mortality risk.The research also lists “exploitative working conditions” as a key driver of NCDs. According to Vale, the complex change from lifestyle farming to commercial farming in the Karoo has had a significant impact on the food environment for farm workers. “Payment has moved from a package of farm food and very limited wages, to a purely cash-based system based on a hard-won minimum wage,” explains Vale. She adds that many workers now travel long distances to buy food at month-end, often with a preference for processed, non-perishable food that can stretch across time and budgets.
Vale found that many members of the Karoo community, which was the focus of this research, live with multiple NCDs, sometimes in addition to being HIV positive. This leaves health workers having to manage drug interactions, adherence to prescribed drugs and juggle supply shortages on an ongoing basis.
Credible insights aid planning

The direct cost burden on the country’s public health system as well as the indirect impact on the economy are substantial. In addition to the cost of pharmacological interventions and consultations with health workers, a large number of individuals are missing work regularly because they are either too ill to work or in queues seeking help from a stretched health system.

On a national scale, the growing rate of NCDs is also impacting life insurers who are seeing significant changes in claims experiences. Correct measurement of the risk and accurate pricing is crucial in enabling life insurers to provide sustainable financial protection for death, disability and critical illness.

There is very little reliable data or research on the prevalence of NCDs in South Africa, because the conditions are not notifiable and also because the focus has been on HIV. “Not having credible insights into the state of the health of your population hinders your ability to plan. Equally, it also prevents life insurers from deriving accurate pricing for risk products. This research is the first step towards building a comprehensive dataset that paints the picture for the entire country.

The series of briefs provides a deep dive into some of the key NCD conditions and analyses South Africa’s incidence and prevalence and what that means for the type of healthcare required in future.

Healthcare actuary Shivani Ranchod of Percept.

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Finally recognition of a real medical issue in South Africa.

I wonder if we will get to see the Diabetes Control Council (DCC)… I will not hold my breath.

Finally recognition of a real medical issue in South Africa.

I wonder if we will get to see the Diabetes Control Council (DCC) in action… I will not hold my breath.

Farmers in the Western Cape used to provide their employees with a generous weekly supply of “rations” or groceries as part of the remuneration package.

As a boy, I remember handing out 3kgs of mutton, beef, or pork, per family, on Sunday mornings and another 2kg on Wednesdays. Workers received 2kgs of wheat flour, a 10kg bag of potatoes, 2 bricks of margarine, 4 rolls of toilet paper, 2kg maize meal, 1kg samp, dried peas and beans, and 40 dried maasbankers(fish), per family.

Every family received 5 liters of fresh milk per pay. The people were healthy and nobody had diabetes or TB.

Then, the ANC government accused farmers of being “paternalistic”. Militant and opportunistic hooligans who represented the ANC accused farmers of exploiting workers. They forced farmers to abandon the system of rations and to pay wages. Inflation then destroyed the purchasing power of the wage.

Government intervention in the economy leads to poverty and diabetes.

When the ruling ANC cadres (even from the health ministry) steal the emergency funds meant for the Covid-19 pandemic (which is a crime against humanity) then you realise that SA has an ANC problem and a governance crisis.

It’s wrong to call it a public health crisis.

South Sudan has a poverty rate of 82% and a diabetes rate of 7%. Haiti has a poverty rate of 77% and a diabetes rate of 7%. Zimbabwe has a poverty rate of 72% and a diabetes rate of 2%.

South Africa has a poverty rate of 55% and a diabetes rate of 15%. It is basic human nature, a genetic trait, to consume high-energy foods whenever it is available because famine was the limiting factor of population size for millions of years. Modern man needs a combination of nutritional information and discipline to protect himself from the negative effect of energy-dense foods. When income growth enables people who lack nutritional information and discipline to afford energy-dense foods, they poison themselves by overconsuming these foods.

The tri-monthly injection of estrogen as a contraceptive also plays a huge role in die obesity and diabetes epidemic among women. Estrogen craves energy-dense foods. Contraceptives prevent a population explosion. It seems as if we have to choose between diabetes and starvation.

The long term injection contraceptives that last 8 weeks (Nuristerate), or 12 weeks (Depo-Provera, Protogen) contain a progestogen, not an oestrogen. These are fundamentally different female hormones.
Please refrain to comment on these highly complicated metabolic and endocrinological matters, as you are clearly not a medical expert.

You are correct. It is a progestin. Thank you for correcting me. I saw the weight gain and the obesity epidemic among young women. The injection causes weight gain. Many of them are insulin resistant. That is my point.

Sorry Petogen, not Protogen. Autocorrect.

I sincerely doubt whether the injectable contraceptive is a major factor in the prevalence of NCDs. Although progestatives might worsen obesity or diabetes, and are ill advised for women with a history of blood clots, they should be replaced by other alternatives like oral contraceptives or IUDs when needed. Women on theses injections should be regularly checked on weight, blood pressure and tested for diabetes.
In other parts of the world low dose combination oral contraceptives are by far the most widely used.
I honestly wonder why you receive so many up votes. Could try to explain that, but leave it to another time.

End of comments.

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