By Dr Morgan Mkhatshwa
South Africa is urbanising rapidly: 63% are living in urban areas. Statistics indicate this will rise to 71% by 2030 and by 2050, eight in 10 people will be living in urban areas.
This will have a negative effect on people’s health. The most significant effect is the increase in non-communicable or lifestyle diseases.
The main problems associated with changes in lifestyle and behaviour, due to urbanisation, are increased alcohol and tobacco use, lack of exercise, poor nutrition, and socio-economic factors.
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 will increase if no effective health systems and policies are put in place to prevent, detect and treat communicable and non-communicable diseases.
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, under-active thyroid and depression.”
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 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 lung and respiratory diseases, heart conditions and cancers. Chronic Obstructive Pulmonary Disease and asthma are two of the most prevalent respiratory diseases.
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.
Achieving good patient health outcomes is the fundamental purpose of health care.
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.
There needs to be co-ordination 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.
*Dr Morgan Mkhatshwa is the head of operations at Bonitas Medical Fund.
**Views expressed here are not of The Star on IOL.
The Star