Chronic disease and trauma plague SA health system

HIV may be the most immediate threat to healthcare in the country but health data gathered from hospitals around the country shows that violence and lifestyle diseases are taking a grievous toll on the health system.

The District Health Barometer, released in Pretoria on Thursday alongside the latest edition of the South African Health Review, showed that outside of HIV/Aids and opportunistic infections associated with it, such as tuberculosis (TB), pneumonia and diarrhoeal disease, the leading cause of premature death in the country is transport injury.

The barometer provides an overview of healthcare delivery at district and metropolitan hospitals across the country, while the South African Health Review provides a snapshot of the performance of the health system.

“This is the first time that an analysis is being done at the district level on the causes of death,” said Candy Day, a technical specialist at the Health Systems Trust, which prepares the report.

Tracking the leading causes of premature deaths among South Africans could help policy-makers prioritise interventions aimed at improving aspects of the health system.

Leading killers
The data shows that HIV/Aids and HIV-related illnesses such as TB, respiratory infection and diarrhoeal disease are the main causes of early mortality in the country. Transport injuries are the fifth leading cause of early mortality in the country.

Other noncommunicable diseases round out the list of the top ten causes of premature death with interpersonal violence featuring ahead of diabetes and ischaemic heart disease.

Day warned that as healthcare workers become more proficient at managing HIV and TB, the weight of the country’s chronic disease burden will become more apparent.

Debbie Bradshaw, director of the Burden of Disease Research Unit at the Medical Research Council, said that lifestyle issues — including everything from poor dietary habits and lack of exercise to smoking and excessive drinking — were behind many of the chronic health problems of South Africans as well as the high rate of trauma cases.

She said that even though the causes of trauma were often social, the government would need to find ways to address and reduce the burden on the health system.

The cost of alcohol
One of the key factors driving the high incidence of transport injuries and interpersonal violence in the country is alcohol abuse. South Africa has the dubious distinction of being among the top five countries with the riskiest drinking patterns — largely frequent binging — in the world. Alcohol abuse is responsible for the deaths of about 130 people in the country every day; it has been shown to be a factor in 29% of all driver injuries and 47% of driver deaths.

Writing in the Mail & Guardian last year, Charles Parry, director of the alcohol and drug abuse research unit at the Medical Research Council, said that in South Africa the tangible economic costs associated with the harmful use of alcohol have been estimated to be in the order of R38-billion a year, or 1.6% of the country’s gross domestic product.

Earlier this month Health Minister Aaron Motsoaledi told Parliament that he had set targets to reduce smoking, drinking and obesity and aimed to draft legislation to curb alcohol advertising and to regulate the fat and salt content in food.

A report released last year by the respected medical journal the Lancet showed that of 23 countries assessed, South Africa had the third highest death rate from noncommunicable or chronic diseases among adults.

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