Let’s invest in lifestyle diseases
ECONOMIC growth, accompanied by a fall in infectious diseases over the past two decades, has changed the profile of the biggest threats to the health of people living in low and middle-income countries.
At the turn of the century, the greatest threats were posed by infectious diseases like diarrhoea, pneumonia, TB, and HIV. Today, the biggest threats are posed by so-called “diseases of lifestyle”. These include diabetes (high blood sugar), hypertension (high blood pressure), and hypercholesterolaemia (high cholesterol), which have been slowly and quietly rising around the world.
Unfortunately, access to care for people with these conditions is poor in many low and middle-income countries. South Africa is no exception. In our research we set out to establish who suffers from these conditions, who has access to care and what the consequences would be if the access to care didn’t change. We also wanted to establish what the cost savings would be for the South African government if access to care improved.
After analysing our findings in relation to these questions, we concluded that South Africa should invest in care for treating diabetes, hypertension, and hypercholesterolaemia. This will, in the long run, save the country a lot of money.
Managing risks versus treating the diseases
As far as deathly and debilitating consequences are concerned, we found that poorer black men were at high risk and they had the worst access to care.
Overall, only 50.4% of people in the study community with hypertension were treated to acceptable levels. Just under 9% were treated adequately for diabetes and less than 1% for high cholesterol.
We estimated that if access to care continued at current levels, premature deaths due to cardiovascular conditions would be around 40 per 1 000 people annually.
Although HIV still causes the greatest percentage of premature deaths in South Africa, diabetes, stroke, and heart attacks are all in the top 10 causes, with diabetes rapidly rising through the ranks. More of these deaths would occur among those who are poor, black and male. There is also substantial risk for blindness and kidney disease.
We further estimated that the cost of treating all of these deathly and disabling consequences of diabetes, hypertension, and hypercholesterolaemia would be $34.2 billion (R461bn) a year – roughly 10% of South Africa’s gross domestic product in 2017.
We also found that if access to care for diabetes, hypertension, and hypercholesterolaemia was improved to levels seen in the UK or Germany, deaths and disability would be reduced. The benefits would also be seen among people who lack access to care, such as poor, black men.
If people are sceptical of South Africa’s ability to achieve access to care at the same level as the UK or Germany, it may be reassuring to note that Cuba has managed to achieve these levels of access to care.
What needs to be done
Even though we have shown that rolling out the guidelines would save costs in the longer term, there still needs to be substantial investment in building programmes for treatment in the short term.
And there needs to be monitoring and evaluation to ensure the guidelines are correctly implemented.
The balance is tipped in favour of wide-scale implementation of the guidelines because they are likely to lead to the well-being of individual patients. This would include reductions in death and disability, and improved equity, quality of life and accompanying cost savings.