OPED: Access to healthcare is a basic human right, but achieving the healthy nation that South Africa needs for productivity and economic growth will take more than universal free healthcare.
Healthcare for Longevity
Social determinants of health, such as lifestyle choices – diet, exercise, and substance use – are crucial in ensuring a healthy South Africa.
Although the death rate in South Africa has slightly decreased, the number of deaths due to non-communicable diseases such as diabetes, cardiovascular diseases, and cancer is on the rise.
Diabetes has rapidly increased in South Africa – from 4.5% in 2010 to 12.7% in 2019 according to the latest statistics, and is one of the highest contributing underlying causes of death. Of the 4.58 million South Africans aged 20–79 years who are estimated to have diabetes, more than 52% were underdiagnosed.
The continued focus on health as a human right, and on the accessibility of care through universal health insurance, disempowers people from taking responsibility for their health.
We confuse health care with health – having access to care is not a promise of health. Everyone has the responsibility for their health and cannot view a healthcare system as the answer to a healthier society.
Healthcare for Better Health?
Viewing health as a personal and social value, rather than exclusively as a right, would increase personal responsibility and investment by people in their health.
When people are allowed to be active participants in their care, instead of passive recipients, and their human rights are respected, the outcomes are better and health systems become more efficient.
It doesn’t help to have free healthcare, such as in the proposed NHI, but people make poor lifestyle choices – in terms of healthy eating, exercise, and substance abuse, for example – and don’t take responsibility for their health.
Health goes beyond the absence of disease and is influenced by genetics along with social and economic factors such as poverty, unemployment, housing, education, nutrition, and the surrounding environment, as well as the choices made by individuals.
The NHI alone, as a strategy to fund healthcare, is only part of the solution and focusing on the three interventions that aim to reduce the health risk, is crucial for a healthy society:
- Primary prevention: to prevent disease or injury before it occurs
- Secondary prevention: to reduce the impact of disease that has already occurred
- Tertiary prevention: to limit the impact of ongoing, chronic illness, or impairment.
Pointing to the success of disincentives to unhealthy lifestyles, such as sin taxes, and incentives such as discounts and loyalty rewards for exercise and healthy food purchases, such measures for promoting health and preventing disease should be extended to the public sector and would be ‘significantly more affordable’ than the NHI.
Healthcare As A Human Right
Ensuring access to healthcare is a social and government responsibility, but this needs to go along with the promotion of health, which goes beyond the health system to entrenching health as a shared social value, and this is the task of all those involved in shaping and influencing values – families, schools, the media, and the legal system.
Governments need to think beyond simply the accessibility and funding of healthcare, to the quality of the health care as well as getting the basic rights in terms of addressing poverty and unemployment, health promotion and prevention strategies, and safe and healthy living environments.
Do Your Part
Citizens on the other hand need to take care of themselves, not only physically but mentally too. Undiagnosed mental health can negatively affect your physical health, leading to substance abuse, obesity, and eating disorders.
Everyone takes responsibility for their health through:
- Regular exercise (at least 30 minutes a day)
- Following a healthy diet high in fruits and vegetables and low in processed sugars and fats
- Stop smoking and avoid the use of drugs
- Limit alcohol
- Prioritize sleep (at least 7 hours a night)
- Limit screen time
- Seek help for physical and mental health issues as soon as they arise.
Who is the author?
Prof Renata Schoeman
Prof. Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville).
As a psychiatrist, she has special interests in cognition (i.e. disorders affecting attention, concentration, learning and memory – such as ADHD), eating disorders, mood disorders and anxiety disorders.
