Non-Communicable Diseases set to knock SA off its feet, warns Health Minister

Less than 24 hours before Health Minister Dr Zweli Mkhize would confirm South Africa’s first COVID-19 case and had to stem panic over an infectious disease outbreak that is making headlines globally, he gave a reminder of another health crisis. Mkhize warned that the South African health system is set to be ‘knocked off its feet’ by a wave of Non-Communicable Diseases (NCDs).

The Minister appealed to researchers at a research symposium on Non-Communicable Diseases at the Lord Charles Hotel in Somerset-West on Wednesday to focus on finding ways to address the growing problem which he likened to a natural disaster.

A tsunami

“This (increase in NCDs) is a tsunami,” he said. “It is not only about the health of our country, but also about the impact it has on development at various levels.”

NCDs, according to the World Health Organisation (WHO) refers to non-infectious diseases such as cancer, diabetes, chronic respiratory illnesses and cardiovascular diseases. In 2018 the WHO attributed an estimated 41 million deaths globally to NCDs.

According to the 2019 South African Health Review, a 2014 burden of disease analysis had concluded “NCDs were the largest broad cause of years of life lost (YLLs) in South Africa”. Mkhize addressed this in his speech and cited StatsSA which in 2015 determined that “NCDs are among the top ten causes of mortality in the country”.

Given the severity of the situation, the Minister stated that “our response to NCDs must be swift and more importantly our action must be evidence-based”. He appealed to researchers to focus their attention on finding innovative ways to manage NCDs and added that there needs to be “a lot more investment in preventative measures”. Mkhize’s statement on investment in preventative measures, however, comes in the wake of Finance Minister Tito Mboweni’s announcement last week of an almost R4 billion budget cut to health.

Mkhize told attendees that it is essential for these preventative measures and interventions to be proven to have an effect on reducing NCDs, as South Africa cannot afford to implement measures that aren’t going to work.

“With limited resources, countries like South Africa must use evidence to shape interventions so that we invest in interventions that have a significant impact,” he said.

Way behind the curve

Yet, South Africa should have been much more concerned about NCDs much earlier, according to Deputy Director for Communicable and Non-Communicable Diseases in the National Department of Health Yogan Pillay.

During his plenary speech at the symposium earlier that morning, Pillay expressed his frustration at the fact that in 2020 “we are way behind the curve” in addressing NCDs. He added that South Africa should be responding to NCDs in the same way it has responded to Communicable Diseases, which it is currently not doing.

In his speech later that afternoon, Mkhize admitted that the country’s methods for managing NCDs so far had not worked as well as was hoped.

“Our attempt as a country to respond to NCDs through development policies, strategies, legislation, regulations and guidelines appear not to have the desired impact on prevention and control. We are failing to decrease premature mortality, morbidity and disability,” he said.

According to the Minister it is vital to remedy this, as NCDs, which come at a massive cost to patients, their families and society, are going to become even more prevalent as the disease pattern in South Africa changes.

“The disease pattern has also shifted to the extent that we are now anticipating problems that are a lot more expensive to treat, more difficult to prevent and which are now going to put a heavier burden on the health services in the country,” he said.

The shift in the disease pattern, according to Mkhize can be attributed in part to South Africa’s success in treating HIV/AIDS and tuberculosis (TB).

“The price of our success with the anti-retroviral treatment is that many people are no longer going to be dying of HIV and TB immediately and therefore they live long enough to develop problems like cancer, diabetes and hypertension,” the Minister said.

Managing NCDs is a complex process, due to the many factors that cause them. According to the WHO NCDs “are the result of a combination of genetic, physiological, environmental and behavioural factors”. This results in the need to address NCDs on multiple levels. In South Africa, according to Pillay, work to address the prevalence of NCDs needs to happen at an individual level and family level as well as within the Food, Beverage and Tobacco industry. Yet, despite calls for an increase in sugar tax by organisations like the Healthy Living Alliance (Heala), Mboweni did not announce any increases in the sugar tax this year.

Mkhize identified alcohol and tobacco use, obesity and physical inactivity as high-risk, but preventable behaviours that could lead to NCDs. Thus, in addition to policy change, there needs to be a change in South African culture, according to the Minister. He explained that this can be achieved by “creating the kind of culture amongst our people that is going to help us to reduce the pressure of these NCDs, and the morbidity and mortality associated with it”.

While highlighting these issues, Mkhize also managed to slip in a reference to National Health Insurance (NHI).

“As part of preparing for the National Health Insurance, we clearly need to re-engineer our health service and ensure that the system focuses on health promotion and disease prevention, as well as community-based approaches and strong multi-sectoral collaboration,” he said.