Mental health problems are pervasive in South Africa, but often overlooked is the effect of climate change.
In recent years, the country has been struck by a series of climate-induced extreme weather-related disasters. These include Cape Town’s “Day Zero” water crisis from 2017 to 2019, the April 2022 floods in Durban, the tornados in KwaZulu-Natal in June this year and the July flooding in the Western Cape. (Although not climate related, Durban was also the epicentre of the 2021 unrest.)
A disaster is defined by the South African Disaster Management Act (in part) by effects that exceed one’s capacity to cope without additional resources.
It is socially marginalised and vulnerable people, of whom women and black Africans make up the majority, who are mostly exposed to and harmed by these disasters, given their lack of resources to adequately cope.
The marginalised also bear a disproportionately high burden of mental health problems.
Using nationally representative South African data on depression, our published works highlight three key messages.
First, in places that have experienced multiple disasters, there is a greater likelihood of depression. In the absence of proactive remedial action, exposure to multiple disasters will be inevitable, leading to chronic mental health problems — as a result, for example, of the wearing down of people’s’ resilience
Second, the likelihood of depression caused by disasters is particularly pronounced among females, black people and individuals with lower education and income. Gender inequality and poverty are hallmarks of South Africa. Repeated disasters risk worsening already high levels of inequality and poverty.
The recently signed Climate Change Act includes the principle of “the need for decision-making to consider the special needs and circumstance of localities and people that are particularly vulnerable to the adverse effects of climate change, including vulnerable workers and groups such as women, especially poor and rural women, children, especially infants and child-headed families, the aged, the poor, the sick and the physically challenged”.
Such vulnerable groups (which also include people with disability, migrants and displaced persons) have fewer resources or support to cope psychologically with the consequences of disasters. According to one national level estimate, in South Africa in general as many as 92% of individuals do not receive the care that they need for mental disorders (including epilepsy and intellectual disability). Furthermore, although estimates vary, one out of every four adults suffer from depression.
Depression, as a common mental disorder that involves a depressed mood or loss of pleasure or interest in activities, undermines developmental aspirations. Workplace-related economic loss caused by such mental health problems is estimated to be 4.2% of the GDP. This is a serious problem for a country hoping to usher in a new age of sustainable development based on equity, social justice and dignity.
Third, climate change is a serious threat to food security, and our research highlights the nuanced relationship between food insecurity and mental health, as evidenced during the emergency phase of the Covid-19 pandemic. Although it is not surprising that the highest levels of depression were consistently observed among those with pre-pandemic depression and food insecurity, new or ongoing food insecurity was a powerful driver of depression during the pandemic.
Mental health disorders are complex conditions that develop through the interaction of various contributing factors. Here, we would like to focus on an existential aspect of the climate and health discourse that is often overlooked, namely the issue of human dignity. We believe that the condition of the individual mirrors that of the environment. Therefore, ensuring dignity, equality, and social justice must go hand-in-hand with ensuring an environment that is not harmful to our well-being.
Ultimately, sustainability means creating a society that prioritises the dignity of life. The sustainable development goals can only be achieved when dignity, equality and social justice are prioritised, highlighting the need for interventions to adapt vulnerable communities for climate resilience.
What is required is a fundamental re-examination of how to create a mentally healthy and just society in which we coexist harmoniously with the natural ecosystem and in which no one is left behind. This is captured within the definition of ‘‘just transition’’ in the Climate Change Act, which includes “ecologically sustainable economies and societies which contribute toward the creation of decent work for all, social inclusion and the eradication of poverty”.
While we will work with government policymakers, policy changes alone are insufficient in creating a healthy, sustainable society. Through our Sustainable and Healthy Food Systems – Southern Africa (SHEFS-SA) research group at the University of KwaZulu-Natal, funded by UK Wellcome Trust, we focus part of our efforts on building food-resilient ecologically sustainable communities in Southern Africa. Such efforts promote human dignity and mental health that can withstand the threat of climate change.
We concur with the work of economic philosopher Serge Latouche that the realisation of a humane society means protecting the dignity of individuals amid pervasive market failure that leaves vulnerable populations behind. More than ever, with increasing climate change threats, we need to create a society in South Africa based on the principles of human dignity and an environment that supports quality of life.
Andrew Tomita is an associate professor at the School of Nursing and Public Health, UKZN. Tafadzwa Mabhaudhi is a professor at the London School of Hygiene and Tropical Medicine and UKZN and the executive director of the Institute of Natural Resources. Rob Slotow is a professor and Oppenheimer fellow in functional biodiversity UKZN.