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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>
Building capacity for evidence-based healthcare and public health in sub-Saharan Africa capacity for evidence-based healthcare and public health in sub-Saharan AfricaMichelle Galloway<p>​The Collaboration for Evidence-based Healthcare in Public Health in Africa (CEBHA+) aims to build long-term capacity and infrastructure for evidence-based healthcare and public health in sub-Saharan Africa, including primary research; evidence synthesis; and, evidence-based policy and practice.<br></p><p>“CEBHA+ adopts a population perspective, encompassing disease prevention and care delivery. The research contributes to the World Health Organisation's Sustainable Development Goals, especially Goal 3," said Professor Taryn Young, executive head of the Department of Global Health and director of the Centre for Evidence-based Health Care (CEBHC) at Stellenbosch University's Faculty of Medicine and Health Sciences.</p><p>CEBHA+ is a collaboration involving institutions in Rwanda, South Africa, Uganda, Malawi, Ethiopia and Germany, and is funded by the German Ministry for Education and Research from 2017 to 2022 as part of the Research Networks for Health Innovation in Sub-Saharan Africa Funding Initiative.</p><p>The African partners include the <a href="">Armauer Hansen Research Institute</a> in Ethiopia, <a href="">Makerere University</a> in Uganda, the <a href="">Universities of Rwanda</a> and <a href="">Malawi</a>, while the German partners are the University of Freiburg and the Ludwig-Maximilians-Universität in Munich. Within South Africa, three CEBHA+ partners work collaboratively to implement project activities – the Chronic Diseases Initiative for Africa, Cochrane South Africa and the CEBHC.</p><p>CEBHA+ encompasses research, networking and capacity development. Research includes looking at evidence-based solutions to enhance screening and improve models of health delivery and population-level interventions for hypertension, diabetes and cardiovascular diseases as well as uncovering what works for road-traffic accident prevention.</p><p>The project promotes closer interactions amongst the African and European partners and brings together African initiatives pursuing similar goals and developing regional capacity. The CEBHC leads the implementation of the capacity development with the focus on enhancing capacity for both the conduct and use of research evidence in public health. Central to the project is integrated knowledge translation.</p><p>"For the CEBHC the project enables collaborative work advancing not only research and capacity development for evidence-based public health, but active engagement with decision makers to ensure our research has an impact on policy and practice," said Young.</p><p><strong>Highlighting the issues</strong></p><p>In March 2020, CEBHA+ hosted its annual networking meeting in Cape Town followed by a national research symposium on Non-Communicable Diseases (NCDs) co-hosted by the South Africa partners and the National Department of Health. This brought together researchers, policy makers and practitioners to exchange knowledge on the prevention and treatment of diabetes, hypertension, cardiovascular disease risk factors, and related mental health conditions; identify the knowledge gaps; and, discuss implications for policy and practices.</p><p>The Minister of Health, Dr Zweli Mkhize, described NCDs in South Africa as "heading for a tsunami". He indicated that there are six NCDs in the top-ten causes of death and that "this is not only a health issue but impacts on all levels of social and economic development. NCDs are a major challenge for sustainable development."<br></p><p>Describing the symposium as "a significant milestone in our efforts to prevent and control NCDs" Mkhize pointed to the need for all sectors and government departments to respond. </p><p>The symposium featured three parallel sessions – population interventions to address risk factors; risk factors, screening and knowledge translation; and, NCD management.  </p><p>"This project is at the forefront of addressing the challenge of the rising burden of disease from NCDs," said Young. “This requires a multidisciplinary approach, engaging with decision makers, conducting regionally relevant research, learning from each other and working together to make a difference in the lives of Africans."</p><p>The project has produced a newsletter, conducted workshops, offered masters and PhD fellowships, produced an evidence-based public-health pocket guide, as well as systematic review and primary research papers. </p><p>See <a href="" style="text-decoration:underline;"><span class="ms-rteThemeForeColor-5-0" style="text-decoration:underline;"></span></a></p><p> </p><p><em>Caption: CEBHC director Prof Taryn Young, the South African Minister of Health Dr Zweli Mkhize and Prof Jimmy Volmink, Dean of the Faculty of Medicine and Health Sciences, Stellenbosch University.</em>​<br></p>
Future looks bright for Dr Lungiswa Nkonki looks bright for Dr Lungiswa NkonkiJackie Pienaar-Brink<p>​​The future looks bright for Dr Lungiswa Nkonki, a senior lecturer in the Department of Global Health at Stellenbosch University (SU), who has been selected as a participant in the Future Professors Programme (FPP).<br></p><p>The FPP – a national capacity-building ​programme of the Department of Higher Education and Training – is aimed at turning senior researchers/lecturers into associate professors and full professors in a shorter space of time than would otherwise have been the case. It offers a structured curriculum that includes intensive seminars and international placement. </p><p>“I am very excited. It is great news to start the year, and in some way an acknowledgement of the work I have done so far," Nkonki (38) says.</p><p>Nominations were submitted by all 26 universities for the first phase of the programme, which commenced in January this year. Only 29 were selected. </p><p>The FPP was initiated by Dr Naledi Pandor, former Minister of Higher Education and Training, and is led by Prof Jonathan Jansen of the Faculty of Education at SU. </p><p>“This mentorship is very important," Nkonki says. “I believe on your journey you need to travel alongside people who have been through similar training. Prof Jansen is an accomplished scholar who made a meaningful contribution in South Africa. That is something that I do admire. It really is a privilege and an honour to be mentored by him, and whoever else he would bring on board."</p><p>Jansen explained earlier that the programme is highly focused on generating serious research professors. Because it aims to be transformative, women and black academics are targeted. The National Research Foundation (NRF) rating system is used to identify candidates with a proven level of success in publishing in respected journals.<em> </em></p><p>Nkonki was born in Port Elizabeth and lives in Claremont, Cape Town. She completed a degree in Medical Bioscience at the University of the Western Cape, followed by a BSc Honours.<br></p><p>Her interest in public health was ignited during her internship at the Health Systems Trust. After completing a Master's in Public Health at the University of Cape Town, focusing on health economics, she did an MSc in Economics at the University of Sussex in the United Kingdom. In 2012 she obtained her PhD in health economics at the University of Bergen in Norway.</p><p>Nkonki, a senior lecturer in the Division of Health Systems and Public Health at the Faculty of Medicine and Health Sciences, joined SU in 2012. She has a Y rating from the NRF and her scientific contribution includes 21 peer reviewed publications, of which eight are first authored.</p><p>In 2014 she was appointed as a panellist for the Competition Commission of South Africa's Private Healthcare Market Inquiry. It was the first evidence-based process in South Africa that carefully gathered evidence and studied the private healthcare market. The final report was published in September last year.</p><p>“I am pleased South Africa is embarking on a journey towards universal health coverage," Nkonki says. “My vision is to contribute towards excellent health economics and to do research that will really help South Africa improve in health care provision as well as health outcomes."<br></p><p><em><br></em></p><p><em>Photo credit: Stefan Els</em><br></p>
Cancer remains a formidable adversary that tests human resilience remains a formidable adversary that tests human resilience Vikash Sewram<p>​Tuesday (4 February) is World Cancer Day. In an opinion piece for News24, Prof Vikash Sewram from the African Cancer Institute reflects on what still needs to be done to combat the disease.<br></p><ul><li>​Read the article below or click <a href=""><span class="ms-rteThemeForeColor-5-0"><strong>here</strong></span></a> for the piece as published.</li></ul><p>Cancer remains a formidable adversary that afflicts all communities without discrimination or boundaries. Its burden impinges on the lives of tens of millions annually, making it a major and increasing public health problem worldwide. The word 'cancer' invokes deep fear as a silent killer, with many viewing this disease as a symbol of grief and pain, a plague straining our intellectual and emotional resources. But our resilience and need to survive is a reflection of human tenacity and unwavering spirit to conquer the odds, and it is this tenacity to continue the fight against cancer that has led to remarkable strides in better understanding the aetiology of the disease, the complexities regarding its biology, methods for prevention, screening, diagnosis and advances in cancer treatment.</p><p>World Cancer Day, spearheaded by the Union for International Cancer Control (UICC), takes place every year on 4 February and is the uniting global initiative under which the world comes together to raise the profile of cancer in a positive and inspiring way. Cancer has a significant health impact on the global population, and as we commemorate World Cancer Day, we ought to reflect, acknowledge and recognise that the continued battle against cancer is not a singular effort and a unified response is mandatory to ensure a path to victory. Everyone can play a role in ensuring global success. 2020 is the second year of the new three-year campaign by the UICC, 'I Am and I Will'. The new theme is an empowering call for personal commitment and represents the power of our actions taken now to reduce the growing impact of cancer. We must also remind ourselves of the broad societal impacts beyond the negative effects it has on individual health outcomes, including productivity losses for cancer patients and their family caregivers. We must not sway in our resilience to ensure efforts for increased early stage cancer detection, screening, and diagnostic services coupled by timeous and appropriately treatment to significantly improve cancer patients' chances of survival and quality of life.<br></p><p>​The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. One in five men and one in six women worldwide develop cancer during their lifetime, and one in eight men and one in 11 women die from the disease. Unless greater efforts are placed into altering the course of the disease, this number is expected to rise to close to 30 million new cases by 2040. With South Africa's growing population of approximately 59 million and an aging population, the caseload is expected to double by 2040 as well. Cancer remains the 6th main cause of mortality in South Africa and latest data from the National Cancer Registry reveals that in 2014, close to 75000 new cases were diagnosed. Cancers of the breast, cervix and prostate continue to dominate with a similar profile extending into Africa.<img src="/english/PublishingImages/Lists/dualnews/My%20Items%20View/cancer-pic.png" alt="cancer-pic.png" class="ms-rtePosition-2" style="margin:5px;width:500px;" /><br></p><p>It is important to note that about 30% of cancer deaths are due to the five leading behavioural and dietary risks, i.e. high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and alcohol use. Many cancers can be prevented by avoiding exposure to these common risk factors. In addition, a s appropriately in order to improve the quality of life and life expectancy of South Africans. There is no 'one' solution to the country's cancer problem.  Decades of research and medical ingenuity have improved and extended the lives of many cancer patients, but despite these advances, a combined effort between the public and private sectors, academia, advocacy groups and patients are required to beat this complex disease.</p><p style="text-align:justify;">Barriers exist at the individual, health system, and government level, which prevent millions of people globally from receiving an early diagnosis and better treatment. There are huge disparities in health resources (infrastructure, human resources, access to treatment, etc.) that make populations in Africa, including South Africa extremely vulnerable to developing and treating cancer. <br></p><p style="text-align:justify;">Encouragement and support of spouses and family members are key to minimising individual-level barriers related to early detection, screening, and diagnosis. Feelings of shame and fear, combined with poor health awareness and cultural beliefs, can also keep an individual from utilising medical care or screening programmes. Prevention efforts linked to early detection and diagnosis are likely to offer improved prognosis and better outcomes. Prevention also offers the most cost‐effective long‐term strategy for the control of cancer. This goal is being viewed as more realistic, socially responsive and financially sound when compared to the aggressive therapeutic options of chemotherapy, surgery and radiation. <br></p><p style="text-align:justify;">Health system-related barriers such as increased awareness among health care workers to detect cancer early, especially at the primary care level, and lack of an efficient and timely referral for testing and diagnosis leads to needless delays in treatment. Therefore, continued efforts in strengthening the capacity of the health sector, improving access to treatments and supportive services remain core to curbing the rising epidemic of cancer.<br></p><p style="text-align:justify;">In our efforts to minimise the cancer burden, the African Cancer Institute at the Faculty of Medicine and Health Sciences at Stellenbosch University has become a key player in the global fight against cancer through its commitment to research excellence, committed and inspired faculty and robust partnerships with world-renowned research and training institutions as well as advocacy and support groups. These partnerships have ensured that the best minds work cohesively in bringing hope to cancer patients and their families worldwide.<br></p><p style="text-align:justify;">*<strong><em>Prof Vikash Sewram is the Director of the African Cancer Institute in the Faculty of Medicine and Health Sciences at Stellenbosch University.</em></strong></p><p style="text-align:justify;"> </p><p style="text-align:justify;"> </p><p><br></p>
Two Global Health scientists among M&G’s ‘200 young South Africans’ Global Health scientists among M&G’s ‘200 young South Africans’Sue Segar<p>​Two FMHS researchers – both with the faculty's Department of Global Health – made the department proud when they were recently featured in the Mail & Guardian's “200 young South Africans".<br> <br>They are Dr Xanthe Hunt (27), a researcher at the Institute for Life Course Health Research and Dr Lieketseng Ned (30), a lecturer at the Centre for Rehabilitation Studies.<br> <br>Hunt, who is also affiliated with California University and is studying with Harvard University, has two areas of research: she focuses on improving maternal and child health, particularly among young children affected by HIV and their caregivers in Kenya, Mozambique, Malawi, Zambia and Tanzania. She is particularly interested in what makes public health programmes for mothers and children work – and how they can be made to work better. She also does research on sexual and reproductive health among people with disabilities and how mainstream health care services can be made more accessible to people with disabilities.<br> <br>She is currently working on a book about disabled people's experiences of accessing sexual and reproductive health services.</p><p>Hailing from the Easter Cape, Ned convenes the postgraduate diploma programme in the centre. Her research is aimed at “contributing to the development of a situated disability and rehabilitation scholarship which centres the African experience. “More specifically, I am passionate about the following niche areas; critical disability and rehabilitation studies, community development practice, indigenous knowledges and methodologies, transformation in higher education and decoloniality," she said. Her work is published in various accredited journals and books.<br> <br>Hunt, who hails from KZN and published more than 30 academic papers, has been described as "an academic phenomenon", and was a recipient of last year's prestigious Chancellor's Medal at Stellenbosch University. She is also the first psychology department student to have her master's degree converted to a PhD, and passed with no changes needed.<br><em> </em><br>Yet, in an interview about the achievement, Hunt said she felt “very flattered". “By being named, I think you begin to feel you should work harder to earn the place.“<br></p><p>Asked what drives her in her work, Hunt said: “Coming from a privileged middle-class background in KZN, I started doing volunteer work in the public health system as soon as I got to university. It cemented my understanding that it was a complete accident that I ended up having access to good services while others did not. That accident is a result of inequalities with historical roots. For me healthcare services and systems can make a big difference in quality of life. I want to figure out how to make those services more equitable as it's unfair that they are not."<br> <br>Ned, who is a board member for the South African Christian Leadership Association and Western Cape Rehabilitation Centre, said her doctorate, entitled 'Reconnecting with indigenous knowledge in education: exploring possibilities for health and well-being in Xhora, South Africa' has really assisted her to have a much more nuanced understand of disability and rehabilitation studies. She is now focused on raising funds to continue her engagements with AmaBomvane for further dissemination of this research using participatory visual methodologies. She also has a research collaboration with the University of Helsinki to focus of disability research in the Global South. <br><br>Ned said she feels “grateful and humbled" about being featured on the Mail & Guardian's 200 List. “It is a recognition of work that is mostly located in the margins. Most importantly, I am filled with joy and gratitude towards AmaBomvane in the Eastern Cape as it is through their knowledges that I am this recognised scholar today." She also voiced gratitude to friends, colleagues and the judges.</p><p>“The recognition is a form of affirmation as an emerging researcher and a future leader. It's a great privilege to be counted among the best minds and influencers in the country. I hope others are affirmed too that it's possible to re-imagine the present and actually re-create a better future" Ned said.<br> <br>Acting head of the Department of Global Health, Professor Taryn Young said: “We are proud of Drs Hunt and Ned in being amongst the Mail & Guardian's '200 Young South Africans'. We celebrate their commitment and passion for their work, and value the contributions they are making to society."<br></p><p><br></p><p><em>Caption: Drs Lieketseng Ned and Xanthe Hunt.</em><br></p><p><em>Photo credit: Wilma Stassen</em><br></p>
MSc in Biostatistics in full flow in Biostatistics in full flowSusan Erasmus<p>​The MSc degree in Biostatistics that was recently launched by the Faculty of Medicine and Health Sciences' Division of Epidemiology and Biostatistics, has been gaining ground. Students are involved in projects on a variety of topics, including HIV, rheumatoid arthritis, cancer and rape.<br></p><p>But what does the programme entail, and how will it help to address public health and clinical problems?</p><p><strong>What is biostatistics?</strong></p><p>Biostatistics is the branch of statistics concerned with how we ought to make decisions when analysing biomedical data. It is an evolving discipline concerned with formulating explicit rules to compensate for both the fallibility of human intuition in general and for bias in study design in particular.</p><p>Biostatisticians would, for example, look at the prevalence of certain diseases in particular population groups – and try to determine the causes based on the information available. Or they would calculate life expectancy in certain patients, interpret data from certain drug trials, look at the geographical distribution of diseases, or evaluate treatment or prevention methods. This information could be used to improve or design health programmes, or to evaluate treatment and the efficacy of emergency care in a particular health setting.</p><p><strong>Why is it important for research?</strong></p><p>The collection, analysis and interpretation of data are key components of medical research projects. This not only enables a biostatistician or researcher to select the right statistical test for a particular study and study setting, but it also enables them to do the kind of analysis of the data to interpret the findings correctly – and to do so in an ethical manner, and with academic integrity. </p><p>It is also important to be able to interpret the findings of other studies correctly – not just the ones with which one was personally involved. Correct interpretation would make it possible to apply research findings to clinical practice – and would provide a basis for determining policy decisions.</p><p>“Biostatistics cuts across all health areas and strengthens research methods, thereby enhancing its rigour," says Prof Taryn Young, Director of the Centre for Evidence-based Health Care and Head of the Division of Epidemiology and Biostatistics. </p><p><strong>What does the degree entail?</strong></p><p>The course offers rigorous training for those with a background or experience in quantitative or health-related disciplines who wish to pursue a career in biostatistics. The programme would be of interest to potential biostatisticians who require practical and technical skills, as well as skills in the application of principles of statistical reasoning to address public health problems and challenges. </p><p>It is a structured master's programme and students complete modules, an internship of three months and a research assignment. The programmatic offering is supported by a dedicated and dynamic team of lecturers from the Division of Epidemiology and Biostatistics and the Department of Statistics, as well as international collaborators. </p><p><strong>Goals</strong></p><p>The programme aims to develop highly skilled biostatisticians who can use their expertise to contribute significantly to addressing issues in public health and in the field of biomedical science. It is hoped that this programme will also help to fulfil South Africa's need for a skilled and independent thinking scientific workforce with exceptional critical intellectual abilities.</p><p>The degree is aimed at students with an interest in and an aptitude for working with technology, statistical analysis and research in the fields of medicine and biology, and who are interested in trying to solve and address challenges faced by the community.</p><p> </p><p><em>Caption: Dr Carl Lombard, Ms Liesel Esterhuizen, Prof Taryn Young, Ms Tonya Esterhuizen and Dr Birhanu Ayele.</em></p><p><em>Photo credit: Damien Schumann</em></p>