Middle-aged Saffers’ health under scrutiny

● Stephen Bissell, 51, poured oat milk into his coffee and stared at a plate devoid of cheese or meat.

“I had my cholesterol checked to get points from my health insurer, and was unhappy about how high it was,” he said, admitting he felt like tucking into a juicy burger.

Bissell is one of many middle-aged South Africans whose lifestyle is catching up with them, and he is exactly the type of person Wits researcher Gudani Mukoma and colleagues recently put under the spotlight.

Mukoma is the co-author of a groundbreaking new “report card” that looked at noncommunicable diseases in those aged 45 to 65 to assess how much data is available on prevalence, and whether policies are in place to help with prevention.

Mukoma told the Sunday Times that adults in this age group are caregivers and workers and yet data on ageing in South Africa is insufficient to inform policy.

As a result, the Wits Developmental Pathways for Health Research Unit went about developing the report card, the first of its kind.

Eight indicators — obesity, diabetes, alcohol use, physical inactivity, tobacco use, diet, hypertension and dyslipidemia (elevated cholesterol or fats in the blood) — were checked for availability of prevalence data, and for whether policies have been proposed and implemented for the respective indicator.

The most interesting finding was that all indicators scored well for either data or prevention policies, but never for both.

“Though national and local prevalence data is available, it is more extensive for indicators such as obesity, hypertension and diabetes than for others such as physical activity and diet,” he said.

“What is obvious is the disparity between prevalence and policy for all indicators.”

Data on prevalence of physical inactivity, alcohol use, obesity, hypertension and diabetes is solid, but the scorecard marks were low for these indicators when it came to policy and implementation.

For tobacco use, diet and dyslipidemia, it’s the other way around.

The study also compared South African and US data on middle-aged adults for the eight physiological and lifestyle indicators included in the Healthy Ageing Adult Report Card.

“It was revealed that South Africa’s middle-aged adults had a higher prevalence level in seven out of eight indicators compared to the US, revealing an immediate need for interventions and policies to address these high rates,” he said.

The most “surprising find” was that South Africa only did better on one score: the consumption of high-fat meals was lower in middle-aged adults compared to those in the US.

But for Bissell, this is the one indicator in which he can improve.

“It is good to regularly check up on your cholesterol and it is part of my medical insurance incentive. It was too high last time and I know it can lead to heart disease and stroke and that is enough for me to worry about. It had not come down but had not gone up either,” he said.

Bissell does not smoke, exercises regularly and is a light to moderate drinker, yet the only bad mark he got at the pharmacy was on cholesterol, which he puts down to the fat in his diet.

“I googled things I could change and realised I was eating too much dairy, too many eggs and too much meat. I am going to try to go more plant-based from now on,” he said.

In one of the most unequal countries in the world, Bissell said being middle class gave you more opportunity to lead a healthy life but also lulled you into a false sense of security that if help was needed it would be readily available and you would not suffer.

But, he added, this is not necessarily the case as you still have to look after your body and it does not help anyone if only a small minority has access to resources and foods that bolster good health in middle age. So where to from here?

Mukoma said: “Future steps should include employing standardised methodologies in national and regional prevalence studies, as well as utilising existing prevalence data for indicators such as alcohol consumption to prioritise and support policy implementation.”

Unfortunately, market forces often work fiercely against the recommendations of health professionals. A recent University of Cape Town study found that despite declining tobacco use at the global level, “SubSaharan Africa is positioned to experience a tobacco epidemic”.

This is a result of “fast economic and population growth, coupled with intensive marketing efforts by the tobacco industry”, according to the researchers — led by economics researcher Samantha Filby — whose paper was published in the British medical journal Tobacco Control.

They analysed the association between cigarette prices and smoking rates in eight Sub-Saharan countries — Botswana, Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania and Uganda.

They concluded that “increasing the excise tax on tobacco products” makes them less affordable and thus results in “lower smoking prevalence because fewer people start smoking and more people quit”.

What is obvious is the disparity between prevalence and policy for all indicators.

Gudani Mukoma, above