Unhealthy Lifestyles Increase Health Risk
Many South Africans are physically inactive, consume poor, unhealthy diets and are overweight or obese leading to all kinds of preventable conditions that kill them prematurely. Up to 40% of cancers can be prevented by living a healthy, balanced lifestyle – this includes avoiding substance abuse, such as the abuse of alcohol and tobacco use.
The latest South African Health Review (SAHR) warns that South Africans, especially urban, poor populations are at increased risk of chronic non-communicable diseases that can be blamed on preventable and modifiable risk factors such as high blood pressure, high blood cholesterol, obesity, physical inactivity, unhealthy diet, tobacco use and the inappropriate use of alcohol. These factors in turn lead to various chronic disease processes that culminate in high death rates that are attributable to stroke, heart attack, tobacco–induced cancers, nutrition-induced cancers and obstructive lung disease.
South African Research
A South African study conducted in 2000, identified heart disease, stroke, hypertension and diabetes as causing 65 000 deaths per year, suggesting that after HIV, AIDS and tuberculosis, the prevention of these diseases should receive priority attention. The SAHR authors also expressed concern that these high-risk patients are not being identified at primary health care level. “Routine screening for risk factors in all individuals in the health services is poor,” they wrote.
In 2003, national data showed that only 18% of men and 22% of women had controlled hypertension, while the prevalence of diabetes in 2000, among adults older than 30 years, was estimated to be around 5,5%. They further identified underlying factors such as increased urbanization, environmental factors, socio-economic and cultural factors, as contributing extensively to the growing prevalence of these diseases.
A study to identify environmental risk factors for non-communicable diseases in an urban townships, found there was generally a shortage of healthy, low-fat food and little fresh fruit and vegetables available. The majority of local shops sold cheap fatty foods and stalls run by street vendors often sold fatty meat and sausages. Another study reported that although a large percentage of African women were overweight or obese, few perceived themselves to be so. “The belief that thinness is associated with personal problems and sickness, especially HIV and AIDS, seems to be a barrier to maintaining normal body weight in some individuals,” the study said.
The authors said South Africa was characterized by a paradox, where obesity in children coexists with stunting and early nutritional deprivation. Both underweight and overweight children are at risk for chronic non-communicable diseases in later life. Young people were found to be adopting bad habits. A national survey among youngsters reported that learners frequently consumed fast foods (38,8%), cakes and biscuits (47,4%), cool drinks and sweets (52%), at least four days a week.
The SAHR also found that the nutritional status of South Africans has deteriorated since 1994. The SAHR authors of the chapter on nutrition found that with the exception of folate and iodine, children’s micronutrient status has deteriorated over the past 14 years.
Severe vitamin A deficiency was recorded in around 15% of children. This is despite the legislated fortification of bread, flour and maize meal since 2003, as well as the national high-dose vitamin A supplementation programme implemented in most provinces since 2001. The cause of the significant deterioration is unknown.
The iron status of children has also deteriorated since 1994 with the levels of zinc deficiency found in the 2005 National Food Consumption Survey ranging from between 27,3% and 58,5%. Experts have warned that a prevalence of zinc deficiencies greater than 20% called for national nutrition interventions.
Research in Finland leads to national policy changes
The authors sited an example from Finland – which had the highest death rate from cardiovascular disease due to heavy tobacco use, high fat diet and low vegetable intake – where a community-based intervention delivered positive results. Community-based interventions address the causes, rather than the consequences of chronic disease and also focus on preventing the emergence of future epidemics.
Finland’s intervention targeted consumers and schools, as well as social and health services and this led to policies banning tobacco advertising, introduction of low fat and vegetable oil products, changes to farmers’ payment schemes and incentives for communities achieving the greatest reduction in cholesterol. The intervention reduced cancer and heart disease mortality by at least 56% and led to an increase in life expectancy in both men and women.