New Epidemics of Democracy: Death in the New South Africa

In the new South Africa, the top ten causes of death are the same as they were twenty years ago. What's changed is their ranking, and also the extent to which they affect different South Africans – a reflection of changing lifestyles over the past two decades.

That was the topic under discussion at the “New Epidemics of Democracy” seminar hosted by the University of the Western Cape's (UWC) School of Public Health (SoPH), in conjunction with the Department of Dietetics, on Tuesday 27 May 2014. The seminar saw presentations from a set of speakers expert in examining diseases, mortality and public health.

Dr Debbie Bradshaw and Dr Victoria Pillay-van Wyk from the Medical Research Council's Burden of Disease Unit, presented up-to-date research exploring what the statistics say about trends in mortality in South Africa over the last 20 years.

Between 1997 and 2010, the list of the top 10 causes of death remained consistent: HIV/AIDS, cerebrovascular disease, interpersonal violence, TB, coronary heart disease, lower respiratory infections, diarrhoeal diseases, hypertensive heart disease, road injuries and diabetes mellitus.

However, the structure of the list changed: interpersonal violence dropped 51% while diabetes increased 29%, and respiratory infections moved up to the number three spot (behind HIV/AIDS and cerebrovascular disease).

“We need to continue efforts to provide access and treatment for HIV positive individuals,” Pillay-van Wyk recommended, “and also to scale up efforts targeting prevention and management of non-communicable diseases, particularly diabetes.”

David Sanders, Professor Emeritus and first Director of the SoPH, explored South Africa's double burden of disease in relation to nutrition – the epidemics of underweight and obesity and how they lead to serious health complications.

Tracing the entry of ultra-processed foods – and related complications – into South Africa, and through South Africa into the South African Development Community (SADC), he examined how this might have a big effect on health. “South Africa is a country that suffers simultaneously from the problems of affluence and poverty,” explained Sanders, “and both of these result in nutritional challenges.”

Rates of anemia, stunted growth, hypertension and diabetes are affected by diet. “I like to call this nutritional immunodeficiency,” said Sanders, “because that brings home to me how, like HIV, poverty and food can have a big effect on overall health. Fast food may be the new tobacco.”

Dr Tracy Naledi, Chief Director of the Western Cape Provincial Health Department, discussed the impact of injury and violence, how they vary between different provinces and groups, and how to respond to them socially.

Violence in the Western Cape occurs at a frequency nearly 50% higher than in other provinces – though this is concentrated in areas of multiple deprivation like Khayelitsha, where poverty and disease are also rife.

Beyond interpersonal violence, she noted, there is also intimate partner violence, and especially gender-based violence. “One in three women have experienced such intimate violence at any time: To understand this we need to contextualise the problem around families and social issues,” said Naledi.

There is good news, though: Homicide has decreased over the past few decades, largely due to fewer gun deaths as a result of political stabilisation and firearm control.

“In the search for health solutions, there's no silver bullet,” Naledi noted, “but if we are to deal with violence and accidents we need to be strengthening communities and how they come together and perceive social issues. Without stronger communities, public health measures can't succeed in any meaningful way.”

After a lively Q&A session, Prof Helen Schneider, Director of the SoPH, summed up the evening. “In many ways, our present disease burden represents a failure to deal with the iniquities of our past, and to take into account our history,” she said, “but as our speakers have shown, it is also to some extent a challenge resulting from our new globalisation.”

The seminar formed part of a series of UWC Faculty of Community and Health Sciences “20 Years of Democracy” seminars inviting health and social sector professionals, educators and researchers to reflect on transformation in South Africa, and what that means for health as well as health education.

Find out more about the CHS 20 Years of Democracy Seminar Series here.