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#CoronavirusSA: Diabetes inaction will cost lives

Posted on by Zukiswa Zimela

Integrating diabetes testing and prevention strategies into the country’s Covid-19 response plans are key to reducing the mortalities the country may face, writes Karyn Maughan.

Diabetes – a life-long condition in which the body either cannot make enough insulin or cannot effectively use what it produces – is on the rise in South Africa, with the International Diabetes Federation (IDF) reporting that the country has highest proportion of adult diabetics on the continent. According to the 2019 report on mortality and causes of death by Statistics South Africa, diabetes is the second deadliest disease in the country. It has killed more people than HIV, hypertension and other forms of heart disease.  

Last year, the IDF released a study finding that the number of South Africans diagnosed with the disease had more than doubled from 2017, to a staggering 4.5–million people. Frighteningly, the diabetes advocacy organisation also found that, in their Africa regional network, South Africa had registered the greatest number of deaths due to diabetes on the continent. 

Type Two diabetes, in particular, clearly constitutes a potentially devastating crisis for South Africa’s already fragile public health care system. The IDF’s 2019 Diabetes Atlas shows that 12.7% of adults in South Africa had diabetes in 2019, a 137% increase on the 2017 figure of 5.4%. The report also bolstered the findings of a forecasting study published in the Lancet in 2018, which predicted that diabetes would be the leading cause of death in South Africa in 2040.  

Covid-19 compounds diabetes issues 

That threat has now been exacerbated by the fact that diabetics are identified as a group of people most vulnerable to severe or deadly outcomes if infected with Covid-19. 

But, it would appear, government has done little to nothing to make information on the numbers of diabetics who have been infected with Covid-19 or how many diabetics have died as a consequence of the virus publicly available – although, it would appear that this information is accessible to the state.  

In early May, Health Minister Zweli Mkhize stated that an as-yet undisclosed analysis of hospitalised patients showed that “consistent with evidence emerging worldwide, hypertension, diabetes and cardiac disease are the three most common comorbidities associated with serious illness from Covid-19”. Weeks later, Western Cape premier, Alan Winde revealed that, of those people who had died in the province to date, 96% had an underlying health condition such as HIV, diabetes, hypertension and tuberculosis. 

Health-e News sent questions to the health department about whether government had done any research on the numbers of diabetics who had died from Covid-19 or its complications, and whether the state had any strategy to test people for diabetes during its Covid-19 testing process. The IDF estimates that two-million South Africans are ignorant of the fact that they have the disease. Arguably, improved screening for diabetes can significantly improve the prospects of such people surviving Covid-19 – particularly when uncontrolled diabetes constitutes such a significant threat for coronavirus patients. 

At the time of publication, the health department had not responded to these questions, despite promising to send them to a resident expert on diabetes. 

Diabetes not a priority 

Up until now, the only in-depth South African research available on the impact of Covid-19 on diabetics has been done by Discovery Health. In May, it released information about the 1733 coronavirus cases reported across its schemes.  

Discovery Health chief executive officer Ryan Noach, said that high risk members tend to be the elderly, and members living with chronic diseases, like diabetes. But the data contained in the report provides no real insight into the vast majority of South Africa’s diabetics: those who are unable to afford private health care and depend on state facilities for care and treatment. 

What’s also apparent is that the state has not, as it has done with smokers, made any attempt to mitigate the risks faced by diabetics with targeted interventions aimed at improving their blood sugar control – a step shown to profoundly reduce the risks of serious Covid-19 outcomes for diabetics.  

This may be because the number of diagnosed diabetics in South Africa is dwarfed by the eight million-strong population of smokers. But, while the debate about the risks of severe Covid-19 infection and death in smokers continues to rage, global research has clearly shown that poorly controlled diabetics are in significant danger of death from Covid-19.  

The Centre for Diabetes and Endocrinology note that, “the problem people with diabetes may face, is primarily a problem of worse outcomes, not a greater chance of contracting the virus. When people with diabetes do not manage their diabetes well and experience fluctuating blood glucose levels, they are generally at risk for a number of diabetes-related complications. And, in general, as a population, people with diabetes do face a higher chance of experiencing severe symptoms and serious complications when infected with any virus and with Covid-19.” 

This has clearly not escaped the attention of organisations fighting for the ban on smoking to be lifted. In papers filed at the Pretoria High Court, the Free-Trade and Independent Tobacco Association accused government of not being consistent or proportional in its decision to ban the sale of cigarettes and tobacco during South Africa’s Covid-19 shutdown but not to place any restrictions on the sale of junk food and sugary drinks – which constitute, they argue, a threat to diabetics. It was an accusation that Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma did not respond to. 

What is apparent is that diabetes is not a priority for South African health authorities – certainly not in terms of awareness drives and, arguably, not in terms of campaigns to ensure that diagnosed diabetics are equipped with the material and information they need to manage the disease. This is despite the fact that, even without the risks attached to diabetes and Covid-19 infection, uncontrolled diabetes remains a significant health risk. It’s a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.  

As endocrinologist Dr Sundeep Ruder wrote in 2016, government’s focus on non-communicable diseases has centred on tuberculosis and HIV, which have individual budget allocations. “Diabetes is under the general non-communicable diseases budget. Non-governmental organisations receive little to no funding for diabetes education, prevention or supplies,” he stated. 

At this point, it is important to note that, globally, Type One diabetics (diagnosed as children as a consequence of genetics or autoimmune condition) make up 10% of the diabetic population. The vast majority of diabetics, 90%, develop the disease as a consequence of obesity and poor lifestyle decisions. Type Two diabetes is, largely, preventable through healthy dietary habits and regular exercise. 

That pathology is no different in South Africa. The exponential growth in diabetes in the country can be concretely linked to its well-documented levels of obesity – with more than half of all South Africans being defined as overweight or obese.  

Covid-19 arguably represents a perfect opportunity for government to not only run an effective diabetes testing campaign – aimed at reducing the risk of pandemic fatalities – but also to channel resources into ensuring that diabetics are educated about the proper management of the condition. 

Enabling diabetics to test themselves and assisting them with management of the disease may require additional budget allocation, but it will arguably also prevent the state from having to pay for amputations and kidney failure treatment further down the line. 

Current projections fluctuate but some suggest that Covid-19 will claim the lives of 45 000 – many of whom are expected to be diabetics. But, after that deadly tsunami eventually lifts, diabetes – which killed over 25 000 people in 2017 – will remain one of South Africa’s most pressing health emergencies.  

Unlike Covid-19, we know that the diabetes epidemic is among us. And we know how to stop it. – Health-e News 

#CoronavirusSA: Diabetes inaction will cost lives

Posted on by Zukiswa Zimela

Integrating diabetes testing and prevention strategies into the country’s Covid-19 response plans are key to reducing the mortalities the country may face, writes Karyn Maughan.

Diabetes – a life-long condition in which the body either cannot make enough insulin or cannot effectively use what it produces – is on the rise in South Africa, with the International Diabetes Federation (IDF) reporting that the country has highest proportion of adult diabetics on the continent. According to the 2019 report on mortality and causes of death by Statistics South Africa, diabetes is the second deadliest disease in the country. It has killed more people than HIV, hypertension and other forms of heart disease.  

Last year, the IDF released a study finding that the number of South Africans diagnosed with the disease had more than doubled from 2017, to a staggering 4.5–million people. Frighteningly, the diabetes advocacy organisation also found that, in their Africa regional network, South Africa had registered the greatest number of deaths due to diabetes on the continent. 

Type Two diabetes, in particular, clearly constitutes a potentially devastating crisis for South Africa’s already fragile public health care system. The IDF’s 2019 Diabetes Atlas shows that 12.7% of adults in South Africa had diabetes in 2019, a 137% increase on the 2017 figure of 5.4%. The report also bolstered the findings of a forecasting study published in the Lancet in 2018, which predicted that diabetes would be the leading cause of death in South Africa in 2040.  

Covid-19 compounds diabetes issues 

That threat has now been exacerbated by the fact that diabetics are identified as a group of people most vulnerable to severe or deadly outcomes if infected with Covid-19. 

But, it would appear, government has done little to nothing to make information on the numbers of diabetics who have been infected with Covid-19 or how many diabetics have died as a consequence of the virus publicly available – although, it would appear that this information is accessible to the state.  

In early May, Health Minister Zweli Mkhize stated that an as-yet undisclosed analysis of hospitalised patients showed that “consistent with evidence emerging worldwide, hypertension, diabetes and cardiac disease are the three most common comorbidities associated with serious illness from Covid-19”. Weeks later, Western Cape premier, Alan Winde revealed that, of those people who had died in the province to date, 96% had an underlying health condition such as HIV, diabetes, hypertension and tuberculosis. 

Health-e News sent questions to the health department about whether government had done any research on the numbers of diabetics who had died from Covid-19 or its complications, and whether the state had any strategy to test people for diabetes during its Covid-19 testing process. The IDF estimates that two-million South Africans are ignorant of the fact that they have the disease. Arguably, improved screening for diabetes can significantly improve the prospects of such people surviving Covid-19 – particularly when uncontrolled diabetes constitutes such a significant threat for coronavirus patients. 

At the time of publication, the health department had not responded to these questions, despite promising to send them to a resident expert on diabetes. 

Diabetes not a priority 

Up until now, the only in-depth South African research available on the impact of Covid-19 on diabetics has been done by Discovery Health. In May, it released information about the 1733 coronavirus cases reported across its schemes.  

Discovery Health chief executive officer Ryan Noach, said that high risk members tend to be the elderly, and members living with chronic diseases, like diabetes. But the data contained in the report provides no real insight into the vast majority of South Africa’s diabetics: those who are unable to afford private health care and depend on state facilities for care and treatment. 

What’s also apparent is that the state has not, as it has done with smokers, made any attempt to mitigate the risks faced by diabetics with targeted interventions aimed at improving their blood sugar control – a step shown to profoundly reduce the risks of serious Covid-19 outcomes for diabetics.  

This may be because the number of diagnosed diabetics in South Africa is dwarfed by the eight million-strong population of smokers. But, while the debate about the risks of severe Covid-19 infection and death in smokers continues to rage, global research has clearly shown that poorly controlled diabetics are in significant danger of death from Covid-19.  

The Centre for Diabetes and Endocrinology note that, “the problem people with diabetes may face, is primarily a problem of worse outcomes, not a greater chance of contracting the virus. When people with diabetes do not manage their diabetes well and experience fluctuating blood glucose levels, they are generally at risk for a number of diabetes-related complications. And, in general, as a population, people with diabetes do face a higher chance of experiencing severe symptoms and serious complications when infected with any virus and with Covid-19.” 

This has clearly not escaped the attention of organisations fighting for the ban on smoking to be lifted. In papers filed at the Pretoria High Court, the Free-Trade and Independent Tobacco Association accused government of not being consistent or proportional in its decision to ban the sale of cigarettes and tobacco during South Africa’s Covid-19 shutdown but not to place any restrictions on the sale of junk food and sugary drinks – which constitute, they argue, a threat to diabetics. It was an accusation that Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma did not respond to. 

What is apparent is that diabetes is not a priority for South African health authorities – certainly not in terms of awareness drives and, arguably, not in terms of campaigns to ensure that diagnosed diabetics are equipped with the material and information they need to manage the disease. This is despite the fact that, even without the risks attached to diabetes and Covid-19 infection, uncontrolled diabetes remains a significant health risk. It’s a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.  

As endocrinologist Dr Sundeep Ruder wrote in 2016, government’s focus on non-communicable diseases has centred on tuberculosis and HIV, which have individual budget allocations. “Diabetes is under the general non-communicable diseases budget. Non-governmental organisations receive little to no funding for diabetes education, prevention or supplies,” he stated. 

At this point, it is important to note that, globally, Type One diabetics (diagnosed as children as a consequence of genetics or autoimmune condition) make up 10% of the diabetic population. The vast majority of diabetics, 90%, develop the disease as a consequence of obesity and poor lifestyle decisions. Type Two diabetes is, largely, preventable through healthy dietary habits and regular exercise. 

That pathology is no different in South Africa. The exponential growth in diabetes in the country can be concretely linked to its well-documented levels of obesity – with more than half of all South Africans being defined as overweight or obese.  

Covid-19 arguably represents a perfect opportunity for government to not only run an effective diabetes testing campaign – aimed at reducing the risk of pandemic fatalities – but also to channel resources into ensuring that diabetics are educated about the proper management of the condition. 

Enabling diabetics to test themselves and assisting them with management of the disease may require additional budget allocation, but it will arguably also prevent the state from having to pay for amputations and kidney failure treatment further down the line. 

Current projections fluctuate but some suggest that Covid-19 will claim the lives of 45 000 – many of whom are expected to be diabetics. But, after that deadly tsunami eventually lifts, diabetes – which killed over 25 000 people in 2017 – will remain one of South Africa’s most pressing health emergencies.  

Unlike Covid-19, we know that the diabetes epidemic is among us. And we know how to stop it. – Health-e News 

#LockdownSA: Prioritise feeding hungry learners

Posted on by Zukiswa Zimela

Discussions about the schooling program for the rest of the year are still underway, but the majority of children who rely on the National School Nutrition Programme remain without access to their meals.

Equal Education (EE) together with education, children’s advocacy and social justice organisations such the Children’s Institute, Section27 and the Centre for Child Law have written a letter to the Basic Education Minister, Angie Motshekga, stating that that there is a pressing need to ensure that learners have continued access to critical nutrition provisioning, through the National School Nutrition Programme (NSNP).

The NSNP provides meals to nine million children across the country — and for many children, the single meal the programme provides is their only square meal a day. According to a 2018 Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security working paper, the programme has reached 9-million children in over 20 000 schools every school day. Although no rigorous assessment of the NSNP has been undertaken, the researchers noted that the programme has the ability to increase children’s educational performance, and has the potential to contribute to household food security.

Protect vulnerable children’s nutrition

But since the national lockdown’s instatement, the NSNP has come to a standstill and children on the programme haven’t been able to access their meals.

Speaking to Health-e News, Leanne Jansen-Thomas of EE says that they understand that the Food and Nutrition Security Coordination Committee (FNSCC) is leading efforts to coordinate various departments, including the Department of Social Development (DSD), the Department of Health (DoH) and the Department of Basic Education (DBE).

“Currently, the FNSCC has sought to introduce a hunger mitigation strategy for children, including children benefiting from the NSNP. Interventions are reported to include the distribution of food parcels to beneficiaries through local and provincial distribution centres with implementing agents having been appointed for each province,” Jansen-Thomas says.

However, according to EE and other concerned organisations, there are issues with this method. The criteria of the selected distribution points, as well as the safety and accessibility of distribution points are not clear.

“But we are concerned that distribution centres may not be adequately accessible to those in need, particularly in rural areas. It is also unclear what safety measures are being put in place to protect children who may be in a position of having to collect food parcels themselves,” she tells Health-e News.

National implementation necessary

She further says that the proposal put forward by the Gauteng provincial government last month — that food packages be distributed to learners through schools — should be implemented nationally.

“This position has recently been implemented by the Western Cape Education Department,” the open letter to Minister Motshekga reads.

According to a statement released by the Westen Cape provincial government, schools started feeding children for two days a week, from 6 April. However, other schools might wish to feed daily, and that is the decision made by schools on an individual basis. The statement further says that learners will not sit down at schools and eat, but will collect the food in containers brought from home.

“We are urging the national DBE and provincial education departments to implement this recommendation at a national level, utilising existing NSNP funding and coordinating with DSD’s food parcel and social relief of distress programmes to ensure all NSNP beneficiaries are fed,” Jansen-Thomas tells Health-e News.

In the open letter, some of the organisations’ recommendations include:

  • schools be deemed essential service facilities for purposes of serving as collection points;
  • social distancing measures be put in place including, for example, staggering collection dates and times and limiting numbers of collections per day;
  • scholar transport buses be used to facilitate mobile collection and delivery; and
  • where school-based feeding programmes are not possible, the use of voucher systems should be considered, provided that vouchers are redeemable at all local outlets (including spaza shops). — Health-e News

For more information on Covid-19 in South Africa, you can call the toll-free line on 0800 029 999, or you can send a message that says “Hi” on WhatsApp to the number 060 012 3456. You can also visit the SA Coronavirus website.  

#LockdownSA: Increased child support grant is a ‘massive relief

Posted on by Zukiswa Zimela

Organisations advocating for the adequate nutritional needs of children have cautiously welcomed the move from President Cyril Ramaphosa to increase social and economic relief for the next six months.

Community advocacy group Amandla.mobi is calling for an increase in the child support grant, and are pleased with the President’s announcement — bolstering social support and economic relief in the country. Amandla.mobi has advocated for an increase since the beginning of the national lockdown, and believes that it’s a step in the right direction.

“As pointed out by many experts — grants are the simplest, quickest and most effective way to get cash to millions of poor households that will otherwise face food insecurity and debilitating poverty,” says Koketso Moeti, executive director of the organisation.

The campaign involved several role players such as the Children’s Institute, economists and various other stakeholders — and was informed by a survey, which helped draft up a community response plan. Moeti says that the top priority which emerged was the need to get some form of income to people.

“It was run in five languages, to ensure that those most impacted participate. And that’s where over 80% of the campaign supporters came from and the demands and signatures were sent to the President, as well as people undertaking online tactics and sharing reasons why they support the campaign,” she says.

Leanne Jansen-Thomas from Equal Education (EE) says that the increase to the child support grant came about due to pressure on the government from civil society organisations.

“The increase on the child support grant is a massive relief; and it is owing to sustained pressure on the government from civil society organisations, coalitions and academics. The child support grant must however pay for a myriad of needs for children — not just food,” says Jansen-Thomas.

Food parcels need strict monitoring

President Ramaphosa also announced that 250 000 food parcels would be distributed across the country over the next two weeks. Both Amandla.mobi and Equal Education want these to be properly managed to ensure that they reach deserving households; more especially that it reaches children.

“It will be important to monitor all relief measures undertaken; even beyond food parcels, to ensure that they get to the right beneficiaries and serve the purpose intended. As we know, procurement is where a lot of corruption happens. Over and above that, transparency will be essential,” says Moeti.

EE is currently engaging with the Basic Education Department and Parliament’s Committee on Basic Education and Social Development, in order to “access accurate information on how many households are receiving food parcels and how the existing national school nutrition programme budget is being used,” says Jansen-Thomas. This information is then significant, because it helps the organisation make an assessment about the food security of all children.

Food security is intersectional

There’s a coalition of organisations calling for the Department of Basic Education and Social Development to ensure that that over 9 million children who ordinarily benefit from the school nutrition programme continue to receive food relief, if they are not benefiting from the food relief from the department, or SASSA.

The organisation is also calling for the following to be implemented:

  • nutritious food to be subsidised;
  • water provision in communities without access to be prioritised;
  • decent and safe living conditions for the homeless;
  • a plan of care for prisoners;
  • respecting the moratorium on evictions;
  • a proper education plan that leaves no child behind; and,
  • price control of basic food items

— Health-e News

For more information on Covid-19 in South Africa, you can call the toll-free line on 0800 029 999, or you can send a message that says “Hi” on WhatsApp to the number 060 012 3456. You can also visit the SA Coronavirus website.  

CoronavirusSA: Food parcel drive

Posted on by Zukiswa Zimela

It is vulnerable groups in society such as the elderly, poor, and unemployed who are most affected when global pandemics such as Covid-19 take place. But various sectors in the country have come together to lessen the impact.

With South Africa’s high unemployment rate, most people in the country can’t afford to buy essentials like basic food items and hand sanitiser in order to keep healthy and prevent the spread of the virus.

Poverty-stricken community members in the North West tell Health-e News that they appreciate government efforts aimed at ensuring their wellbeing during these difficult times.

Mary Mosala (45) from Manokwana Village near Taung shares a one-bedroom shack with four other family members. They depend mostly on a social grant to buy food. She recently received a visit from the North West Department of Social Development and was handed a food parcel.

“We are really grateful for the visit from government and the food we have received. I normally go out and look for piece jobs to feed my family but now because we have been told to stay in our homes to prevent the spread of the virus [so] I am forced to stay indoors. I am really happy to have received this food parcel and it will keep us from going hungry,” says Mosala.

Elisa Mooki (27) from Jouberton near Klerksdorp lives with her younger sister and two children in a RDP house. They also depend on social grants to buy food. Mooki has welcomed the food parcel which government handed over to her family.

“Ever since our parents passed away, life has been difficult and I have had to look after my younger sister. I am currently unemployed and we depend on social grants in order to survive. This food parcel will add to our grocery because our food gets finished quickly because the children are no longer eating at school – they also have to stay [at] home due to this lockdown.

“I appreciate the efforts taken by government and I hope that they will reach more households which are affected by poverty across the country,” says Mooki.

Spokesperson for the North West Department of Social Development, Petrus Siko tells Health-e News that they are doing their best to ensure that vulnerable groups are protected during these difficult times.

“[Thus] far we have distributed nearly 2 000 food parcels across the province. We also enjoy support from the private sector and NGOs. The department intends on going to all four districts in the province to identify and hand out food parcels to those who match our qualification criteria.”

Siko adds that the department has also set up shelters for the homeless in Mahikeng, Rustenburg and Ventersdorp where they can stay during the lockdown period.

“We have set up shelters for the for the homeless at the Ben Marais Hall in Rustenburg, JB Marks Treatment Centre in Ventersdorp and the Mahikeng Secure Centre in the capital. Here we are able to feed, clothe and screen people who were living on the street before the lockdown period. Nursing staff are always available at these centres to provide the necessary health care around the clock,” says Siko

The department urges people across the province who do not have a stable income to contact a social worker who is designated to their ward or local councillor in order to receive food parcels from government. – Health-e News

For more information on Covid-19 in South Africa, you can call the toll-free line on 0800 029 999, or you can send a message that says “Hi” on WhatsApp to the number 060 012 3456. You can also visit the SA Coronavirus website.  

HEALA calls for 20% tax on sugary drinks

Posted on by Zukiswa Zimela

The alliance has been encouraged by public support on proposals for an increase in the Health Promotion Levy (HPL)

Gathered outside number 40 Church Street in Tshwane, activists and people living with non-communicable diseases (NCDs) have submitted a memorandum to Treasury, calling for an increase on the health promotion levy.

The levy, also known as the sugary drinks tax, is currently 11% and the Healthy Living Alliance (HEALA) is demanding that it be increased by an additional 9% which will put the levy at 20%.

According to the organisation, the increase in the levy by April 1 will assist in reducing the high number of NCDs such as type 2 diabetes, hypertension and stroke, which are currently regarded as a burden to the health system.

Support from citizens 

Nosipho Msiza (32) was diagnosed with hypertension almost five years ago and is one of the people who support the proposal to increase the levy.

“My cholesterol levels, blood pressure, and blood sugar levels were ridiculously high when I went to the clinic for a screening. And it was a tough wake-up call for [me] especially, because when you come from a family of obese people, you don’t see anything wrong with it.”

She says that the idea of having to be on medication for the rest of her life encouraged her to make a lifestyle change and shed some weight.

“I used to weigh 115kg and I have lost some weight now. I also realised that it is possible to lose weight and be healthy at the same time. I now educate people in my community about eating healthy and the increase in the levy will be good for everyone.”

Msiza also believes that government should increase the promotion of healthy food options and to also ensure that healthy food is affordable.

One step to tackling NCDs 

Mandla Magaza, an activist for the Treatment Action Campaign (TAC) Tembisa branch, says that the increase will cement government’s commitment to addressing NCDs.

“For us, it is difficult because during clinic hours, we do health talks and it sometimes becomes a challenge to encourage healthy eating when unhealthy foods such as sugary drinks are not taxed as they should be, and are readily available. The tax increase would make it easy for us to spread the message on healthy eating as we would have government’s full support when it comes to discouraging people from consuming sugary drinks.”

While delivering the memorandum, HEALA informed representatives from Treasury about public support shown in a petition on Amandla.mobi, which received over 11 000 signatures in support of expanding sugary drinks tax to fruit juices.

“We call Minister Tito Mboweni to commit to this in the upcoming Budget Policy Statement. Unlike the VAT hike which we were not consulted on, a sugary drinks tax has public support and means healthier people and more funding for health,” says HEALA programme manager, Lawrence Mbalati.

Treasury applauds HEALA 

Treasury Chief of Staff Marlon Geswint received the memorandum on behalf of the minister and gave assurance that he would share the document with relevant role-players.

“There has been previous engagement on this so rest assured that this will be shared with the relevant authorities. As you, we look forward to seeing how the minister is going to respond to it,” he says.

Geswit also commended HEALA on their activism in promoting healthy living. “We must commend you that you are busy with a really good initiative. And we want to wish you everything of the best as you continue to educate the general public and move forward in your cause. So on behalf of the ministry, I accept the memorandum.”

Following a study done by PRICELESS (Priority Cost Effective Lessons for System Strengthening) which found that the HPL resulted in higher prices for sugary drinks, and untaxed healthier beverages like water did not increase in price.

“This is a first indication that the tax could motivate consumers to pick healthier options that are not taxed rather than taxed sugary drinks, which is very encouraging,” adds Mbalati.

The Minister of Finance’s budget speech, which will held at the end February, is expected to yield positive news for HEALA.

“We are happy that somebody from Treasury accepted our memorandum so we are now hoping that they will consider our recommendations and we will be looking at the upcoming budget speech that will be taking place at the end of this month to see if our call of the increase of the sugary drinks tax from 11% to 20% and not only that but to also further include 100% fruit juices has been taken seriously or not,” says Mary-Jane Matsolo, campaign and advocacy coordinator for HEALA.

Matsolo adds that they also hope to see government not giving in to pressure from unhealthy food and beverage manufacturers, but to put the health of South Africans into consideration especially when it comes to fighting to reduce the burden the health system faces because of the rising numbers of people who need treatment for NCDs. – Health-e News

Health-e News is a media partner of the Healthy Living Alliance.

Sparking a fresh fruit revival in the heart of Venda

Posted on by Zukiswa Zimela

Tshakhuma Fruit Market attracts tourists from all over South Africa, but locals consumption of the market’s offering of fresh fruits, vegetables and nuts is dwindling, according to fruit vendors.

“We are fortunate as people of Venda [Vhembe] to have so many fruits at our disposal, but I don’t think we value all these fruits enough. Some even go a week without eating any fruit, despite having all these quality fruits around us,” said Vhulahani Masia, a fruit vendor at Tshakhuma Fruit Market.

Tshakhuma Fruit Market, situated just outside Thohoyandou in the Vhembe District, is the only 24-hour fresh produce market in Vhembe, and sells bananas, mangoes, litchis, tree nuts, pecan nuts, nectarines, avocados and more. The market was established over two decades ago, and to this day, the majority of produce is locally grown.

Masia, who has sold bananas, avocados, paw-paws and litchis at the market since 1996, believes there is general decline in sales at the fruit market. According to her, decrease in interest and consumption of fruit is pronounced in the younger generation.

“I have been selling fruits at this market since 1996 and I can say that over the years there has been a decline in the number of local people who purchase fruits here. It’s something we should worry about, as it might mean that people no longer see the importance of fruits,” she says.

She added: “Something should be done urgently to educate local people about the importance of eating fruit before it’s too late. People who usually come here for fruits are mainly tourists from far away, and they often say that they wished they stayed this side [Venda], so they can have these fruits daily.”

Fresh fruit and vegetable reduce NCD risk

Eating fruits on a regular basis has various health benefits, as people who eat more fruits and vegetables are at a reduced risk of developing some chronic diseases. Per World Health Organisation (WHO) guidelines, fruits and vegetables are important components of a healthy diet, while reduced fruit and vegetable consumption is linked to poor health and increased risk of contracting noncommunicable diseases (NCDs) such as diabetes, high blood pressure and more.

“Including fruits and vegetables as part of the daily diet may reduce the risk of some NCDs, including cardiovascular diseases and certain types of cancer,” says WHO.

According to a 2019 study published in Nature, into body mass indexes (BMI) across the world, obesity rates in rural populations are on the rise. The dietary shift from traditional food that includes natural fruits and vegetables, to highly processed food, is one of the risk factors mentioned in the study.

Last year, Limpopo Department of Health introduced a new standardised eight-day cycle menu which includes fruits and vegetables at all its hospitals to promote healthy lifestyle and to fight obesity.

‘Our children don’t like eating fruits’

Although the region has easily available fresh produce, as the market is a testament to, fruit vendors feel that education around healthy diet is lacking.

“I think we still need more education on the importance of eating healthy meals, which includes a lot of vegetables, and a fruit on the side at all times. Our children don’t like eating fruits, but I think we’re to blame as parents because we don’t instill the importance of eating fruits and vegetables when they are still toddlers,” says Mavis Mudzanani, another vendor at the Tshakhuma Fruit Market.

“The worst part is that we only start valuing the importance of eating healthy when we are sick and by that time, the damage has already been done. We should start utilising the fruits and vegetables at our disposal to promote healthy eating habits, especially among our children,” she adds.

Nurse Phumudzo Themeli says that a child’s lunchbox is the perfect place to start with healthy eating practices.

“Children should be taught the importance of eating fruits and vegetables, and it should start with their lunchbox. Eating fruits and vegetables has a lot of health benefits such as strengthening the immune system which in turn helps the body fight off various diseases such as most NCDs such as heart diseases, strokes, diabetes, and high blood pressure.” – Health-e News.

Hawkers booted out of local school

Posted on by Zukiswa Zimela

For years, schools in Ikageng have allowed hawkers to sell food to learners inside school premises, but one primary school has decided to bar them.

Sarah Nceba has been selling her bunny chow, chicken feet and vetkoeks (fat cakes) at Dan Tloome Primary School in Ikageng, Potchefstroom for many years, but this year she was told she couldn’t sell her food inside school premises. Nceba says now she sells the meals outside school premises, but she is no longer making enough money to feed her family.

“Hawkers have had a good relationship with the school. I mean I have been selling here for the past three years, but I was surprised this year when we were told to no longer sell our food inside the school. No one really explained to us why, but we heard rumours that the department says hawkers sell unhealthy food that cause children to become obese and tired.”

She says that she now sells her food outside the school, but things aren’t the same. “I don’t make enough money anymore as I return home with most of the stock. This was my family’s only source of income, so now I cannot provide for them like I used to before. It has become hard,” she says.

Nceba adds that the school should’ve warned them about the new developments and also guided them [the hawkers] on what should be sold.

“I think it would’ve been best if the school sat down with us, tried telling us what [should] be sold, or if we should change our menu. That would’ve been better because all we’re trying to do is feed our families and not harm anyone,” says Nceba.

Motheletsi Retsang, school safety and health coordinator from the Dr Kenneth Kaunda District office says that the decision isn’t final as all members of the school need to be involved in final decision making.

“Nothing is final yet, we need to consult the SGB [school governing body] and teachers. Only after that, a final decision can be made. Changes will affect everybody, so everyone has to be consulted so that we come up with a conclusion that suits everyone,” he says.

Unregulated school food environment

School tuckshops, and food and beverage vendors at schools have been under increased scrutiny, with calls for implementation of regulation coming from the advocacy organisation, Healthy Living Alliance (HEALA).

In 2018, HEALA conducted an audit of the food environment at 61 schools in Soweto and the East Rand, covering 62 883 learners. The aim of the audit was to investigate what primary and high school learners consume at schools by looking at the school nutrition programmes and what was being sold at tuckshops and by vendors.

According to this audit, over 88% of Gauteng schools had vendors. The audit further states that the vendors are not monitored in schools, except to make sure that they don’t sell cigarettes. The audit also found that sugary drinks were commonly consumed items with the kota, and that another popular item was ice lollies (frozen sugary drinks).

HEALA calls on the Department of Basic Education to implement the Tuckshop Operator Guidelines by ensuring that highly processed and fried food are not sold on school premises, and that the Department of Health should pass Regulation 429 into law. HEALA also calls on the Department of Health to ensure that stronger legislation is in place regarding the advertising and marketing of sugary drinks and junk food to children.

Also in 2018, Health-e News reported on the Scoping study, which investigated the school food environment nationally. The study showed that tuckshops and school hawkers are largely unregulated, with lax implementation of government guidelines, and that children gravitate towards unhealthy and low nutrition food. The study also highlighted structural barriers to school’s implementation of healthy tuckshops, such as affordability of healthy ingredients, and lack of proper food preparation facilities. – Health-e News

Health minister supports the reduction of sugar in sweetened beverages

Posted on by Zukiswa Zimela

Currently, the health promotion levy — implemented in April 2018 — is almost half of the World Health Organisation’s recommendation which research has shown could be more effective.

Health minister Dr Zweli Mkhize “supports the principle” of the Health Promotion Levy, commonly known as the sugary drinks tax, his spokesperson Dr Lwazi Manzi told Health-e. 

“The minister cannot proclaim on the actual number as that is the business of Treasury [but] he supports the principle of the sugar tax,” she said.

This comes after Health-e asked Mkhize whether or not he in favour of the World Health Organization’s recommended 20% levy on sugar-added beverages.

“We support that there should be a reduction in the content of sugar in drinks and in consumable foods. All that has to be about the overall culture of getting people to take less sugar and take less starch, try and keep a balanced diet which is healthy and recommended so that we can avoid diabetes,” Mkhize told Health-e.

Mkhize and other health officials were commemorating World Diabetes month, the Minister of Health Dr Zweli Mkhize took to Alexandra township and raised awareness about the impact of diabetes on individuals, families, the health system and society at large. This was in line with this year’s global theme for World Diabetes Day “Family and Diabetes”.

“Every South African has been affected by diabetes — whether directly or indirectly. For those who have experienced or witnessed the complications of this deadly disease, it can be devastating and disruptive for families and communities,” Mkhize wrote in Health-e last week.

In April 2018, government introduced an 11% Health Promotion Levy on all sugar-added beverages. The tax was introduced as a way to discourage people from drinking sugary drinks in an attempt to stem non-communicable diseases (NCDs), particularly diabetes, heart disease and strokes.

But over a year since the levy was implemented, activists and researchers say this is not enough. Mathematical modelling done by the Wits School of Public Health’s research tank PRICELESS SA, published in Plos, indicates that a 20% tax on sugary drinks would result in 220 000 fewer obese South Africans and contribute up to R7-billion in revenue that could be used to fund health initiatives.

Living with Diabetes

Pitso Molemane has been living with diabetes for about 35 years and said people must eat healthily and exercise in order to fight diabetes.  “I have gone under so many complications with diabetes, from minor stroke to your heart attack and all that,” he added. “At that age, I was not even aware of what diabetes is.”

According to Molemane, NCDs such as diabetes are scared of physical activity and healthy eating. But living a healthy lifestyle is a challenge because unhealthy food is easily accessible — especially in low-income black communities such as Alexandra. According to 2018 research published in the South African Health Review, the distribution of healthy food outlets is unfairly skewed towards suburban areas in Gauteng. These areas — mostly populated by affluent residents — have the highest number of stores with healthier food options. The inner city of Johannesburg and in black communities also had a high concentration of fast food outlets.

There are two things that can deal with diabetes, healthy eating as per what the dietician is telling you to do, also exercising a lot, but very important is that you need to take your medication as per the orders of the doctors.

Diabetes is deadly

About 10  000 new cases of diabetes are reported each month. Research shows that non-communicable diseases currently account for more than 40% of deaths in the country. Studies have also shown that the excessive consumption of sugar-sweetened beverages has been linked to obesity, which leads to an increased risk of non-communicable diseases.

Gauteng Health MEC, Dr Bandile Masuku said, diabetes is one of the diseases that continuously burden the province’s health facilities. However, he added, diabetes can be prevented more especially type 2 diabetes because it can be prevented and can be controlled.

Masuku said diabetes awareness is also part of the National Health Insurance (NHI) discussions that are currently underway. “NHI cannot be sustainable if we don’t control some of these diseases like diabetes,” he said.

Mkhize urged all South Africans and their families to adopt and maintain healthy lifestyles by eating healthy meals, exercising frequently and by regular health screening and testing to avoid preventable and manageable diseases such as diabetes.

“Diabetes is now amongst us, what is important is how do we deal with it, we must also learn to be specialists on diabetes, it’s very important to know the symptoms.”

According to Mkhize, if implemented, the NHI will play an integral role in ensuring patients living with diabetes have an uninterrupted supply of medication. “The NHI will create funds for the country to be able to organise the best [chronic] treatment,” he added. Mkhize did not elaborate on how he or the health department envisions the procurement of chronic medicine to operate under the NHI Fund.

The national health department has also launched a new campaign focusing on cancers and diabetes, the aim of the campaign is to encourage South Africans to go to for early screening.

Mkhize said: “There is a new epidemic growing out there. All our [health facilities] are going to be ready with early screening, early information and early interventions in those kinds of diseases.” – Health-e News

Calls for South Africa’s sugary drinks tax to increase intensify

Posted on by Zukiswa Zimela

Activists say Treasury and national health department must abide by international health standards for the levy on sugary drinks to be effective in curbing the rise of non-communicable diseases in the country.

Ahead of the midterm budget speech civil society organisations demanded  National Treasury commit to increasing the Health Promotion Levy (HPL), commonly known as the sugary drinks tax, to 20%.

In 2018, the government implemented the 11% HPL on all sugar-sweetened beverages, but activists say this is not enough and the levy needs to be increased to 20% as per the World Health Organization’s recommendation.

Speaking to Health-e, MaryJane Matsolo of the Healthy Living Alliance says the 11% was inadequate to make a difference. “This is not enough to significantly decrease the consumption of sugary drinks in South Africa. Ordinary people need to be protected from the poison which is sugary drinks, ” she says. Currently, Matsolo says, sugary drinks are easily accessible to ordinary South Africans — specifically poor people — who are already susceptible to various non-communicable diseases (NCDs) such as diabetes, stroke and heart disease.

“The issue of NCDs needs political will that’s why we want the minister of finance Tito Mboweni to tell the nation what are the plans to increase the HPL to 20%. We are hoping that the minister and Treasury will take our call into during the midterm budget speech,” she explains. “We will be waiting with expectation next year in February when he ultimately announces what is going to happen to HPL in the budget speech.”

Mboweni made no mention of the levy in his mid-term budget speech. Treasury says that the midterm budget does not make any tax adjustments as that would create uncertainty. But the department says that taxes, such as this one, tax may be increased in the budget speech in February.

Between September and October over 11 000 people countrywide, have signed the petition calling Mboweni to announce increased the levy to 20% from 1st April 2020 which will be its second anniversary.

Higher levy means lower NCDs

The Treatment Action Campaign says increasing the sugary drinks tax is important for the health of South Africans and are supporting the call. “There is no way we can not support this, our people are dying of NCDs just because they don’t know the dangers of the food and drinks they are consuming,” says Simo Sithandabantu, TAC’s provincial manager in Western Cape.

He says he only hopes that government will listen and come back to the people with the expected response “This is a start, there is still a lot to come if the government doesn’t listen we will mobilise all nine provinces and bring everything to stand still,” Sithandabantu told Health-e.

Activists are hoping that their continued call for a WHO-standard levy will not fall on deaf ears.

“In the past three years, we have sent Treasury many submissions and petitions asking for a stronger Health Promotion Levy of 20%. We’re calling on our government to stand up to companies like Coca-Cola who watered down the sugary drinks tax to 11%,” says Lawrence Mbalati, Heala’s progammes manager.

According to National Treasury, the initial proposal was to introduce the levy at 20%, however, Treasury decided to take a phased-in approach of starting at a lower rate and a tax-free threshold. “This was based on the concerns of potential jobs losses which were raised during the consultation process,” Treasury in response to questions sent by Health-e.

The department says when Mexico introduced a tax on soft drinks in 2014, it started at a rate of 1 peso per litre (equivalent to a 10% increase) and this resulted in decreases in consumption of sugary beverages.

Responding to whether are there any plans to increase the tax to 20%, Treasury says it normally reviews their tax policy interventions after few years of implementation and make adjustments where it is necessary.  Similarly, the HPL will be subjected to a review process in the future. – Health-e News