Understanding patterns in urban disease

Dr Tolu Oni of University of Cape Town adresses the healthcare challenges of urbanisation. (Photo: Michael Hammond)

Dr Tolu Oni of University of Cape Town adresses the healthcare challenges of urbanisation. (Photo: Michael Hammond)

Health. It is often neglected, treasured when taken away and an area where research and understanding are desperately needed as disease patterns change and adapt to new environments and human dynamics.

Dr Tolu Oni’s research is driven by the issues of healthcare, urbanisation and rising rates of infection.

“My research aims to contribute to the analysis of changing patterns of disease and the implications for the health and wellbeing of the population in the context of urbanisation,” explains Oni. “I have worked in the field of HIV and tuberculosis (TB) in the South African urban informal setting since 2007, and my current research focuses on urban health and equity.”

She says that she is especially interested in understanding the interaction between commonly co-occurring chronic infectious and non-infectious conditions, upstream health determinants and the unplanned urban environment.

Growing urban population

Growing urban population levels are impacting how disease is transmitted and how it affects the people living in these communities. The healthcare system today is not responsive enough to examine the factors which impact on a person’s health and how this can be addressed from the ground up.

“Many of the aspects which influence health lie outside the healthcare sector. I want to find ways of collaborating with other organisations, pulling in both health and non-health related institutions, to see how we can work together to make much-needed changes,” says Oni.

It was while working as a researcher in TB and HIV, in the context of infection and how better to diagnose and understand the burdens and patterns of these diseases, that Oni was struck by two significant realisations.

The first was that they were waiting for people to come in with conditions and then trying to work out what factors caused them. Yet TB is a preventable disease. The second was that people were coming in with a myriad of other chronic conditions, not just those with which they were originally affected.

Tailored, holistic, healthcare

“It struck me that we were not looking at patients and population in a holistic way — some HIV and TB patients had, for example, diabetes, and the healthcare system is structured so one specialist deals with one element while another deals with the other,” says Oni. “It made no sense to me. I left this role so I could look at the patterns and try to understand how these diseases co-exist. We need a healthcare system which is responsive and can be tailored to how population health evolves.”

Oni’s work looks at both ends of the system — healthcare delivery and prevention. Illnesses such as TB, HIV, diabetes and hypertension are largely preventable. She is looking for answers as to why these are still growing and impacting urban populations.

“In our country we have some of the leading TB researchers and I find it perplexing that, in this context, we still have one of the highest TB burdens globally,” says Oni. “They should not co-exist.”

She says that there is a disconnect somewhere and that her research is about finding ways to work across this. “It’s vital that we push the boundaries of fundamental research — for example drug discoveries —but also address the disconnect between academia and research, and the impact of disease on the population.”

Focus on urban health

For this researcher, it’s important that her work affects people at the population level, uncovering the broader determinants of common diseases. It is also what drives her focus on the urban setting, rather than on the rural.

“South Africa may not have the fastest urbanising populace globally, but we are the most urbanised in Africa at 62% of our people in an urban setting,” says Oni. “There is a lot known about rural health, but we need to prioritise urban health. It is more complex, with dynamic population movement and exposure, and the urban space can greatly impact on health.”

Oni says that it has been through mentorship, support and guidance that she has been inspired to choose her path and to continue with her research and work.