Obesity: a ticking time bomb in South Africa – HSF South Africa

National Obesity Week 15 to 19 October 2017

In South Africa National Obesity Week follows World Obesity Day on the 11th October. Obesity will continue to increase in South Africa unless changes are made at an individual, familial, community and policy level. The HSFSA also supports government’s efforts to regulate the food industry as one of the strategies to reduce and halt overweight and obesity.

Obesity is defined as a state of having too much body fat, to the extent that it negatively affects health. Whilst obesity has afflicted a small portion of most societies for centuries, only in the last half century has it drastically increased. Obesity is now one of the biggest global health problems of the 21st century. Whilst the prevalence of obesity is levelling off in high-income countries, rates continue to increase in low and middle-income countries, including in South Africa. Half of South Africans aged 15 years and older are categorized as being overweight and 40% of women as obese.

South Africa’s double burden

South Africa is still plagued by undernutrition as high unemployment levels and inflation continues to drive food insecurity. Ironically, undernutrition and overnutrition have become part of the same problem, the one fueling the other. The seemingly opposite conditions are found in the same communities and even within the same households. A low household income results in a monotonous diet based on refined starch, little protein, poor diversity of fruit and vegetables, and salt as the main taste enhancer. With urbanization many traditional vegetables and legumes which provided some good nutrition are readily replaced by cheap processed meat, crisps, deep fried foods, and sugary snacks and drinks. Food choices are mostly driven by price and accessibility. “Bad access to good food and good access to bad food” – says local participants from a report into hidden hunger 1. In one study where researchers compared prices in rural food stores, healthier food choices cost on average 70% more 2. Changes in food consumption patterns confirm that South Africans are eating more kilojoules, more sugary beverages, more processed and packaged food, and fewer vegetables 3.

This poor dietary pattern becomes deficient in many vitamins, minerals and fibre – yet remains sufficient in energy. “In fact, hyperpalatable foods high in added sugar, fat and salt easily provide a surplus of energy. Combined with low activity levels, this is the perfect recipe for obesity” says Gabriel Eksteen, Nutrition Manager at the Heart and Stroke Foundation SA.

Poverty and undernutrition also have an indirect biological impact on obesity. Poor nutrition during pregnancy, infancy or childhood changes metabolism in preparation of a life of food shortages. When a child is subsequently exposed to a surplus energy from a modern diet, obesity and diabetes is more likely than in well-nourished peers. Equally, infants born to obese

mothers are biologically predisposed to becoming obese themselves – with 70% of South African women overweight, the ripple effect can be immense.

Rising middle-class

In South Africa undernutrition also coexists with over-indulgence, further fueling obesity. The rising middle-class who can afford more nutritious food is also unfortunately increasing their portion sizes and adding luxury items high in fat and sugar such as take-outs and sugary drinks. Parents and caregivers who expose their children to a sedentary lifestyle and poor eating habits place them at risk for becoming obese. Childhood obesity is a powerful predictor of adult obesity.

Obesity is weighing down South African progress

South Africa continues to experience urbanization, an increasingly unhealthy modern food supply, and reduced levels of physical activity. Given this trend, obesity is predicted to steadily increase. The World Obesity Forum estimates that nearly 4 million South African school children will be overweight or obese by 2025. The 2016 Global Burden of Disease study reports that although South Africans are gradually living longer, but a greater proportion of life is spent suffering from chronic diseases 4. Unless we act now, the health consequences of obesity will overburden the health care system and decreased productivity will stifle economic progress.

Act now

South Africans need to work together to fight obesity. The Heart and Stroke Foundation SA calls on all role players, including government, the corporate sector, civil society, and the food sector, to act decisively to bring about change. The World Health Organization and the World Obesity Forum both recommend systemic changes to battle obesity. This includes promoting intake of healthy foods and physical activity, preventing obesity pre-emptively during pregnancy and in early childhood, and improving access to weight management services. Environmental changes to improve access to affordable healthy food and opportunities to be physically active is important, whether at school, at work or in communities. Policies to tax unhealthy food and initiatives to subsidize healthier choices are also recommended and cost-effective. Finally, there should be continued pressure on food manufacturers to limit marketing of unhealthy foods and reformulate products.

Professor Pamela Naidoo, CEO of the HSFSA, states that “South Africa is a complex country with glaring inequalities. Obesity, which poses a major risk factor for the onset of many medical conditions, is but one consequence of the inequalities we face. Consequently, the HSFSA is determined to help multi-stakeholder initiatives to reduce obesity and drive advocacy towards this goal.”

References

1) Hidden hunger in South Africa, OXFAM, 2012

2) Temple et al, Nutrition, 2011

3) Ronquest-Ross et al, South African Journal of Science, 2015

4) Global Burden of Disease Study, Lancet, 2017

CANSA Newsletter – October 2017

 

Available for download from CANSA:

Infographics: Breast Cancer | Cervical Cancer | Colorectal Cancer | Uterine Cancer | Lung Cancer

 

Knowing the Big Five that Assail South African Women

1 October 2017 – The link between the Big 5 and South African women has nothing to do with our country’s magnificent wildlife legacy, but rather everything to do with the disease, cancer, that plays havoc with South Africa’s sisterhood.

With October being Woman’s Health Awareness month, the Cancer Association of South Africa (CANSA) highlights the five leading types of cancer that indiscriminately afflict women in South Africa – breast, cervical, colorectal, uterine, and lung cancer.

While access to good healthcare for all, would be a significant contributing factor to lowering cancer deaths and improving outcomes, CANSA firmly believes in sharing awareness and knowledge and how this strategy can go a long way in lowering cancer risk and improving the overall disease landscape in the country.

Elize Joubert, CANSA CEO states, “Early detection and diagnosis, reduces the severity of the disease and also decreases the mortality rate.  Research has shown that a regular breast self-examination plays an important role in discovering breast cancer, compared to finding a breast lump by chance.”

The Big 5 Cancers

Both breast and cervical cancer have been identified as a national priority with increasing incidences occurring.  Approximately 19.4 million women aged 15 years and older live at-risk of being diagnosed with breast cancer – the cancer affecting women in South Africa the most.  In 2013, deaths from breast cancer and cancers of the female genital tract, accounted for 0.7% and 1% of all deaths in South African respectively.[1]

“We encourage all women to conduct regular self-examinations once a month. CANSA advocates a mammogram every year for all women from age 40 for purposes of non-symptomatic breast screening.  Women 55 years and older should change to having a mammogram every two years – or have the choice to continue with an annual mammogram.  Know how your breasts look and feel – discuss any changes you observe with your health practitioner. And get to know the warning signs or symptoms.” Joubert added.

The Radiological Society of South Africa (RSSA) are offering special mammography reduced fees at all RSSA affiliated mammography clinics throughout the country, during October – http://www.cansa.org.za/files/2017/10/RSSA-Discount-Breast-Awareness-Participation-2017.pdf

The second most common cancer amongst women in South Africa is cervical cancercaused by the Human Papilloma Virus (HPV). CANSA strongly recommends all women who have been sexually active should start having Pap smears between the ages of 18 and 20 years, and Pap smears may cease at the age of 70 years if the individual has had two normal Pap smears within the last five years. Pap smears tests are uncomfortable but painless – they help lower the risk of cervical cancer, not just detect it early. When abnormal cells are identified and removed, in many cases it is prior to cancer cells actually developing.

Colorectal cancer or colon cancer is the third most common cancer affecting women in SA.   CANSA continues to appeal to women to get to know their bodies and start looking out for any telling signs and symptoms that may reveal this hidden scourge.  Change in bowel habits (diarrhoea/constipation), rectal bleeding or blood in stools and persistent abdominal discomfort (cramps, gas or pain) are among some of the warning symptoms of colorectal cancer.

Millicent Mulelu, colorectal cancer survivor says although a cancer diagnosis can have a profound impact on one’s life and those around you, it should not be regarded as a death warrant. “There are ways to beat the condition but you need to remain optimistic, resilient and never give up hope, because only hope will see you through.”

Cancer of the uterus, also known as endometrial cancer or uterine cancer is number four of the most common cancers affecting women occurring in the tissue of the endometrium which is the lining of the uterus.

Joubert explains, “Again, we advise that should any of the following warning signs appear, they should be investigated further by a medical practitioner – abnormal vaginal bleeding or discharge; and pain in the pelvis or abdomen especially when urinating or during sexual intercourse. Early detection is key and leads to better treatment outcomes.”

And then there is lung cancer that occupies position five.  Statistics reveal that the more a person smokes, the greater the risk of developing lung cancer. It’s also more likely to develop in people who start smoking at a young age. However, if someone stops smoking, the risk of developing lung cancer falls dramatically and after approximately 15 years, the chance of developing the disease is similar to that of a non-smoker.

 

 

Infographics: Breast Cancer | Cervical Cancer | Colorectal Cancer | Uterine Cancer |Lung Cancer

 

By paying greater attention to the ‘Big Five’, women will be better prepared to reduce their personal cancer risk and avoid the physical and emotional impact that can accompany a cancer diagnosis.

“We recognise the role of women as societal and economic participants as well as caretakers who influence the health of the whole family.  Clinical Breast Examinations, Pap smears and Healthy Lifestyle Risk Assessments are all offered at CANSA Care Centres country-wide to increase early detection.  We also support patients and their families through counselling and support groups,” concluded Joubert. (http://www.cansa.org.za/cansa-care-centres-contact-details/).

CANSA also has various Mobile Health Clinics which offer screening to people in communities who do not have easy access to health screening (http://www.cansa.org.za/cansa-mobile-health-clinics/). During October, people can participate in a CANSA ‘Shades of Pink’ Walk to raise awareness about cancers affecting women and funds to help CANSA in its screening and support efforts for women. See here for the nearest event.

Visit www.cansa.org.za, contact the nearest CANSA Care Centre, call CANSA toll-free 0800 22 66 22 or email: [email protected].  CANSA offers multi-lingual support on Whatsapp: 0721979305 for English and Afrikaans and 0718673530 for Xhosa, Zulu, Sotho and Siswati.  Follow CANSA on Twitter: @CANSA (http://www.twitter.com/CANSA), join CANSA on Facebook: CANSA The Cancer Association of South Africa and follow CANSA on Instagram: @cancerassociationofsouthafrica

[1] Vorobiof D, Sitas F, Vorobiof G. Breast cancer incidence in South Africa. Journal of Clinical Oncology 2001 (September 15 Supplement); Vol 19, No. 18s: 125s -127s.

Fears as Durban loses last state cancer specialist – Bhekisisa

Written by: JOAN VAN DYK for Bhekisisa
Only two state cancer specialists remain in the province of more than 10-million people.

Durban loses its last public sector oncologist today as shortages of specialists in the province continue.

The doctor’s departure from Inkosi Albert Luthuli Central Hospital leaves KwaZulu-Natal with just two oncologists, both practising at Grey’s Hospital in Pietermaritzburg.

Chairperson of South Africa Medical Association’s KwaZulu-Natal branch Mvuyisi Mzukwa says these two doctors are swamped and dealing with a backlog of patients, some of whom have been waiting for treatment since 2011.

The closure of cancer services may be the latest symptom of what the South African Medical Association (Sama) and human rights organisation Section27 says are the province’s failing health systems. In May, the duo took to the streets to protest issues such as staff shortages, poor working conditions and deteriorating infrastructure and equipment.

In a five-page memo delivered to KwaZulu-Natal health MEC Sibongiseni Dhlomo, Sama alleged that the provinces had severe shortages of specialists such oncologists but also obstetricians, psychiatrists and orthopaedic and general surgeons. The association also said health facilities operated amid shortfalls of soap, gloves, needles and clean linens. Doctors also complained of rat and insect infestations.

As the province’s shortage of specialists grows, so too will waiting lists for treatments, warns Mzukwa.

But KwaZulu-Natal health department spokesperson Sam Mkhwanazi says the department is already recruiting new oncologists and in the interim, private sector oncologists and radiotherapists will provide cancer treatment at Inkosi Albert Luthuli Central Hospital. These specialists will be overseen by the head of Pietermaritzburg’s oncology unit at Grey’s Hospital.

Meanwhile, the KwaZulu-Natal department of health is running a deficit of more than R1-billion this year, according to information presented at the health budget vote in March. This includes an R500-million shortage for HIV treatment for the 2017/ 18 financial year.

The health systems and policy manager at the Rural Health Advocacy Project, Russell Rensburg says some companies contracted to maintain medical equipment and provide medications have not been paid. He explains that many continue to provide services and credits them with helping keep the health system afloat.

Rensburg told Bhekisisa in January that although provincial health budgets have almost doubled in the past 15 years, they have not kept up with the rising cost of employees.

Employee compensation now accounts for about 65 % of provincial health expenditure, according to a 2016 working paper released by the Rural Health Advocacy Project.

Rensburg warns that the country’s recession and ratings downgrade could topple KwaZulu-Natal’s health system if government fails to adjust current and projected budgets that have largely been based on false assumptions.

He explains: “The current budget is based on a projection that the economy would grow by between 1.2 and 1.5% in the next year. But the country is now in a recession and the ratings downgrade will affect our ability to loan money. The department has its head in the sand.”

The recession is likely to reduce levels of taxable income as companies shy away from investing and creating jobs in the country. Meanwhile, the recent downgrade in South Africa’s credit ratings means there will likely be less money for public expenditure as more cash goes to service debt.

Other provincial health departments will also suffer, he says. In September, South Africa introduced new HIV treatment guidelines that now offer antiretrovirals to anyone who has tested HIV-positive, meaning many more people now qualify to receive the drugs than before. Previously, people would have had to wait until their CD4 counts — a measure of the immune system’s strength — fell to 500.

Rensburg says that government is spending money to increase access to HIV treatment and roll out the National Health Insurance while there may not funds to sustain existing programmes.

He explains: “We are facing a financial crisis in health and it is being ignored.”