Is your lifestyle killing you?
- By Dr Karen Hofman and Professor Stephen Tollman
Based in the Wits School of Public Health, Dr Karen Hofman (MBBCh 1978) and Professor Stephen Tollman (BSc 1979, MBBCh 1984, MMed 1999) wrote for Business Day about lifestyle diseases as serious as HIV and AIDS that threaten socio-economic growth.
The first meeting of the United Nations General Assembly on non-communicable diseases in September 2011 finally alerted the world to what South Africa’s medical professionals have long suspected — the burden of cancer, heart disease, diabetes and chronic lung disease is as serious a threat as HIV/AIDS and tuberculosis to social and economic development.
The World Economic Forum has ranked these ‘lifestyle’ diseases among the top threats to economic development. Their effect on the workforce and its productivity, and the potential future cost to the health system, is daunting. Similarly, they will have a great effect on household resources and income security.
All four diseases have their origins in a common set of risk factors. These include poor diet, lack of physical activity, smoking, the harmful use of alcohol and, most importantly, poverty.
For most poor people, the choice of cheap, nutritious foods and safe areas to exercise is an unknown luxury.
Still, a growing number of South Africans are buying prepared food from local shops or restaurants. For example, two-thirds of households in rural SA now buy their food from supermarkets, where access to cheap nutritious food remains a challenge. Therefore, even as people have access to a wider variety of foods, their choices are limited to highly processed products, which carry the very ingredients that cause non-communicable diseases.
The results are predictable. Close to 25% of all schoolchildren in SA are now obese, many of whom are poor and the majority of whom are female — despite persisting under-nutrition in some communities. In the next 20 years, deaths from heart disease alone are projected to increase by 40%. In the Western Cape, there are three to four amputations a week from preventable diabetes complications. These numbers are made worse by the fact that many patients die prematurely without ever knowing they were suffering from one of these silent killers. In S A , 35% of these deaths occur before the age of 60.
We need urgent solutions for S A to reach its stated life expectancy goals — 58 years for men and 60 for women by 2015. At a time when there are competing pressures for scarce healthcare resources, we need to focus on finding creative approaches that provide good value for money. Often this requires thinking beyond the traditional tools of hospitals, doctors and nurses.
Non-communicable diseases offer us an opportunity to do just that. After all, there is no condom against excessive salt in processed foods.
There are some easy victories to be scored outside the health system. To achieve them, other sectors must be called to action. For example, S A has been a world leader when it comes to tobacco control. Over the past two decades, legislation raising tobacco taxes and banning indoor smoking has led to a significant drop in smoking, and concomitant reductions in illness and premature death.
Successful policies in other countries have included bans on food adverts that target children and nutritious school food policies. In the UK and Australia, industry is spearheading an effort to gradually reduce salt in processed foods. Heart disease fell by 25% in Poland two years after legislation on polyunsaturated fats and removal of price subsidies on butter.
Similarly, South African industry chiefs need to explore ways to deliver products to stem the tide of non-communicable diseases. (After all, they also suffer from a workforce made less productive from the ravages of diabetes and heart disease.) For example, Woolworths is leading the way by beginning to reduce the salt content of many of its products.
As Health Minister Aaron Motsoaledi has noted, we face tough choices, and tackling non-communicable diseases cannot be done by the health sector alone. Just as the causes of these diseases are found in our supermarkets, our cafeterias and our kitchens — indeed, in all sectors of society — so too are the solutions. While we cannot forget the role of the health sector, we must also look beyond to identify efficient approaches.
By focusing on non health-sector interventions that target lifestyle conditions, S A can achieve good bang for its buck. While these diseases may be non-communicable, by joining forces to address them, the solutions can be contagious.