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22 January 2007
Accompanying South Africa's newly emergent black middle and upper (wealth) class on its march to affluence and 'the good life' is a hidden killer: heart disease. Estimates taken from a recent South African Medical Research Council study show that despite the high number of deaths attributable to infectious diseases, non-communicable diseases (NCD) - such as heart disease, diabetes and cancer - account for a large proportion of the deaths. In the year 2000, HIV/AIDS accounted for 29% of the deaths in South Africa, while cardiovascular disease and diabetes alone - the latter often 'graduating' to heart disease - accounted for 19%.
But it is the increase in heart disease among urban black South Africans that is of concern to health professionals, and the focus of a report produced by a joint South African-Australian research team using case studies from Johannesburg's Chris Hani Baragwanath Hospital.
Titled 'Emerging epidemic of cardiovascular disease among urban Africans: Acute Coronary Syndrome at Baragwanath Hospital, Soweto', the report - involving the University of Queensland, Wits University and Chris Hani Baragwanath Hospital - marries a cross-sectional study from 2004 with data from 1975-80, and points to black men being most at risk.
Of the 154 Acute Coronary Syndrome (ACS) patients worked with at Baragwanath in 2004, 42% were black, 32% were white and 26% Asian. The average age was 56 years and 71% were men.
In the 1950s black South Africans were virtual strangers to heart disease. At Soweto's Baragwanath Hospital, the number of patients admitted with Acute Coronary Syndrome (ACS) on an annual basis - according to the study - averaged at three. Moving into the 1980s, the figure hardly rose, the number inching up to five, even though the population had grown considerably. While tuberculosis (TB) was the big killer, ischaemic heart disease (manifested in strokes and heart attacks, caused by a lack of oxygen in the brain and heart respectively) had yet to arrive on urban black Africa's largely impoverished doorstep.
Until 2004, when the report idenitfied 64 black South Africans with ACS being admitted to Chris Hani-Baragwanath.
This figure, while comparatively shoved into a corner by the HIV-Aids pandemic, represents a radical shift in urban black South Africa's health landscape. 'These data are important', says the report, 'because they may herald the emergence of a significant epidemic of ischaemic artery disease in South Africa'.
While this points to a serious increase in 'the annual incidence of ACS among black Africans... in Soweto' - a scenario Wits University specialist physician Professor Derick Raal says could well be replicated throughout urban black South Africa' - the MRC report examines 'Chronic Diseases of Lifestyle' at a national, multi-racial level.
With financial and technical assistance provided by the Food and Agriculture Organization (FAO) of the United Nations, the reports' authors say that since the 1980s 'there has been an 'explosive increase in communicable diseases largely because of the increasing burden of HIV/AIDS and tuberculosis (TB).
'The result has been an increase in the last three decades of many non-communicable (chronic) diseases, particularly ischaemic heart disease, hypertensive disease, stroke, diabetes...' and a host of cancers.
The reason, claims the report, is that 'significant changes have been taking place in the lifestyle of many South Africans, which are contributing to their risk...'. Chief culprit seems to be urban black South Africa's adoption of a "western" diet; fast-foods, physical inactivity and tobacco-use. Less than two months ago a World Health Organisation (WHO) report issued a warning to the continent, estimating that 'more than one-third of African women and a quarter of African men are estimated to be overweight', figures it predicts will rise to 41 percent and 30 percent respectively over the next 10 years.
In Cameroon, where the diet is rich in palm oil, cornflower products and red meat, '35 percent of the population is overweight or obese'. Similar rates are found in Gambia and Nigeria, particularly among women, according to figures presented at a recent conference organized by the Oxford Health Alliance of health professionals and academics.
'Studies on (South Africa's) dietary intake', says the MRC report, show that the black population is undergoing a transition from a traditional high fibre, high carbohydrate intake to a more typically western diet, which has an increased fat and added sugar intake, a lower unrefined carbohydrate intake and an increased intake of animal protein sources and saturated fat'. The report points out that despite the fact that stunting and chronic energy deficiency still affects a large number of black infants and children, these eating patterns are nevertheless reflected in the 'high prevalence of overweight and obesity in the adult and child population'.
According to a report by Associated Press in November last year, worldwide, an estimated 1 billion people are estimated to be overweight, compared to the 800 million who are undernourished.
"We have gone from under-nutrition to over-nutrition without ever having passed healthy nutrition," says Krisela Steyn, the retired director of the South African Medical Research Council's Chronic Disease and Lifestyle unit.
Sitting during work and leisure time - 'sedentary behaviour' - is cited as another cause for the increase in cases of obesity, which - agree health professionals - as with the high prevalence of tobacco and alcohol-use, 'helps to explain the increased prevalence of cardiovascular disease, diabetes, hypertension and certain cancers... particularly in the youth'.
So as to prevent against this problem of chronic disease placing unbearable additional burden on the country's health system, the report recommends that in the next decade health authorities 'develop successful intervention programmes aimed at health promotion in children, and which utilise the school environment as a vehicle for change and adoption of a healthy lifestyle'.
Given warnings by health professionals that health systems already stretched by the AIDS virus, malaria and poverty-related diseases could collapse under the additional burden of the modern South Africa lifestyle: heart disease, strokes, cancer and diabetes - all conditions linked to obesity - the health department would be foolish to ignore such recommendations. Especially in a country where the level of physical activity has fallen generally and obesity in females has risen enormously - it could be the answer to providing for a stronger, healthier population in the future.
We have cardiologists and experts in this field ready to be interviewed and give any information needed to get this message across to your readers, as well as ordinary South Africans who have suffered from heart disease and are happy to share their stories.
FOR MORE INFORMATION CONTACT:
Michelle Kearney,
Project Director: Communications & Public Relations,
The Heart and Stroke Foundation SA
+27-21-447 4222 -
email: michelle@heartfoundation.co.za
**This article was written by CNN Africa Journalist 2006 Angus Begg
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