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Advancing evidence-based health care guidelines evidence-based health care guidelinesFMHS Marketing & Communications<p>Dr Michael McCaul, a Senior Lecturer in the Division of Epidemiology and Biostatistics, is playing an instrumental role in informing evidence-based health care guidelines, not only on a national level, but on a global scale.<br></p><p>As a clinical epidemiologist and guideline methodologist specializing in evidence synthesis, McCaul's was appointed to the National Essential Medicines List Committee (NEMLC) during the Covid-19 pandemic. NEMLC is appointed by the Minister of Health with the objective of selecting medicines to be used in the public sector, based on a structured, unbiased and robust decision-making framework. NEMLC develops and reviews an essential medicines list for use in the public sector, accompanied, where possible, by standard treatment guidelines.</p><p>During the pandemic, the committee reviewed evidence for 33 molecules for potential treatment or prevention of Covid-19 and completed 69 rapid reviews. </p><p>McCaul led rapid reviews for Covid-19 and Adult Primary Health Care and provided methods guidance. His work with NEMLC has continued beyond the pandemic and he still regularly produces evidence synthesis summaries and systematic reviews informing national standard treatment guidelines and the National Essential Medicines List in South Africa.</p><p>“I have specifically been appointed as part of the Primary Healthcare and Adult Hospital Level Expert Review Committee, and together with Dr Clint Hendricks from the University of Cape Town, recently updated and published the Emergencies and Injuries Standard Treatment Guidelines (STG) Chapter," says McCaul. All the STGs and rapid reviews for the National Department of Health are available here: <a href="" style="text-decoration:underline;"><span class="ms-rteForeColor-8"></span></a>.</p><p>McCaul, who is a founding member of the <a href="" style="text-decoration:underline;"><span class="ms-rteForeColor-8">South Africa GRADE Network</span></a>, have also provided evidence-based medicine and GRADE methods training and workshops to NEMLC and Primary Health Care and Essential Drugs List committees. The SA GRADE Network aims to advance the use of GRADE for evidence-informed decision making for policy and practice in the country. GRADE, which stands for 'Grading of Recommendations in Assessment, Development and Evaluation', is a practical approach to grading the quality of evidence and strength of recommendations. The SA GRADE Network is jointly managed by the Stellenbosch University's Centre for Evidence-based Health Care, and Cochrane South Africa, based in the South African Medical Research Council.</p><p>McCaul has a clinical background in emergency care and a special interest in research methods, evidence synthesis, biostatistics, and guideline development. “A key focus of my career is conducting applied research with real-world impact for policy and practice," says McCaul. “I have focused my efforts contributing to and building guideline development literacy and methods in low and middle-income countries, specifically in sub-Saharan Africa." He has been involved in a number of guideline development initiatives with varying roles, from an expert panellist in advanced first aid guidelines, to guideline methodologist for national emergency care guidelines, to GRADE and guideline methods co-chair for the World Health Organization.</p><p>In academia he also consults as a biostatistician to undergraduate and postgraduate students, supervises master's and doctoral students, and conducts high-impact systematic reviews, methods research and primary epidemiological research.<br></p><p><br></p><p><em>Caption: Dr Michael McCaul</em><br></p><p><em>Photo credit: Damien Schumann</em>​</p>
SA’s first Global Minds PhD scholar graduates’s first Global Minds PhD scholar graduatesFMHS Marketing & Communications – Edna Ellman<p>​Lynn Hendricks, lecturer in the Division of Health Systems and Public Health at the Faculty of Medicine and Health Sciences since 2022, has had quite the year. <br></p><p>Her Global Minds PhD project entitled 'More than a Pill: Producing the Story of Adherence to ART for Young Women Living with Perinatal HIV' won at the inaugural Inclusive Health Research awards in Brazil earlier this year. The project was a collaboration between KU Leuven and Stellenbosch University. </p><p>Hendricks, who graduates on 12 December, is the first Global Minds PhD scholar from South Africa and started her joint PhD in 2018. KU Leuven, Belgium's largest university, selects exceptional students from developing countries as scholarship candidates to obtain their PhD there, with the view of them using the expertise gained in their home country.</p><p>“The best part of working with two universities in my PhD was the international collaboration with local flavour and context. We were able to learn from one another and to visit and immerse ourselves in our home environments while making huge strides theoretically and academically. Having the community be integrated and engaged from conception to dissemination of this project has been the most inspiring chapter. Words can never do justice to describe how much I have learnt from the real experts – our young women in Cape Town – who has inspired the world with the bravery and courage to share their stories," Hendricks says.</p><p>“Graduating and satisfying conditions for graduation at two universities was a tale only lions could tell. I was registered at KU Leuven for a PhD in Social Sciences with Prof Karin Hannes and for a PhD in Public Health with Prof Taryn Young. This meant two protocol review, two ethics applications, two doctoral schools and reporting, two thesis review committees, and finally two higher degrees committees, and two submissions. It was taxing, challenging, and so rewarding. The support of my supervisors, family, colleagues, and friends carried me through.</p><p>“During my PhD journey I became a mother and together these experiences have moulded me into the researcher and person I am today. I believe in equity, justice and inclusion. I believe that academia rests on the shoulders of giants and these giants are our public and communities. It's why we do what we do."</p><p>Hendricks says the graduation in KU Leuven was very different to the ordinary ceremony. “Because it was in Belgium, I was unable to have my family present. “There is an open presentation of your work, with a jury present (all in robes and velvet hats) in a courtroom setting with a free access public link to join and watch the presentation. After the presentation each member asks a few questions. The jury then leaves the room for what seems like ages, and after they return it is announced that you have achieved Doctor of Social Science, and you are presented with your degree certificate. Unfortunately, there is no gown. So, I am so excited that I get to walk across the stage at Stellenbosch and celebrate with my family and friends here. And that I finally get to wear the red gown!</p><p>“I have been so amazed how God has opened doors for this girl of the Cape Flats. Anything is possible if you just believe and put in the work to make your dreams happen. But never forget, research is a team sport, and each player must and can have a voice."<br></p><p>​<br></p><p><em>Caption: Prof Karin Baatjes, FMHS Vice Dean: Learning and Teaching with Dr Lynn Hendricks, and her SU study supervisor Prof Taryn Young.</em><br></p>
Honorary doctorate recipient proud to join Maties family doctorate recipient proud to join Maties familyCorporate Communication & Marketing / Korporatiewe Kommunikasie & Bemarking<p>​​“I stand here before you deeply honoured and profoundly humbled by the recognition bestowed upon me and the privilege of joining the illustrious family of Stellenbosch alumni."<br></p><p>With these words, the internationally recognised scholar and biostatistician Prof Lehana Thabane accepted the honorary doctorate awarded to him by Stellenbosch University (SU) at its December graduation. He received the degree Doctor of Science (DSc) (Medicine and Health Sciences), <em>honoris causa</em>, on Tuesday (12 December 2023) at the graduation ceremony for the Faculty of Medicine and Health Sciences.</p><p>Thabane was honoured for his pioneering work in health research and clinical trials methodology and his advocacy for evidence-based medicine and healthcare, for transferring his expertise and knowledge through academia and building capacity for applied clinical research, and for his strong commitment to mentoring the next generation of scientists.</p><p>In his acceptance speech, Thabane emphasised the important role universities play in society. “They are the crucibles where future leaders are forged equipped with the skills and knowledge to harness technology for the betterment of humanity, from combating diseases to mitigating the adverse effects of climate change." </p><p>He hailed SU as an institution of high repute that “not only stood in the vanguard of South Africa's transformation from the shadow of the apartheid system, but also continues to blaze your trails in scientific innovation, contributing to brighter future for generations to come." </p><p>He encouraged graduates to embrace the transformative power of collaboration and mentorship, sustain a positive perspective, and refine their soft skills.</p><p>“In your pursuit of knowledge and wisdom remain humble and thirsty for more. Use your newfound knowledge for the betterment of humanity and always hold gratitude close to your heart." </p><p><strong>More about Thabane</strong></p><p>Prof Lehana Thabane is a professor of Biostatistics at McMaster University, and Vice-President of Research at St Joseph's Healthcare Hamilton in Canada. His ground-breaking work in developing and applying novel biostatistical methods for new clinical trial designs, including platform trials for COVID-19, has paved the way for innovative medical and behavioural interventions globally. Thabane is sought after by other eminent members of the international scientific community to serve as lead statistician on pivotal trials. </p><p>He has a particular passion for developing future scholars and has supervised more than 200 MSc and PhD students and mentored more than ten international fellows. Thabane's commitment to empowering students through education and training has seen him lead significant capacity-building initiatives in countries across Africa, including the launch of the Biostatistics MSc programme at Stellenbosch University in 2017, which has produced more than 30 skilled biostatisticians. He has held an appointment as an extraordinary professor in SU's Division of Epidemiology and Biostatistics for the past six years.</p><p>Thabane has published more than 1,000 peer-reviewed papers in leading journals, including the New England Journal of Medicine, Lancet, and Annals of Internal Medicine, and his work has been cited over 60,000 times. He has also collaborated on more than 300 national and international studies.<br></p><ul><li><strong>Photo</strong>: Prof Lehana Thabane at the graduation: <strong>Photographer</strong>: Stefan Els</li></ul><p>​<br></p>
Sugar tax alone not enough to combat obesity & NCDs tax alone not enough to combat obesity & NCDsCorporate Communication & Marketing / Korporatiewe Kommunikasie & Bemarking [Alec Basson]<p>​​In April 2018, the South African government, in response to a recommendation of the World Health Organisation, introduced a tax on sugar-sweetened beverages (SSB) known as the Health Promotion Levy (HPL) in an attempt to reduce citizens' sugar intake and to curb obesity in the country. <br></p><p>However, the jury is still out on whether this sugar tax alone will be enough to combat obesity, which is regarded as one of the risk factors for non-communicable diseases (NCDs) such as heart disease, stroke, cancer and diabetes. Among the unconvinced are registered dietitians and key industry role-players (KIRs), according to a study by researchers from the Division of Human Nutrition and the Centre for Statistical Consultation at Stellenbosch University.<br></p><p>The researchers surveyed dietitians and KIRs on their awareness and opinions of the HPL, perceived SSB purchasing of consumers and the barriers or facilitators for the implementation of the HPL.<br></p><p>The findings of their study were published recently in the <a href=""><strong class="ms-rteThemeForeColor-5-0">South African Journal of Clinical Nutrition</strong></a>.</p><p>The research findings indicated that dietitians and KIRs held the perception that the HPL is not adequate to have a sustainable impact on lowering NCDs and obesity.<br></p><p>“Dietitians and KIRs were positive about the HPL although the majority agreed that the implementation of a sugar tax alone will not make a difference because multiple factors contribute to NCDs and obesity. They believed the HPL of 11% was too little to have an impact on the purchasing behaviour of consumers.<br></p><p>“Dietitians did report a perceived decrease in the daily purchasing of SSBs by their clients in favour of mainly sugar-free beverages and water since the implementation of the HPL. Some dietitians were concerned that SSBs were substituted with other sugar-containing food items."<br></p><p>According to the researchers, this corresponds with other studies showing that nutrition interventions targeting specific foods or beverages may lead to adverse compensatory behaviour, such as increased consumption of alternative but similarly unhealthy foods and beverages.<br></p><p>The researchers add that while most KIRs agreed that the food industry understood the Government's rationale to implement the HPL, they also held the opinion that consumers were unaware of, nor understood the sugar taxation legislation.<br></p><p>“Consumers' lack of knowledge as well as their habitual purchasing of sugary drinks were regarded as key barriers to the successful implementation of the HPL."<br></p><p>Both dieticians and KIRs emphasised the importance of educating consumers about the sugar tax legislation, say the researchers. This was also regarded as a key factor to enhance the successful implementation of the HPL.<br></p><p>“Some dietitians confirmed using the HPL as a motivational tool to encourage reduced consumption of SSBs, while others taught their clients to read the nutritional information table with an emphasis on total sugar content and glycaemic carbohydrates, and how to understand endorsement logos."</p><p>The researchers point out that most dieticians and KIRs were unsure how the revenue generated through the HPL would be utilised. <br></p><p>“They held the opinion that the revenue should be earmarked for the treatment and prevention of NCDs and for health promotion to garner consumers' trust and facilitate change. However, they were sceptical and believed that the money would only benefit the Government." <br></p><p>The researchers say both groups were also concerned that the sugar tax could be regarded as intrusive by some consumers and as inappropriate by those who are not at risk of developing obesity or NCDs.<br></p><p>Going forward, the researchers call for integrated intervention strategies requiring multi-sectoral engagement to reduce the consumption of sugary drinks and to prevent obesity in the long run. <br></p><p>“The HPL should form part of a multi-pronged approach that includes fiscal measures, consumer education and controlled marketing of SSBs to create a supportive environment in which consumers make healthy choices, for instance the combination of education, effective food labelling and banning of marketing SSBs to children.<br></p><p>“Politicians, the SSB industry, consumers, trained dietitians and public health experts all have a part to play.<br></p><p>“Health professionals, in particular, play a crucial role in facilitating behaviour change and creating an enabling environment to support successful implementation of the sugar tax, especially if they use their expertise to influence policy-makers and the media."<br></p><p>The researchers say the findings from their study underscore the importance of an enabling environment that supports the availability and accessibility of healthy food choices in various settings as a vital cornerstone of the effectiveness of the HPL. <br></p><p>They add that more should be done to educate South Africans about the goal of the sugar tax and to create a supportive environment to improve their overall health and nutritional status.<br></p><ul><li><strong>​Source: </strong>Yolande Smit, Zarina Ebrahim, Maritha Marais, Daan Nel & Nelene Koen (2023). Does sugar taxation on sugar-sweetened beverages alter purchasing behaviour of South African consumers? Perspectives of dietitians and key industry role-players. <em>South African Journal of Clinical Nutrition</em> 2023: 1–8: DOI: <a href=""><strong class="ms-rteThemeForeColor-5-0">10.1080/16070658.2023.2249246</strong></a></li></ul><p><strong>​Photo by Doris Jungo from </strong><a href=""><strong class="ms-rteThemeForeColor-5-0">Pixabay</strong></a><br></p><p>​<br></p>
Creating inclusive workspaces for people with disabilities inclusive workspaces for people with disabilitiesNatasha Maclean & Lieketseng Ned<p>​​​​The International Day of Persons with Disabilities was celebrated on Sunday 3 December. In an opinion piece for the <em>Cape Time</em>s, Natasha Maclean and Prof Lieketseng Ned from the Centre for Disability and Rehabilitation Studies write that companies that focus on intangible aspects such as fostering an inclusive culture and rebranding themselves as pro-disability are more likely to create inclusive workspaces.</p><ul><li>Read the original article below or click <a href=""><strong class="ms-rteThemeForeColor-5-0">here</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>for the piece as published.<br></li></ul><p><strong>​Natasha Maclean & Lieketseng Ned*</strong> <br></p><p>Globally, people with disabilities are still underrepresented in the workplace. The situation is the same in South Africa. While we have well-defined laws, we are still failing to ensure that employment targets for people with disabilities are met in both the private and public sectors. As we celebrate the International Day of Persons with Disabilities on 3 December, we should also emphasise the need for disability-inclusive employment that has received growing attention in response to this underrepresentation.</p><p>Amidst the guidelines and policies such as the Technical Assistance Guidelines on the employment of people with disabilities, which includes specific guidelines on reasonable accommodation (RA) and fair recruitment procedures, companies still struggle to recruit and employ people with disabilities to meet the set employment equity targets. In addition to systemic exclusion and other barriers facing people with disabilities, many companies may not know how to facilitate disability-inclusive employment. </p><p>Against this background, we conducted a <a href=""><strong class="ms-rteThemeForeColor-5-0">case study</strong></a> to identify and explore factors which enabled a state-owned enterprise (SOE) in the Western Cape to meet their employment equity targets for recruiting persons with disabilities.  We focused on a regional branch of a partially government-owned SOE in the province that employs approximately 570 employees – from top-level managers to porters and cleaners.  </p><p>We interviewed Human Resources Managers, Human Resources Employees and employees with disabilities who are permanently employed at the SOE. For secondary data, we reviewed the company website, other organisational documents including annual integrated reports, as well as two internal policies that ensure procedures for reasonable accommodation, and compliance with the Employment Equity Act (EEA) 55 of 1998 (amended to the Employment Equity Amendment Act 4 of 2022) respectively. <br></p><p>We found that the the advancement of people with disabilities is a key focus of the company as shown in its 2019/2020 annual integrated report. One example of this is the increase in the representation of people with disabilities to 2.5% of the total workforce, nationally. This increase was attributed to:<br></p><ul><li>the creation of awareness about inclusion of people with disabilities; <br></li><li>a dedicated task team devoted to ensuring accessibility, inclusion and reasonable accommodation;</li><li>running annual declaration campaigns and sensitisation initiatives on disability matters;</li><li>recommendations made regarding reasonable accommodation requirements nationally by existing employees with disabilities;</li><li>networking support group sessions held quarterly focusing on issues affecting employees with disabilities and offering a platform to determine best practice strategies and solutions;  </li><li>constant engagement with the disability sector organisations to stay abreast of disability developments; and</li><li>aligning disclosure and reasonable accommodation policies to address requirements as recommended by employees with disabilities.</li></ul><p>We also found that the company's internal policy aimed at ensuring procedures to provide reasonable accommodation (RA) for persons with disabilities outlines disclosure of disability and the accompanying protection of confidentiality and personal information. It also specifies a special budget to be made available for the provision of reasonable accommodation, monitoring of compliance, and ensuring a non-discriminatory workplace. <br></p><p>The policy encourages employees with disabilities to be involved in decision-making around RA and also prescribes that dispute-resolution processes should be put in place. All procedures regarding provision of RA are drawn up according to the policy. This policy gets reviewed according to changes in the workplace and regulations. Audits are conducted to determine compliance and implementation of RA. Responsible persons are appointed and held accountable for RA both regionally and nationally.<br></p><p>Regarding the company's other internal policy aimed at ensuring compliance with the EEA, our study showed that organisational strategic objectives are set according to an analysis of workforce demographics. In this way, the company can make sure that all categories of employment reflect South Africa's demographic profile. The policy document offers a clear definition of disability, outlines various impairments and prescribes fair recruitment and selection processes as well as equitable training and development. <br></p><p>In addition, the policy document enforces action plans to monitor and evaluate progress made to achieve employment equity targets. The document mandates quarterly meetings with representation from designated equity groups and leadership of the organisation. Individuals and departments are held responsible and accountable for achieving employment equity targets both regionally and nationally. Achievement of these targets is linked to performance of individuals and departments.</p><p>Our analysis of the interview data showed designing the recruitment process and the workplace environment for inclusion as a key facilitating factor which has enabled the company to recruit effectively. This included embracing diversity in the workplace as a key facilitator of inclusive environments. This was accomplished through workshops on learning about each other's cultures and disability awareness sessions focusing on topics such as the everyday challenges faced by employees with disabilities and why RA is necessary. </p><p>Line managers who are directly involved in recruiting and managing employees were specifically targeted for such awareness and sensitising educational disability workshops to foster an inclusive culture. This culture created a safe space for disclosures of disability.  Human resource practitioners consult with employees with disabilities to ensure that any released job advertisements, recruitment drives, and interview venues and processes are accessible to people with disabilities. <br></p><p>The company also found the formation of alliances with disability organisations and disability specific recruitment agencies helpful for effective recruitment and integration of employees with disabilities. These organisations also ensure that requirements of a specific job are suitably matched to a candidate with a disability (job matching). <br></p><p>So, what does this tell us about how companies could improve representation of people with disabilities in the workplace?<br></p><p>It is clear from our study that companies that focus on intangible aspects such as fostering an inclusive culture and rebranding themselves as pro-disability are more likely to create inclusive workspaces. Once this has been achieved, it becomes easier to facilitate the tangible aspects such as making sure that recruitment and placement processes as well as budgets are inclusive, physical spaces are altered, and employees are provided with assistive technologies to enable accessibility.    <br></p><p>We believe there is much to learn from inclusive companies as far as meeting employment equity targets for people with disabilities is concerned. Hopefully, our study can help employers improve employment for people with disabilities, and also show occupational therapists how to engage employers and better prepare people with disabilities to enter or return to the labour market.<br></p><ul><li>Photo by Marcus Aurelius at <a href=""><strong class="ms-rteThemeForeColor-5-0">Pexels</strong></a>.</li></ul><p><strong>*</strong><strong>Natasha Maclean & Lieketseng Ned are affiliated with the Centre for Disability and Rehabilitation Studies in the Faculty of Medicine and Health Sciences at Stellenbosch University.​</strong></p><p><br></p>
World Toilet Day: Many still lack safe toilets, proper sanitation facilities Toilet Day: Many still lack safe toilets, proper sanitation facilitiesJo Barnes<p>​World Toilet Day was observed on 19 November. In an opinion piece for the <em>Mail & Guardian</em> Dr Jo Barnes (Department of Global Health) calls on the government to ensure that all South Africans have access to safe toilets and proper sanitation facilities.</p><ul><li>​Read the article below or click <a href=""><strong class="ms-rteThemeForeColor-5-0">here</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>for the piece as published.</li></ul><p><strong>J</strong><strong>o Barnes*</strong><br></p><p>During Queen Victoria's reign, there were numerous topics that could not be mentioned in conversation in polite circles. Today that list has shrunk dramatically, but one topic of conversation still elicits uneasiness or else, tasteless jokes – the toilet.</p><p>Sanitation is essential for survival. According to the United Nations (UN), 4.2 billion people live without safe sanitation, while 673 million still practise open defecation and 3 billion lack basic handwashing facilities. This sanitation crisis means that untreated or poorly treated human sewage is spreading diseases into water supplies and the food chain for billions of people. This sanitation crisis causes an estimated 432,000 diarrhoeal deaths every year. <br></p><p>The attention to safe toilets has added great advantages that cannot be argued away. Over the past two centuries, safe toilets have added – on average – 20 years to the lifespan of humans. <br></p><p>The UN has announced that, globally, the world is off track to meet Sustainable Development Goal 6 to ensure sanitation and water for all by 2030. Funding is falling short, demand is rising, water pollution is worsening and existing governance structures to deal with these problems are often weak and fragmented. Poor and marginalized people are much more likely to lack safely managed sanitation services and often face many forms of discrimination. They can be left behind as they try to access and manage sanitation services or improve their current facilities with their own meagre resources. Unsurprisingly, the UN's slogan for this year's World Toilet Day (19 November) is "Leaving no one behind".<br></p><p>It is really difficult to obtain reliable data on the state of sanitation service delivery in South Africa. There is an emphasis on water provision and infrastructure, but all aspects of sanitation receive almost no attention and are often simply left out of official reports. That is already an indication of deep structural problems on the part of government.<br></p><p>​The lack of access to water and sanitation has a disproportionate impact on vulnerable groups such as women, children, the aged and people with disabilities. The South African government state does not adopt a human-rights-based approach to service delivery in especially sanitation services and infrastructure. Added to that, there are widespread systemic failures in governance and budgeting, especially in local authority structures  ̶ the very arm of government most directly involved in delivering safe and affordable sanitation to people is failing us on a large scale.<br></p><p>According to the StatsSA General Household Survey, the percentage of households that have access to improved sanitation increased from 61.7% in 2002 to 82.2% in 2017. Despite this improved access to sanitation facilities, many households continue to be without any proper sanitation facilities. Access at an overall level has improved, but that covers a wide variation in service levels with district and local averages, particularly in poor areas, remaining low. Improved also does not mean functioning well –many of these facilities are unreliable or some distance away from the home. This is a great social injustice, giving rise to collective resentment and resulting in unnecessary damage to the local infrastructure that is still working in a manner of speaking.<br></p><p>Fortunately, there is an upsurge of attention to toilet construction in international circles. Toilets on their own however are usually not sufficient to deliver safe sanitation. There is no single ideal toilet design. There can only be a 'best choice' out of a number of options, given the circumstances in a particular setting. <br></p><p>All toilets need some sort of system to deal with the resultant sewage in a safe manner or be connected to a communal treatment system for that purpose. The closer to home or to an individual toilet this treatment process is, the higher the risk that the individuals living on the property will not be willing to do the hard work of maintaining the safe disposal of the sewage. This increases the health risks for the whole community as well as the environment. Communal systems on the other hand often make use of water as a carrier medium and that poses a big problem in our country with its periodic droughts and large arid areas.<br></p><p>What can we do about this? I am concerned that some people in the middle and upper-income groups will try to take over this service on their premises. In some communities where municipal systems have totally collapsed, the inhabitants have started withholding their payment to the municipality, pooling the money and taking over the running of these systems themselves. While that drastically improved the working of such systems, there are legal and operational implications. It also opens the door to withholding services to those who cannot pay, thereby greatly increasing the social injustice aspect.<br></p><p>I wish I had easy solutions to suggest. The best that I can recommend is concerted and serious pressure on the local politicians to improve the operation of our municipalities. The government needs to look very seriously at the accountability and qualifications of the officials entrusted with the running of these systems. If this is ignored, the country will be facing a huge disaster, encompassing both disease outbreaks and upheaval in our communities. The government has been warned and we are waiting.<br></p><ul><li>Photo by Point3D Commercial Imaging Ltd at <a href=""><strong class="ms-rteThemeForeColor-5-0">Unsplash</strong></a></li></ul><p><strong>*Dr Jo Barnes is Senior Lecturer Emeritus in the Department of Global Health in the Faculty of Medicine and Health Sciences at Stellenbosch University.</strong></p><p>​<br></p>
Mental health is complex, cannot just be reduced to a checklist of symptoms health is complex, cannot just be reduced to a checklist of symptomsMark Tomlinson<p>​​World Mental Health Day is marked each year on 10 October. In an opinion piece for the <em>Daily Maverick</em>, Prof Mark Tomlinson from the Institute for Life Course Health Development argues that mental health is deeply complex and cannot just be reduced to a checklist of symptoms. We also need to pay attention to the role that the deeply human needs of belonging, social connectedness, gratitude, kindness and hope play in our wellbeing.<br></p><ul><li>Read the article below or click <a href=""><strong class="ms-rteThemeForeColor-5-0">here</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>for the piece as published.</li></ul><p><strong>Mark Tomlinson*</strong><br></p><p>World Mental Health Day is marked each year on October 10<sup>th</sup>. The day is intended to bring global attention to issues around mental health and mental disorder. The theme for 2023 is '<a href=""><strong class="ms-rteThemeForeColor-5-0">Mental health is a universal human right</strong></a>', and this year the goal is to raise awareness and initiate action to promote and protect the mental health of everybody as a universal human right. </p><p>Recent years have brought renewed focus on mental health. There are many reasons for this. Perhaps the most proximal one is the 'fallout' from the COVID-19 pandemic. Lockdowns, school closures, quarantine, and the deaths of millions of people have resulted in a surge of distress, of anxiety and depression and suicidality. </p><p>The renewed focus on mental health is to be welcomed. There is not a single country in the world where all people suffering from a mental disorder receive the care they need.  And the poorer the country the bigger the gap between need and treatment. To date, much of the focus has been on identifying symptoms, diagnosis and referral for care. And of course, this is essential.  But I have increasingly begun to worry about the technical nature of much of this. We are increasingly seeing a conflation of mental health with mental disorder. Where scoring above 11 on a 27-point rating scale has become a sign of depression.  It is not. And where quite normal responses to adversity (such as loss) become medicalised, and where we squeeze the deep complexity of people's lives into a checklist of symptoms.  </p><p>Recently, I had the good fortune to be an advisor on a learning platform that supports youth mental health innovators globally (funded by Grand Challenges Canada). One of these innovators is '<a href=""><strong class="ms-rteThemeForeColor-5-0">Organización de los Pueblos Indígenas de la Amazonía Colombiana (OPIAC)</strong></a>'. OPIAC works in Colombia in Latin America in partnership with indigenous young people. The region is characterised by historical trauma, loss of territory, violence, discrimination, economic precariousness, and the breakdown of many social institutions.  Deforestation, logging, and forced removal have resulted in many young people losing their ancestral homes and their connection to the jungle and the river. </p><p>In recent years there has been a significant increase in the number of young people in this region attempting and committing suicide. In my first engagement with the young people, they were quick to tell me (politely, forcefully and with utter conviction) that “we do not want your checklists of depression or anxiety". They described these as irrelevant to the situation they found themselves in – no matter what the diagnostic manuals said. “What we are experiencing is spiritual loss, the loss of our connection to the river, the jungle and our ancestral homes". “Please don't talk to us about depression". </p><p>In recent years, through the work of funders such as the <a href=""><strong class="ms-rteThemeForeColor-5-0">Templeton World Charity Foundation (TWCF)</strong></a>, there has been a global effort to broaden our understanding of what constitutes wellbeing and mental health. A key tenet of this is the concept of human flourishing. For TWCF, flourishing is understood as something holistic encompassing physical as well as mental wellbeing. At its core is the idea of social connectedness, and that agency and the capacity to act in a focussed way in the world, is scaffolded by <a href=""><strong class="ms-rteThemeForeColor-5-0">strong social relationships</strong></a>. Flourishing is acting in the world with purpose, humility, empathy and with a deep sense of curiosity about the world. For some, it encompasses the spiritual – in its broadest definition – a sense of something larger than ourselves.  For some, this might be God.  For others it is the sense of awe felt when gazing at the Milky Way, or the wonder at the birth of a child. </p><p>I want to touch briefly on three strengths – and to locate them temporally – that I believe are integral to flourishing. These include <em>gratitude</em> (for the things we are grateful for in our past), <em>kindness</em> (being kind in the current moment), and <em>hope</em> (how do we face an uncertain future). We need a mindset shift that targets past, present and future challenges, using gratitude, kindness and hope.  </p><p><em>Gratitude: </em>It is rare, that a person has nothing to be grateful for. For many whose lives have been characterised by hurt and disappointment it may not immediately be obvious.  But it may be a teacher who took interest. A neighbour.  It might even be a stranger that sacrificed for something that you have now.  In South Africa, it might be the thousands of activists who gave their lives in the struggle against apartheid. Gratitude, almost by definition, makes us focus on the positive. On what we have, rather than what we don't. Being grateful also makes us less anxious. </p><p><em>Kindness: </em>Kindness is the act of helping another without any promise of reward or punishment. Functionally, it is gratitude in the present moment. Kindness is a key contributor to social cohesion and social connectedness. It is also really good for both – the giver and the receiver. And finally, it is closely tied to empathy. </p><p><em>Hope:</em>  Hope is the idea that goals can be met through action and agency even though it may not always be clear whether the goals may actually be met. Hope is not optimism.  There is some uncertainty in hope, and as Rebecca Solnit has pointed unlike optimists and pessimists who already know the outcome, people with hope choose instead to act to make things happen. Hope is about activism. For <a href=""><strong class="ms-rteThemeForeColor-5-0">Solnit</strong></a>, “hope is not a door, but a sense that there might be a door at some point, some way out of the problems of the present moment even before that way is found or followed" </p><p>In this piece, I am not arguing that the identification and treatment of mental disorders is not essential. It is. As I said earlier, there is not a country in the world where the provision of mental health care meets the actual need. But what I am suggesting is there is more to it than that.  We are always more than our current symptoms. We have lost touch with the role that the deeply human needs of belonging, social connectedness, gratitude, kindness and hope play in our wellbeing, and how they are in fact they are likely to be the only way out of our current moment of psychic discontent. <br></p><ul><li>​Photo by Sam Moghadam Khamseh on <a href=""><strong class="ms-rteThemeForeColor-5-0">Unsplash</strong></a>.</li></ul><p><strong>*Prof Mark Tomlinson is co-director of the Institute for Life Course Health Development in the Department of Global Health at Stellenbosch University.</strong></p><p>​ </p><p>​<br></p>
World Hypertension Day: Policies to curb hypertension, diabetes must focus on people’s needs Hypertension Day: Policies to curb hypertension, diabetes must focus on people’s needsCorporate Communication & Marketing / Korporatiewe Kommunikasie & Bemarking [Alec Basson]<p>​​​Non-communicable diseases (NCDs) such as heart disease, cancer, chronic respiratory disease and diabetes are the leading cause of premature death worldwide. People with hypertension (high blood pressure) and diabetes have a greater chance of suffering from heart disease, which accounts for more than 17,7 million deaths annually. To address the risk factors for hypertension and diabetes in South Africa, policies and programmes (population-level interventions) must focus on the underlying socio-economic, environmental, behavioural or cultural conditions in which people live and work.<br></p><p>This is according to a study<strong>*</strong> by researchers in the Department of Global Health in the Faculty of Medicine and Health Sciences at Stellenbosch University. The study was published recently in the peer-reviewed journal <a href=""><strong class="ms-rteThemeForeColor-5-0">BMC Health Services Research</strong></a>. It forms part of a larger project <span style="font-size:11pt;line-height:107%;font-family:calibri, sans-serif;"> ̶ </span> Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) <span style="font-size:11pt;line-height:107%;font-family:calibri, sans-serif;"> ̶ </span> on population-level interventions to curb hypertension and diabetes in the country. </p><p>The researchers interviewed expert decision makers such as managers, directors and policymakers who participated in the planning and developing of policies, programmes or supportive  environments for the prevention and management of these conditions. These decision-makers were from national and provincial government departments, agencies involved in NCD-related programmes, NGOs, the food industry and academic and research institutions.<br></p><p>As part of their study, the researchers used the World Health Organisation's Global Strategy for Diet, Physical Activity and Health as a framework, and focused on three broad categories – supportive policies, supportive programmes and supportive environments. Supportive policies are fiscal, legislative and regulatory measures that can target risk factors for hypertension and diabetes. Supportive programmes can be national, district or community-based programmes that reach people where they live, study or work. A supportive environment refers to activities that influence the creation of circumstances in which healthy choices are the easier option for people.<br></p><p>Speaking ahead of <a href=""><strong class="ms-rteThemeForeColor-5-0">World Hypertension Day</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>(17 May), the researchers say their study shows some of the key enablers and challenges for the planning and development of targeted population-level interventions to reduce the risk factors for hypertension and diabetes.</p><p><strong>Enablers</strong></p><p>“The decision-makers we spoke to, emphasised stakeholder engagement and collaboration, contextualisation of policies and programmes, ongoing monitoring and evaluation and organic growth as key enablers for policy formation. They mentioned the value of partnerships between communities, industry, academia and relevant government departments. </p><p>“They also said it is important for policies to be responsive to the needs of the community, and that a public health approach should be used because striking a balance between the economic and nutritional needs of people who are at higher risk of hypertension and diabetes was essential to planning for interventions and creating supportive environments.<br></p><p>“Participants also highlighted the need for monitoring and evaluation of policies and programmes to capture, for example, positive change, information about consumer perspectives and further information to inform future policy formation. Another enabler was planning programmes that could organically grow from smaller initiatives that show positive results in evaluation."<br></p><p><strong>Key challenges</strong></p><p>According to the researchers, key challenges for the formulation of supportive policies and programmes, and to enable supportive environments, included the lack of time, resources and funding, lack of stakeholder consultation, regulations and competing priorities and ineffective monitoring and evaluation.</p><p>“The decision-makers indicated, for example, that a lack of time resulted in the National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2020–2025 (NCD Strategy) being developed without much stakeholder consultation. They pointed out that without consultation and buy-in from key stakeholders, especially communities, policy formulation processes are compromised, risking successful implementation and uptake from stakeholders. <br></p><p>“They also said competing interests between government and other sectors have a detrimental effect on policies and programmes aimed at reducing the risk factors for hypertension and diabetes. Competing priorities translated into unethical sponsorships such as industries supplying and promoting unhealthy diets through sponsorship of governmental events, sending conflicting messages to the public.<br></p><p>“According to them, competing interests, the lack of baseline data and electronic monitoring systems made it difficult to measure the impact of interventions and to refine and improve policies as exemplified in the Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013-17 and the Regulations Relating to the Reduction of Sodium in Certain Foodstuffs and Related Matters."<br></p><p>The researchers say the perceptions of the decision makers show that collaborative planning and engagement, funding, reliable evaluation data, as well as a careful assessment of the needs and circumstances of communities are essential to successfully plan and formulate policies and programmes to reduce the risk factors for hypertension and diabetes.<br></p><p>They add that the feasibility and sustainability of programmes can only be ensured when the resources are provided, and environments enabled to promote healthy lifestyles in communities. <br></p><ul><li><strong>Source</strong>: Hendricks, L; Uwimana‑Nicol, J; & Young, T 2023. Decision makers perceptions and experiences of developing population‑level interventions targeting risk factors for hypertension and diabetes in South Africa: a qualitative study. <em>BMC Health Services Research </em>(2023) 23:146: <a href=""><strong class="ms-rteThemeForeColor-5-0"></strong></a></li></ul><p><strong>​*</strong><em>This study was supported by the Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) project funded by the German Federal Ministry of Education and Research as part of the Research Networks for Health Innovation in Sub-Saharan Africa Funding Initiative. </em><em>CEBHA+ is a nine-partner, six country consortium aimed to establish long-term capacity and infrastructure for evidence-based healthcare and public health in sub-Saharan Africa, to strengthen African research institutions, and to build competence in the understanding and rapid uptake of evidence in health system institutions.​</em></p><p>​<br></p>
COVID-19 and the impact on women and the impact on womenHannah Simba & Silindile Ngcobo<p>​​​Surviving the COVID-19 pandemic for women means more than just surviving the disease, as there are threats beyond the risk of infection, write doctoral students Hannah Simba (Department of Global Health) and Silindile Ngcobo (University of Cape Town) in an opinion piece for <em>News24</em> (2 December).<br></p><ul><li>Read the article below or click <a href=""><strong class="ms-rteThemeForeColor-5-0">here</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>for the piece as published.</li></ul><p><strong>Hannah Simba & Silindile Ngcobo*</strong><br></p><p>Is the ongoing COVID-19 pandemic gender neutral? No. We believe that surviving the current pandemic for women means more than just surviving the disease, as there are threats beyond the risk of infection. </p><p>The differences in how women fare during a pandemic compared to men are largely due to long-existing inequalities and social disparities, which are exacerbated by the pandemic, rather than biology. Inequalities created and compounded by outbreaks leave women in a more vulnerable position. To put it into perspective, globally, women form <a href=""><strong class="ms-rteThemeForeColor-5-0">70%</strong></a> of the healthcare and social services workforce. This automatically puts them at the frontline during a pandemic response, and thus at a greater  risk of infection. </p><p>In a <a href=""><strong class="ms-rteThemeForeColor-5-0">study</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>investigating mental health outcomes of frontline healthcare workers in China, women and nurses were far more likely to suffer from depression, anxiety, insomnia, and distress.  </p><p>It is true that during crises, epidemics and pandemics, <a href=""><strong class="ms-rteThemeForeColor-5-0">women tend to take up more caregiver responsibilities</strong></a> than usual, often at the expense of their health. Particularly in the COVID-19 crisis, wherein some instances families have to stay at home while self-isolating or during movement restrictions, women can be overworked and overstretched as they take on more domestic care. This increasing burden of care can also take time away from paid work. The responsibility of taking care of the sick at home also often falls more on the women. In some cases, they have a double-barrel role of being the caregivers both at work and at home. </p><p>We've seen news reports about how women are also at a greater risk of more <a href=""><strong class="ms-rteThemeForeColor-5-0">violence and abus</strong>e</a> during the pandemic. The lockdown and isolation policies implemented in many countries put women at a higher risk of domestic and sexual abuse as they are likely to spend more time with their abusers. The United Nations Entity for Gender Equality and the Empowerment of Women, also known as UN Women, even talked about this violence as a <a href=""><strong class="ms-rteThemeForeColor-5-0">shadow pandemic</strong></a>. The need for protection of women against abuse is therefore heightened during the pandemic. Studies looking into the surveillance and evaluation of effective interventions for those at risk of domestic violence during the pandemic are still lacking. </p><p>The COVID-19 crisis also poses a threat to women's <a href=""><span class="ms-rteThemeForeColor-5-0"><strong>reproductive righ</strong><span><strong>t</strong></span><strong>s</strong></span></a>. Sexual and reproductive health services remain important even during pandemics. In some countries, however, these become overlooked as funding becomes diverted to pandemic responses. This has dire health (including mental health) consequences for women needing these services. It is projected that due to COVID-19, millions of women and girls may be deprived of family planning services.</p><p>As if this is not enough, women and girls are also more likely to become or remain food insecure. According to the world food programme, the number of people who will face a food crisis is expected to double because of COVID-19. It warned of a <a href=""><strong class="ms-rteThemeForeColor-5-0">hunger pandemic</strong></a>. For women and girls, this could have even worse implications as they already constitute 60% of those facing a food crisis.</p><p>One thing we shouldn't forget is that the current pandemic is not unique when it comes to women's issues being overlooked. Past outbreaks such the <a href=""><span class="ms-rteThemeForeColor-5-0"><strong>Zika virus (ZK</strong><strong>V)</strong></span></a>, <a href=""><strong class="ms-rteThemeForeColor-5-0">Ebola Virus Disease (EBV)</strong></a>, and the 1918–1919 <a href=""><strong class="ms-rteThemeForeColor-5-0">Influenza Pandemic</strong></a>, have shown how gender norms, unprepared health systems, inaccessible healthcare services, and power dynamics can increase women's vulnerabilities during a crisis.</p><p>For example, in the ZKV outbreak, power dynamics favoured women's exclusion in decision-making, resulting in their autonomy being infringed and their sexual and reproductive health rights undermined. In the EVD outbreak, gender roles exposed women to a high risk of infection through caregiving and burial activities. The low-resilient health systems led to women not being able to access healthcare services timely. During the Influenza pandemic, public health officials implemented response strategies such isolation and quarantine, to curb transmission which meant more responsibility for women with caregiving roles at home and thus a greater risk of infection.<br></p><p><strong>Responses and strategies</strong></p><p>So, what COVID-19 public health responses and strategies are needed to make women less vulnerable during the pandemic? </p><p>A good starting point would be to recognise the extent to which the pandemic affects women. A next step would be to address gender norms and the need for shared responsibilities at home and in the workplace. The relevant authorities should prioritize frontline workers' health, including mental health for all women. <br></p><p>They need to integrate sexual reproductive health rights for all women, put in place monitoring strategies, and provide accurate and accessible family planning education and all the necessary healthcare services that women need. <br></p><p>What would also be important is to incorporate and keep surveillance and protection systems for victims of gender-based violence. There must also be clear plans of action to assist women in the informal labour sector when there are movement restrictions with economic repercussions. <br></p><p>One aspect that would make responses and strategies more effective would be the appointment of women in leadership and management positions for national task teams and global organisations. <br></p><p>The time has come for governments to put their money where the mouths are and start prioritising, supporting and funding ongoing scientific research and collaboration on the issues mentioned in this article. <br></p><p>These recommendations could go a long way in helping us achieve Goal 5 of the   Sustainable Development Goals which aims to achieve gender equality and the empowerment of women by 2030.<br></p><p style="text-align:justify;">​*<strong>Hannah Simba</strong><strong><sup> </sup></strong><strong>is a doctoral student in the Department of Global Health at the Faculty of Medicine and Health Sciences at Stellenbosch University.</strong><strong> </strong><strong>Silindile Ngcobo is a doctoral student at the University of Cape Town. This article is a revised version of their recent paper </strong><a href=""><strong class="ms-rteThemeForeColor-2-0">in</strong><strong><em><span class="ms-rteThemeForeColor-5-0"> Frontiers in Global Women's Health</span>.</em></strong></a></p><p style="text-align:justify;"> </p><p><br></p>
Overpopulation, climate crisis could overwhelm us, climate crisis could overwhelm usMark Tomlinson<p>On Saturday 11 July, we'll observe World Population Day. In an opinion piece for <em>Daily Maverick</em> (6 July), Prof Mark Tomlinson (Institute for Life Course Health Research) writes that we need to act now to avoid being overwhelmed by overpopulation and the climate crisis.<br></p><ul><li>Read the article below or click <a href=""><strong class="ms-rteThemeForeColor-5-0">here</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>for the piece as published.<br></li></ul><p><strong>What does COVID-19 have to do with World Population Day?</strong><br></p><p><strong>Mark Tomlinson</strong><br></p><p>In 1989, the United Nations established <a href=""><strong class="ms-rteThemeForeColor-5-0">World Population Day</strong></a><strong class="ms-rteThemeForeColor-5-0"> </strong>which is observed on 11 July every year. The choice of 11 July was prompted by a milestone  ̶  the world population reaching five billion on 11 July 1987. </p><p>Each year, World Population Day has a theme that highlights an issue relevant to the global population. For example, in 2011 – when the world population crossed the seven billion mark – the theme was on engaging with and activating all seven billion people in the challenges related to our planet. This year, the focus is on reproductive health and gender equality, and the United Nations has called for countries to attend to the 'unfinished business' of the 1994 International Conference on Population and Development. The 'unfinished business' is the recognition that achieving gender equality is essential if we are to achieve sustainable development. <br></p><p>Why is population growth and the associated issues such an important issue today? The magnitude of population growth has been colossal. It took the world hundreds of thousands of years (and modern humans about 10 000 years) to reach a global population of one billion. This milestone was reached in 1800. In the subsequent 220 years, the global population has grown <a href=""><strong class="ms-rteThemeForeColor-5-0">to an estimated 7.8 billion</strong></a>. Linked to this growth has been massive changes in where people live. For most of human history, people largely lived in rural areas.  </p><p>In 2007, the global urban population outnumbered their rural counterparts for the first time. The shift was considerable – in 1950 approximately three-quarters of a million people lived in urban areas, but by 2018 this had swelled to 4,2 billion.  South Africa has followed this trend with more than two-thirds of South Africans now living in urban areas. <br></p><p>We are currently in the midst of a global COVID-19 pandemic, and in South Africa we are in month four of a state of strict lockdown. Hundreds of thousands of people have lost their jobs, children have been out of school for months and entire industries lie dormant. In this context, one might legitimately ask how important is World Population Day, and of what relevance is it for our current situation?  <br></p><p>The first reason lies squarely in the climate concerns the world now faces, which in turn have their roots in population growth and increased human encroachment on animal habitats. As it is now accepted (outside of a marginal group of climate change deniers), massive industrialisation in the last 200 years has resulted in significant environmental degradation. <br></p><p>The environmental catastrophe we may face (referred to as a Sixth Extinction by Elizabeth Kolbert (Kolbert, E. <em>The Sixth Extinction: An Unnatural History</em>. 2014. Henry Holt and Company) is a direct consequence of human activity resulting in massive increases in greenhouse gases which have led to temperature increase, shrinking glaciers and more frequent extreme weather events. The impacts of climate change are numerous, but a significant one has been the increasing displacement of people. As I have argued, a big part of this has been the shift from rural to urban centres, but increasingly it is linked to climate shifts and weather events. For example, <a href=""><strong class="ms-rteThemeForeColor-5-0">in Bangladesh</strong></a> it has been estimated that by 2050 one in every seven people will have been displaced by climate changes. </p><p>'Climate migrants' are only one of the examples of how population movement is putting further pressure on already vulnerable cities, forcing an ever-increasing expansion into previously remote animal habitats and 'wild areas'.  Rapidly expanding cities are devastating wildlife to the point where we are losing our biodiversity at a rate of 1 000 times of what it was in pre-human times. The <a href=""><span class="ms-rteThemeForeColor-5-0"><strong>total mass of wild anima</strong><strong>ls</strong></span></a><strong class="ms-rteThemeForeColor-5-0"> </strong>has been reduced by over 80%, while plant mass has been reduced by 50%. </p><p>One consequence of this is that the wildlife that remains, has had to adapt to living in a new proximity to human beings. These new 'intimate' configurations, and the increased contact between humans and wild animals, has massively increased outbreaks of infectious zoonotic diseases. Zoonotic diseases are caused by pathogens such as viruses, bacteria, and fungi that are transmitted to humans by animals (David Quammen. <em>Spillover: Animal Infections and the Next Human Pandemic</em>. 2012. W.W. Norton & Company). COVD-19 is only the most recent example of this, and whilst we are yet to track the specific animal where COVID-19 originated, that it originated in an animal is in little dispute.  </p><p>One of the conundrums of climate breakdown is that what is happening is not immediately visible and it requires a long-term view to appreciate what is happening – something that may be difficult for many. Act now to mitigate consequences in 20 years. Take a hit economically now so that your grandchildren will be in a better economic position than they might otherwise be. <br></p><p>A possible (beneficial) consequence of the current pandemic is that the reality of our encroachment, and the resultant diseases that we are going to be at risk of suffering from, is going to be increasingly difficult to deny or rationalise away. Added to this, we are also now beginning to see the shifts and changes at a much more personal level. For example, there is <a href=""><strong class="ms-rteThemeForeColor-5-0">increasing evidence</strong></a> that as temperatures rise, pregnant women exposed to higher temperatures and pollution are more likely to have a child that is premature, underweight or even stillborn. </p><p>Finally, as the environment degrades, breadwinners (often men in poor countries) increasingly leave agricultural areas, out-migrating in order to seek work. This <a href=""><span class="ms-rteThemeForeColor-5-0"><strong>leads to</strong></span></a> an increase in the workload of women as well as reducing their access to resources. And in the aftermath of extreme weather events and disasters it is women who assume the burden of care for family members. This further limits their capacity to seek and engage in paid work.   </p><p>The current pandemic has shone a terrifying spotlight on human vulnerability and has highlighted our human arrogance and our delusional sense of superiority and dominance over the natural world. The world has been shut down by a minute virus (0,000065 mm in diameter), and we are at a loss about the way forward. Our current predicament offers an opportunity to 'build back better', and to acknowledge our interdependence with each other as well as the natural world. If we fail to heed the lesson, future pandemics and climate breakdown will make our current COVID-19 pandemic seem like a walk in the park.  <br></p><p><strong>*</strong><strong>Prof Mark Tomlinson is co-director of the Institute for Life Course Health Research in the Department of Global Health at Stellenbosch University.</strong></p><p><strong> </strong></p><p><br></p>