Although diabetes is deeply personal to many of us, it’s important to take a step back, sometimes, and look at diabetes in South Africa – the big picture.
Diabetes in South Africa
So I guess this is straying over into diabetes advocacy a little, and away from the more classic diabetes management conversations we’ve been having. But I think it’s important. I also think we need to soften the word advocacy. We’re not talking about picketing and striking and sticking it to the man. We’re talking about looking at the diabetes situation in South Africa, and seeing what changes need to be made, and then working towards making those changes.
One of the biggest changes that needs to be made is that we have to start talking about diabetes more – in the media, in the workplace, in schools. There’s always this huge flurry of coverage in November during National Diabetes Month, but the rest of the year is a little… quiet, shall we say?
The 3 big stats around diabetes in South Africa
- Diabetes kills more women than anything else in South Africa (Stats SA).
- It’s also the 2nd leading cause of death in men (Stats SA).
- 1 in 2 people with diabetes in South Africa is undiagnosed (IDF).
Half of all people with Type 2 diabetes in our country don’t know they have it! Isn’t that outrageous? No wonder it’s killing so many people, because they only find out they have it when they present with long-term complications, like blindness, amputation, kidney failure, heart disease…
To understand more about diabetes in South Africa, we asked Shivani Ranchod to shed some light on the situation for us. Shivani is a health actuary with a deep commitment to South Africa’s health sector. She has extensive experience across the health system, including working with funders and healthcare providers, government and regulators. And she’s currently appointed to the Government Technical Advisory Centre (GTAC).
What does the future look like if we don’t do anything to improve diabetes in South Africa?
The unfortunate reality is that the future looks significantly worse than those already frightening statistics that you’ve outlined. The current situation is dire. If we look at the long term trends of what’s led up until now, we’ve seen a steady increase in incidence and prevalence of diabetes. And there are no reasons to believe that increased trend is not going to continue into the future.
And the reason for that is because there are these big underlying systemic features that drive diabetes that we’re not actively engaging with. We’re really kind of tackling the symptoms that we’re seeing when it becomes acute and extreme. And if you had to think of it as the classic iceberg, we’re dealing with the visible tip of the iceberg. And it’s not just that there’s a big iceberg under the water – it’s getting bigger and scarier every day that passes.
Let’s talk about the financial side of things – what financial impact will diabetes have on the economy? What is the cost of inaction?
When we think about the costs of disease, any disease, it’s important to consider the direct costs to the healthcare system. So what does it cost to prevent, treat, etc. But we also have to think more broadly – what is the economic cost in terms of productivity? What does this mean for the workforce? What are the societal costs in terms of caregiving, the way households are structured, all of those sorts of costs.
And when you look at the scale of diabetes, you translate those statistics back into the role women play from a caregiving perspective, and think about what that means. When you just think about the scale for running an economy and people being able to be functional and working and thriving, the scale is really enormous. So when you start to think about solutions, who’s responsible for tackling these problems?
Actually, it’s quite helpful to see the costs in the broader sense. So it’s not just about the National Department of Health, and how they deal with the direct healthcare costs of it. It’s actually also about employers getting around the table and saying: what are we doing about this? It’s about insurance – what is the cost to life insurance?
How will NHI and diabetes interact? When will NHI be a reality for South Africans?
I wish I had a crystal ball so I could tell you when NHI is going to happen! In theory, we’re very far progressed through the policy-making process. So you know, it shouldn’t be that far off in the future. I think in reality, every step of this reform, because of the scale of it, and because of how politically fraught it is, has taken multiples longer than expected.
And if you look elsewhere in the world, it takes a long time for countries to move towards universal health coverage. Compound that with the kind of fiscal pressure that we’re under at the moment, and the kind of political pressure that the current leadership is under, and you can see why it’s taking so long.
So all of those are very concerning, because our current healthcare system isn’t thriving. And there are these big glaring gaps of things that we’re not grappling with, like diabetes. It’s not the only one, but it is it is a major one that we’re not grappling with.
NHI and diabetes in South Africa
And we are in this terrible limbo, and we have been in this terrible limbo for years now. We’re not putting all of our energy and efforts into strengthening how healthcare is delivered, but rather waiting for the magic moment when National Health Insurance will allow us to fix everything. So that’s the thing that makes me sad: we’re waiting for things to be better at some future point, as opposed to acting now.
So I actually prefer not to think how will we do this under NHI? I prefer to have the conversation of what should we be doing right now? Because there’s a lot that we can do now that is immediate. What do we need to be doing now? And there are a bunch of things. It would be very helpful to have an investment case that can be taken to National Treasury, that shows the kind of long- term expected costs and starts to put down the cost benefit analysis for the interventions so that they can start thinking about how to fund those investments. Hving that investment mindset is really helpful.
What role should people with diabetes play?
It’s not a crazy idea that a community of people living with diabetes could change how this unfolds. Yes, we have to change. So it’s not just elevating the awareness within South Africa, but actually starting to tell the world a story about a South Africa that is grappling with diabetes on a day to day basis in a very serious way. So that lifts into the awareness of global donors.
The other thing that also has to shift is the global narrative: that diabetes is a developed world problem that exists in the Global North. Because that influences what gets funded, what research gets funded. A huge part of the HIV story in South Africa has been donor pressure. So you know, donor money coming into the country and then being able to set quite a strong agenda. It would be very helpful to have that for diabetes.
Listen to the full episode with Shivani here – or wherever you listen to podcasts.
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About the podcast guest:
Shivani is an experienced healthcare actuary, having worked across health systems with funders, providers, policymakers, regulators and international agencies. She has co-founded four firms: Percept (a trans-disciplinary advisory firm), Alignd (a provider of value-based financing solutions for complex patients), Swansong (a provider of digitally-facilitated advance care planning) and Yugma (a strategic investor into solutions for a healthier and more financially resilient world). She is also a long-term advisor to the Government Technical Advisory Centre (GTAC).
She was previously the Head of Actuarial Science at UCT. She brings academic rigour, a deep commitment to the health system and patients and personal courage to everything that she does.
She sees her work life as an extension of her meditation and yoga practice: an imperfect (but always evolving) attempt to bring careful attention to bear on socially-meaningful problems.
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