20 August 2020 – The South Africa Non-Communicable Diseases Alliance (SA NCDs Alliance) is raising concern over the systemic neglect of non-communicable conditions (NCDs) like obesity, diabetes, high blood pressure, cancer, asthma and mental health problems due to neglected NCDs prevention and treatment. Download infographics
Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance says, “People living with NCDs believe it’s a health right to have proper access to care and medicines, especially now during a time of pandemic. Before COVID-19, the NCDs group of conditions killed most South Africans and remained neglected within government policy and budgets. For so long the many millions of people living with NCDs have lamented, ‘it would be better if I had HIV, then I would get access to quality care and medicines.”
NCDs, called underlying conditions during COVID-19, cause most deaths in South Africa. Diabetes kills more women than any other single illness for many years. (1) Government media acknowledge that 90% of those who die following COVID-19 infection had one or more NCD. (2)
Act on NCDs Now – Accountability
The early figures coming out of Wuhan showed that NCDs increased the risk of complications and dying. It was clear that survival depended on well-managed conditions such as diabetes. It immediately exposed the fault lines in NCDs care.
The aim is to get government to implement ongoing care for those living with NCDs by health workers during and beyond COVID-19. This includes ensuring adequate supply of medications that don’t involve travel and visits to facilities and making use of online and tools for consultations to minimise physical interaction and exposure.
The Alliance further proposes performance indicators to assess government’s response to COVID-19 and ongoing NCDs care such as maintenance of food and medicine supply chains, protection and support for vulnerable and neglected people and maintenance of usual health services.
“As South Africans went into lockdown in March, the SA NCDs Alliance initiated online support, counselling and information services to keep people healthy such as the diabetes care line. Those of us living with diabetes soon learned that optimal blood sugar control is the best way to survive a COVID-19 infection. However, getting care and a regular supply of medicines in the public sector involved a stark choice; get your medications or get the virus. Unlike for HIV and TB, a remote non-clinic supply point is a rare option. Insulin, absolutely critical to sustain life in diabetes, is only available at a hospital-level even if there is a clinic next door,” elaborated Pinkney-Atkinson.
Zodwa Sithole, Head of Advocacy for CANSA added, “Patients are feeling frustrated and despondent as they struggle to access vital support services. A cancer patient’s low immunity and high infection risk for COVID-19, results in anxiety and physical distancing and hygiene measures add to a feeling of isolation even as lockdown levels are eased. Part of the response was the launch of our CANSA Tele Counselling service offering free, confidential cancer-related telephonic counselling available in seven languages.”
Nosipho (3) puts the human face on the access issue. In late pregnancy, she always needs insulin and asthma medication. Being a savvy diabetic, she knows she is at risk and tries to avoid the minimum five-hour round trip to get her insulin in central Cape Town during the COVID-19 surge. She knows that the risk of infection is high by using public transport and the long waiting lines at the hospital. When asked, the government sectors were unable to offer a solution.
For other NCDs like cancer, there are implications of delaying any screening that can result in cancers being detected at a later stage and affecting treatment outcomes.
Pinkney-Atkinson concludes, “What works to keep diabetics and other people living with NCDs safe, is not a mystery. There is plenty of evidence, we need action to provide ongoing NCDs care during COVID-19. (4) During the COVID-19 pandemic and beyond, we must go beyond stopping the virus and our right to get our ongoing essential services safely. We need these drugs and supplies (needles and syringes) to stay alive.”
For more information, please contact Dr Vicki Pinkney-Atkinson, Director of SA NCD Alliance at email [email protected]
Call 083 38 38-159. Alternate contact is Lucy Balona, Head: Marketing and Communication at CANSA at email [email protected].
Call 011 616 7662 or mobile 082 459 5230.
References:
(1) Statistics South Africa. Mortality and causes of death in South Africa, 2016: Findings from death notification [Internet]. Pretoria; 2018 [cited 2018 Mar 28]. Available from: http://www.statssa.gov.za/publications/P03093/P030932016.pdf
(2) SA Government News Agency. SA COVID-19 cases rise to 3 034. SANews.gov.za. 2020;2
(3) Not her real name
(4) Young T, Schoonees A, Lachman A, Kalula S, Mabweazara S, Musa E, et al. Taking stock of the evidence. Cape Town: Better Health Programme South Africa; 2020. 50 p
About NCDs+
NCDs are a large group of health conditions that are generally not spread from person to person and used to be called chronic illness until 2000 when the Millennium Develop Goals force a new definition. Often the 5 main NCDs groups of conditions are noted: diabetes, circulatory disorders, mental health, cancer, and chronic respiratory illnesses. However, there are many more conditions that do not get a mention. Globally NCDs conditions are responsible for 41 million deaths annually and they are leading cause of death in South Africa since 2013. Diabetes is the leading cause of death of South African women.
However, the NCDs agenda is not just about illness it goes to a whole of society and whole of government response and for this we need an expanded understanding, meaning, NCDs+. The expanded NCDs+ advocacy agenda includes prevention, vulnerable populations, stigma control and disability. NCDs+ has many determinants (social, economic, and commercial) that disproportionately impact poor people. The Sustainable Development Goals (SDGs) address NCDs+ and its inclusion as an equal part of universal health coverage. (National Health Insurance in South Africa).
About the SA NCDs Alliance
The SA NCDs Alliance, established in 7 years ago, is a civil society partnership between three trusted NCDs advocacy organisations: CANSA, Diabetes SA and the Heart & Stroke Foundation SA.
Its mission is for the people of South Africa have equitable access to quality NCDs+ prevention and management within universal health coverage/ NHI.
For this important COVID-19 and NCDs+ advocacy project nearly 90 civil society organisations are collaborating:
Cancer Alliance South Africa
Dementia South Africa
Epilepsy South Africa
Global Mental Health Peer Network
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) SA
National Kidney Foundation SA
Palliative Treatment for Children SA (PatchSA)
South African Disability Alliance
South African Federation for Mental Health
The SA NCDs Alliance’s goal in this programme it to ensure that the policy window of opportunity opened by the COVID-19 pandemic is used to make NCDs a priority in government policy through collaboration with NCDs civil society to put it on a par with HIV & TB. www.sancda.org.za
Diabetes helpline +27-81-578-6636
24 June 2020 – This Nelson Mandela Day CANSA gives back to cancer patients, those affected by cancer and caregivers by launching its CANSA Tele Counselling service. This is confidential, professional, cancer-related telephonic counselling to cancer patients, caregivers and their families and parents or guardians of children living with cancer. Counselling is available in seven languages (English, Afrikaans, isiXhosa, isiZulu, siSwati, Sesotho and Setswana) and is free of charge. #CANSATeleCounselling #ConnectWithHope #MandelaDay
Gerda Strauss, CANSA’s Head of Service Delivery says, “We challenge all to take action and to inspire change this Mandela Day, by donating and sponsoring 67 minutes of counselling. Help us with the costs and expenses to run the service and provide continued in-service training and debriefing sessions to counsellors. We don’t want to add the burden of payment for these sessions to those who are already battling, so we need your help. Even Madiba, when he was first diagnosed with prostate cancer in 2001, reached out to CANSA and benefitted from our support and we’d like to be there for more patients and loved ones and connect with hope. Our launch includes a webinar in mid-August to health professionals to celebrate this Tele Counselling, in addition to our face-to-face counselling services since 1931.”
CANSA has been developing an in-house telephonic counselling service for some time as cancer takes a psychological, emotional and physical toll on cancer patients. This service has just been accelerated due to the limited specialised support available to cancer patients, their caregivers and families during the lockdown period, when face-to-face contact and limited virtual support is not always possible as a result of the COVID-19 pandemic.
Strauss adds, “Patients are feeling frustrated and despondent as they struggle to access vital support services. A cancer patient’s low immunity and high infection risk for COVID-19, results in anxiety and social distancing and hygiene measures add to a feeling of isolation even as lockdown levels are eased. So, this is the perfect time to launch the telephonic counselling. The establishment of this service will not only serve patients during this difficult period, but will become a permanent care and support offering, enabling patients who live far from our Care Centres to also access support and in a language of choice. It’s available during normal business hours.”
“We’re thrilled and thankful that we can partner with Novartis and Roche who made it possible for CANSA to establish and set up this specialised support system in place for cancer patients and loved ones,” concluded Strauss.
CANSA Tele Counselling can be accessed via the CANSA Help Desk on 0800 22 66 22 toll-free to make an appointment with a CANSA counsellor. Or send an email to [email protected].
(For more information, please contact Lucy Balona, Head: Marketing and Communication at CANSA at email [email protected]. Call 011 616 7662 or mobile 082 459 5230.)
About CANSA
CANSA offers a unique integrated service to the public and to all people affected by cancer. CANSA is a leading role-player in cancer research and the scientific findings and knowledge gained from our research are used to realign our health programmes, as well as strengthen our watchdog role to the greater benefit of the public. Our health programmes comprise health and education campaigns; CANSA Care Centres that offer a wide range of care and support services to those affected by cancer; stoma and other clinical support; medical equipment hire, as well as a toll-free line to offer information and support. We also supply patient care and support in the form of 11 CANSA Care Homes in the main metropolitan areas for out-of-town cancer patients and CANSA-TLC lodging for parents and guardians of children undergoing cancer treatment.
Queries CANSA
Visit www.cansa.org.za or contact the nearest CANSA Care Centre, call CANSA toll-free 0800 22 66 22 or email: [email protected]. In addition to online resources and Facebook support groups, CANSA offers multi-lingual support on WhatsApp: 072 197 9305 for English and Afrikaans and 071 867 3530 for isiXhosa, isiZulu, siSwati, Sesotho and Setswana. Follow CANSA on Facebook:
CANSA The Cancer Association of South Africa, Twitter: @CANSA (http://www.twitter.com/CANSA), Instagram @cancerassociationofsouthafrica, LinkedIn and Pinterest.
For millennials, it ain’t looking good, but are hard-hitting campaigns just fat-shaming and counterproductive?
The video features a small white box that looks like a cigarette packet. No pictures, just stark lettering.
People on the street are shown the box and asked a question: “What is the biggest preventable cause of cancer after smoking?”
They guess. Drinking? Sunbeds? No. The packet is opened. It is stuffed with greasy, plump slap chips.
On bleak white posters and billboards splashed across London and the United Kingdom and a barrage of social media messages the question is repeated.
Some letters to the answer are left out, in an easy game of hangman. OB_S__Y.
Yes, Cancer Research UK wants to tell the British public in a hard-hitting advertising campaign, being overweight or obese could be the new smoking: as smoking rates fall, obesity levels have crept up. If the trend continues, obesity may eventually overtake smoking as the biggest cause of cancer.
The message is SC_RY.
The country’s millennials — the supposedly quinoa-loving, juicing, detoxing generation born between the early 1980s and the mid-1990s — are likely to be the most overweight since records began, Cancer Research UK calculates, based on Health Survey for Englanddata from 2015.
More than seven in 10 millennials will be overweight by 2026-2028, the organisation predicts. This compares with around half of all baby boomers — those born between 1945-55 — who were overweight or obese at the same age.
In South Africa, obesity figures are equally alarming. South African women have the highest overweight and obesity rate in sub-Saharan Africa, according to a 2014 study published in the medical journal The Lancet.
The country’s 2016 demographic and health national survey reveals that two out of every three women (68.5%) and just over a third of men 15 years and older are overweight or obese. The Lancet study’s results were similar: 69.3% for women and 39% for men.
South African women’s obesity and overweight rate is almost double the global rate of about 30%, according to The Lancet study, for which researchers collected data from 188 countries.
For adults, overweight and obesity ranges are determined using weight and height to calculate a person’s body mass index (BMI), which for most people correlates with the amount of body fat. Overweight is defined as a BMI of 25 to 29.9 and obesity as a BMI of 30 or more, according to the United States government’s Centers for Disease Control (CDC).
A woman who is 1.65m tall and weighs 69kg, for example, has a BMI of 25.3 and is therefore overweight. If a woman of 1.73m weighs 90kg, her BMI is 30 and she is obese. (There are some exceptions, such as sportspeople.)
“While obesity groups tend to increase in the older age groups, South African millennials are also affected, with three out of five women and one in five men between the ages of 20 and 34 years estimated to be overweight or obese,” says Jessica Byrne, a registered dietician and spokesperson of the Association for Dietetics in South Africa (Adsa), referring to statistics in the 2016 demographic and health survey.
“South Africa faces a massive and growing burden of obesity.”
Lifestyle changes may prevent 4 in 10 cancers
Being overweight or obese is linked to 13 different types of cancer, research published in the New England Journal of Medicine in 2016 shows. This includes cancers of the breast in postmenopausal women, says Lorraine Govender, national advocacy co-ordinator of the Cancer Association of South Africa (Cansa), as well as cancer of the colon and rectum, endometrium, kidney and pancreas. It may also be associated with an increased risk of cancer of the liver, cervix, ovary and aggressive prostate cancer.
Statistics from the South African National Cancer Registry reveal a steady increase in the incidence of both lung and colorectal cancers from 2009 to 2013 among men, Govender points out.
The incidence is the rate at which new cases of a condition in a population increases over a specified period of time, according to the CDC.
“From 2011 the figures show that colorectal cancer incidence has increased in comparison to lung cancers,” Govender explains. “This could be the start of the impact of the obesity epidemic in South Africa.”
Among women in South Africa, Cancer Registry statistics show an increase in reported new cases of breast cancer and colorectal cancer. Govender says this is “possibly resulting” from the growing obesity epidemic.
Linda Bauld, Cancer Research UK’s prevention expert, explains that “extra fat doesn’t just sit there. It sends messages around the body that can cause damage to cells. This damage can build up over time and increase the risk of cancer in the same way that damage from smoking causes cancer.”
But only 15% of people in the UK know that obesity is a cause of cancer, Cancer Research estimates.
A 2015 study in the British Journal of Cancer confirms smoking is still responsible for a huge 54 300 cases of cancer in the UK every year but being overweight or obese causes nearly half as many (22 800 cases or 6.3%). The results suggest that more than 1 in 20 cancer cases would be prevented by maintaining a healthy weight, Cancer Research UK argues.
In South Africa, Govender explains, there is not sufficient research to show the actual percentage of cancers that are lifestyle-related. But, apart from obesity, preventable cancers include those linked to tobacco, alcohol consumption, exposure to the sun and ultraviolet-emitting tanning devices, pollution and lack of physical activity.
“Cancer is not inevitable,” says Govender. “It is possible that many cancers related to overweight and obesity could be prevented.”
Will blunt messaging convince millennials to shake off the kilos or is it fat shaming?
“Fat shaming!” and “Damaging!” — a chorus of protest met Cancer Research UK’s awareness campaign.
Sofie Hagan, a London-based Danish comedian, did not tactfully omit a single letter when she took to Twitter to vent how P_SS_D off she was: “Right, is anyone currently working on getting this piece of shit Cancer Research UK advert removed from everywhere? Is there something I can sign? How the fucking fuck is this okay?”
But Cancer Research says the campaign was never about fat shaming or blaming someone for their cancer.
“It’s not about anybody’s personal eating habits or blaming the individual,” says Malcolm Clark, policy manager for obesity at Cancer Research UK. “Yes, we wanted to raise the fact that there is a link between obesity and cancer, but the aim was to get action across the population to tackle this; to get policymakers and regulators to do more and to show where government should focus its efforts. The purpose was to have a public health campaign.”
The campaign was based on science, Clark emphasises. And although these figures make for grim analysis, they also show that positive changes can decrease the risk of cancer.
In South Africa, Govender says, nongovernmental organisations such as Cansa play a vital role in creating awareness — especially in the absence of a functional and well-resourced national cancer control plan.
But Cansa’s language is considerably more measured. Obesity is a highly stigmatised condition, Govender points out, and even clinicians may use alienating language when they try to talk to patients about their weight.
Adsa’s Jessica Byrne says that, although shock tactics may raise awareness, as has been successfully done in highlighting the dangers of smoking, there is a delicate balance between educating the public about the dangers of obesity and stigmatising or creating a negative body image in those who are overweight.
“Perhaps supportive messages should also focus on the importance of healthy lifestyle choices to prevent cancer, rather than singling out obesity,” she explains.
Cancer Research UK is still awaiting the results of the impact its campaign has had.
There will be considerably more than 15% of people who know about the link between excess weight and cancer, Clark predicts, especially given the level of response, coverage — and outrage.
