World Health Day (WHealthD) marks the anniversary of the inception of the World Health Organization (WHO) in 1948. The day is annually commemorated, globally, on the 7th April in order to highlight and bring awareness to the key elements that affect and contribute to the health outcomes of every nation around the world. The CEO of the Heart and Stroke Foundation South Africa (HSFSA) states that “our organization aligns with the mission and vision of the WHO, to ensure that South Africans get an equitable distribution of resources to live a healthy, productive and long life.”
The theme for WHealthD this year is “My health, my right”. This year’s theme is championed by the WHO to drive the agenda for the health rights of everyone, everywhere so that everyone has access to quality health services, education and information. Moreover, safe drinking water, clean air, good nutrition, quality housing, decent working and environmental conditions, and freedom from discrimination are also paramount for healthy living. As recognized by the WHO and other global health-related organizations, including the HSFSA, the right to good health care for millions of individuals is under threat. Increasingly, disasters, environmental pollution, climate change, wars and conflict are posing a barrier to human and animal health. Associated factors threatening access to health care and reduced health infra-structure are food insecurity and the implosion of non-communicable diseases (NCDs) such as cardio-vascular disease (CVD), diabetes, respiratory disorders, neurological disorders, mental health conditions and so on. Climate change has also been found to drive the increase in infectious diseases and other communicable diseases. The HSFSAs team are of the opinion: “Given the gloomy scenario, the time to act on securing health rights for all, is now”. The call for action and health knowledge dissemination is becoming more vital with each passing day.
The Foundation plays a leading role in the fight against preventable heart disease and strokes, with the aim of seeing fewer South Africans suffer premature deaths and disabilities. Hence for WHealthD we are focusing on the CVD burden. According to the new Global Burden of Disease (GBD) special report published in the Journal of the American College of Cardiology, globally CVD related death counts increased from 12.4 million in 1990 to 19.8 million in 2022 reflecting global population growth and aging, and the contributions from preventable metabolic, environmental, and behavioral risks. This report identifies the leading risk factors for cardiovascular disease, which includes air pollution, household air pollution, lead exposure, low temperature, high temperature, systolic blood pressure, LDL-Cholesterol, body mass index, fasting plasma glucose, kidney dysfunction, dietary, smoking, secondhand smoke, alcohol use and physical activity. Having our rights met with regards to the aforementioned access to quality health sustaining and promoting environments plays a significant role in reducing the burden of CVDs and other NCDs.
Cardiovascular disease accounts for most NCD deaths, or 17.9 million people annually, followed by cancers, chronic respiratory diseases, and diabetes. NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing the probability of death from any of the four main NCDs between ages 30 and 70 years by one third by 2030. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in the WHO AFRO Region countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people in higher socioeconomic groups, because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services.
The African region experiences a high burden of NCDs, mainly cardiovascular diseases (heart disease and strokes), cancer, diabetes, chronic respiratory diseases, and poor mental health. The countries with the highest age-standardized death rates were in the Southern Africa region (Lesotho, Eswatini, Mozambique, Zimbabwe and Botswana) with only the Central African Republic in the top six countries outside this region. It is estimated that each year, more than 1.6 million people between the age of 30 years and 70 years die prematurely from at least one of the four major NCDs in the African Region, representing 63% of all NCD-related deaths. Cardiovascular diseases, cancers, diabetes mellitus and chronic respiratory diseases account for over 70% of these deaths.
The HSFSA is particularly concerned with the Sustainable Development Goal (SDG) three (3) which speaks to Good Health and Well-Being.
The rapid rise in NCDs is predicted to impede poverty reduction initiatives in the WHO AFRO Region countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people in higher socioeconomic groups, because they are at greater risk of being exposed to harmful products, such as tobacco, or unhealthy dietary practices, and have limited access to health services.
Every day, 225 South Africans die from heart disease and strokes. Rapid urbanization in South Africa has seen a change in food consumption patterns where people are consuming more kilojoules, sugary beverages, processed food, and fewer fruit and vegetables. This in combination with other rising CVD risk factors such as physical inactivity and tobacco smoking, has resulted in a steady increase in deaths due to CVD in recent years. CVD places additional pressure on an already heavily-burdened healthcare system and impacts the livelihood of many South African households.
Kinza Hussain, a seasoned dietitian at the Foundation, reminds us that “Adequate nutrition falls under the rights of every individual, despite ethnicity, culture, religion and sociodemographic”. A report by the Food and Agriculture Organization (FAO) revealed that about 20% of the total population in Africa are undernourished, of which most reside in sub-Saharan Africa. Focusing on Southern Africa, a UN World Food Programme (WFP)’s Hunger Map places South Africa, Namibia and Mauritius at a prevalence of undernourishment between 5% and 14.9%. It has been reported that climate change, conflict and economic slowdowns and downturns are the major causes of food insecurity (FI) in the region and its sub-regions. Poverty, socioeconomic disparities, social exclusion and rapid population growth also have a role to play in the rise in FI. At the household level, most findings from low-and-middle-income countries (LMICs) reveal lack of understanding needed to boost food production, particularly on farming methods, large family size, poverty (due to low income or unemployment) and instability in government policies or poor governance as the major causes of FI. Other causes include fluctuations in food availability and access and high food prices.
A link between FI and negative health outcomes has been well established. In children, FI has been associated with decreased academic performance, decreased emotional and intellectual development, delayed development of motor skills, poor general health, iron deficiency anemia, underweight and obesity and stunting. In adults, it has been associated with diabetes, hypertension, anxiety, depression and other negative health outcomes. In the sub-Saharan African context, FI has been found to be associated with dyslipidemia, hypertension and overweight, especially among women. Further to this, the risk factors for depression in people living with HIV have been explored, revealing that FI was one of the key risk factors. It is therefore crucial when considering strategies to improve outcomes of non-communicable diseases and infectious diseases to place FI at the core. FI needs to be positioned at the heart of health and human rights.
Other factors like environmental pollution and climate change also need attention. Over 90% of people breathe unhealthy air resulting from burning of fossil fuels. A heating world is seeing mosquitoes spread diseases farther and faster than ever before. Extreme weather events, land degradation and water scarcity are displacing people and affecting their health. Pollution and plastics are found at the bottom of our deepest oceans, the highest mountains, and have made their way into our food chain. Systems that produce highly processed, unhealthy foods and beverages are driving a wave of obesity, increasing cancer and heart disease while generating a third of global greenhouse gas emissions.
In our global attempts to reach the Sustainable Development Goal 3.4. by 2030, which describes the aim to reduce NCDs by one third, through prevention and treatment, and promote mental health and well-being, we also have to incorporate political, social and commercial decisions which are driving the climate and health crisis. South Africans are encouraged to make a difference in their homes, in their communities and ultimately our country by spreading awareness that our health is our right! We therefore urge our government to honor the UN Convention for Health and Human Rights.
