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.
Social determinants of health such as lifestyle choices - diet, exercise, and substance use ' play a crucial role 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 to death. Of the 4.58 million South Africans aged 20-79 years who are estimated to have diabetes, more than 52% were underdiagnosed.
Prof Renata Schoeman, Head of the MBA in Healthcare Leadership programme at Stellenbosch Business School says on World Health Day (7 April) 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 own 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 health care system as the answer to a healthier society."
Prof Schoeman says that 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 own care, instead of passive recipients, and their human rights respected, the outcomes are better and health systems become more efficient.
"It doesnt help to have free healthcare, such as the proposed NHI, but people make poor lifestyle choices ' in terms of healthy eating, exercise and substance abuse, for example ' and dont take responsibility for their own health," she argues.
Prof Schoeman points out that 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."
She says that the NHI alone, as a strategy to fund healthcare, is only part of the solution and that 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, she says "such measures for promoting health and preventing disease should be extended to the public sector, and would be 'significantly more affordable' than the NHI."
"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," Prof Schoeman said.
She emphasises that governments need to think beyond simply the accessibility and funding of healthcare, to the quality of the health care as well as "getting the basics right" in terms of addressing poverty and unemployment, health promotion and prevention strategies, and safe and healthy living environments.
"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."
Prof Schoeman suggests that everyone takes responsibility for their own 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
- Prioritise sleep (at least 7 hours a night)
- Limit screentime Seek help for physical and mental health issues as soon as they arise.