South Africa is urbanising rapidly: 63% of South Africans are already living in urban areas. Stats indicate this will rise to 71% by 2030 and by 2050, eight in 10 people will be living in urban areas. While it is unavoidable that people migrate to cities for work, it does have a negative effect on people’s health. The most significant effect is the increase in non-communicable or lifestyle diseases.
Dr Morgan Mkhatshwa,Head of Operations at Bonitas Medical Fund, says that the main problems associated with changes in lifestyle and behaviour, due to urbanisation, are:
- Increased alcohol and tobacco use
- Lack of exercise. Cities are often over-populated, there are too few public spaces for physical activity and many residents have to use public or private transport because of long commutes to work, schools and amenities
- Poor nutrition. Changes in diet include more processed and refined food, an increase in high-fat and high-sugar diets, less fruit and vegetables, less complex carbohydrates and fibre
There is an increasing recognition of the importance of social, economic and physical environments as determinants of health and well-being. Unfortunately, the poorest people living in under-serviced inner city areas or informal settlements are the most exposed to unhealthy urban environments. With urbanisation, the double burden of non-communicable diseases (NCDs) will increase if no effective health systems and policies are put in place to prevent, detect and treat communicable and non-communicable diseases.
‘Our analysis of lifestyle diseases indicate that hypertension is the most prevalent non-communicable disease, followed by high cholesterol and diabetes Type 2. Obesity, high cholesterol, diabetes Type 2 and hypertension are all symptoms of metabolic syndrome, caused by poor nutrition and a sedentary lifestyle.
‘The science around nutrition has long been problematic. Published results have varying conclusions but concur that highly processed and food with high sugar and “bad fat” content should be avoided.
‘Also, in the top seven conditions are susceptibility to blood clotting, asthma, underactive thyroid and depression,’ says Dr Mkhatshwa. Asthma is a respiratory condition most often caused by pollution or other irritants in the environment and mental health conditions can also be a consequence of urban living.
Oncology is also becoming more and more prevalent. The number of Bonitas members with cancer has more than doubled since 2016.
Motor vehicle, industry and domestic fuel use increases air pollution which is responsible for a range of lung and respiratory diseases, heart conditions and cancers. Chronic Obstructive Pulmonary Disease (COPD) and asthma are two of the most prevalent respiratory diseases.
‘We have the expertise to respond to these risks and lifestyle diseases by providing comprehensive, integrated care, every step of the way,’ explains Dr Mkhatshwa. ‘And, through our Managed Care programme, we help equip our members to take responsibility for their health by providing information and education, encouraging wellness, paying for preventative care and providing cover for medical costs incurred. However, more needs to be done and we advocate collaboration with public health authorities to educate and encourage South Africans to look after their health.’
Covid-19 and NCDs
It is common knowledge that Covid-19 and non-communicable diseases such as hypertension and diabetes interact to create a perfect storm. The pandemic has made people more aware of having to take responsibility for their health and preventing or managing chronic disease optimally. ‘Co-morbidities have an impact on those who contract Covid-19 and there is possibly a synergistic issue with the coronavirus and these co-morbidities that exacerbates the prognosis and burden of disease.’
‘Achieving good patient health outcomes is the fundamental purpose of healthcare,’ says Dr Mkhatshwa. ‘Measuring, reporting and comparing outcomes is perhaps the most important step towards unlocking rapid outcome improvement and making better choices.
‘Managed Care is a critical component and improves quality of care and we know that proactive intervention and working with members to prevent or control lifestyle diseases is the only way forward. Because when ‘I’ becomes ‘we,’ illness can become wellness.’
The GP is pivotal
We believe there needs to be coordination of care and that members should be encouraged to nominate a General Practitioner as the first port of call for all health care needs, who can refer to a specialist or auxiliary provider as the need arises. This eliminates inefficiencies caused by ‘doctor hopping.’
‘To tackle the rising burden of disease, we need medical schemes to work together with public health authorities, particularly in the context of the challenges of urbanisation, lifestyle diseases and the Covid-19 pandemic.’