31 March 2025 By Willemien Jansen (HST Copy and Content Editor)
Bipolar disorder remains a significant mental health challenge in South Africa, affecting countless lives and placing a heavy strain on healthcare resources. The burden of disease associated with bipolar disorder is profound, as it not only impacts patients' quality of life but also contributes to broader societal issues, including unemployment and increased healthcare costs. South Africa grapples with a quadruple burden of disease stemming from communicable diseases like HIV/AIDS and tuberculosis; mortality rates among mothers and children; and non-communicable diseases (NCDs), including hypertension and cardiovascular diseases, diabetes, cancer, mental illnesses, chronic lung diseases such as asthma, as well as injury and trauma. Understanding the prevalence and implications of bipolar disorder within the South African context can shed light on the urgent need for better mental health resources and support systems. It is essential to recognise how this condition serves as a major contributor to the overall burden of disease in the country, affecting individuals and families alike. In addressing the nuances of bipolar disorder, this article aims to explore its impact on the South African population, highlighting the importance of awareness, treatment, and support as crucial elements in mitigating its effects on both individuals and society. Impact of Bipolar Disorder on South Africa's Disease Burden Bipolar disorder significantly affects individuals and the wider healthcare system in South Africa. Its prevalence, associated healthcare costs, and impact on quality of life are crucial elements of the disease burden in the country. Prevalence of Bipolar Disorder in South Africa Bipolar disorder affects up to 4% of the South African population. Though underdiagnosed, its visibility is increasing, particularly among younger adults. It often develops between the ages of 15 and 19. Factors contributing to its prevalence include genetic predispositions, environmental triggers, and socioeconomic conditions.
Access to mental health services is limited, particularly in rural areas, further complicating the diagnosis and treatment of bipolar disorder. Healthcare Costs and Resource Utilisation The financial burden of bipolar disorder, and all mental illness, on South Africa's healthcare system is substantial. Direct costs include hospitalisation, outpatient visits, and medication, while indirect costs stem from lost productivity and caregiver burden. In public healthcare, mental health resources are often inadequate. Psychiatric services struggle to meet demand, leading to longer wait times and decreased quality of care. Quality of Life and Mortality Rates Bipolar disorder considerably impairs quality of life. Affected individuals experience fluctuations in mood that can lead to difficulties in personal relationships and employment. Suicidal behaviour is a serious concern, with studies showing that individuals with bipolar disorder have a higher risk of mortality compared to the general population. The stigma surrounding mental illness remains a significant barrier in South Africa and also exacerbates feelings of isolation and hopelessness, further deteriorating mental health. Addressing these challenges, through of example public awareness campaigns, is essential for improving health outcomes in South Africa.
Interventions and Outcomes Effective interventions for bipolar disorder in South Africa can significantly reduce its burden on individuals and the healthcare system. Various treatment options, societal support mechanisms, and policy reforms are crucial for improving patient outcomes. Effectiveness of Bipolar Disorder Treatments Pharmacological treatments, including mood stabilisers and atypical antipsychotics, are standard interventions. Medications like lithium have demonstrated effectiveness in managing manic and depressive episodes. Psychotherapy, particularly cognitive behavioural therapy (CBT), complements medication by helping individuals develop coping strategies. Studies suggest that combining both approaches improves remission rates and enhances patients' quality of life. Access to proper healthcare is critical. Rural regions in South Africa often struggle with limited availability of mental health professionals, affecting the overall effectiveness of treatments. Ensuring treatment accessibility in these areas is vital for achieving positive outcomes. Support Systems and Social Stigma Support systems play a pivotal role in managing bipolar disorder. Establishing family support networks can help individuals navigate their condition more effectively. Communities that foster understanding can reduce isolation and encourage seeking help. Peer support groups also offer invaluable resources. Shared experiences can empower individuals to engage in their treatment actively and maintain connections with others facing similar challenges. Future Directions in Healthcare Policy Future healthcare policies need to prioritise mental health, particularly bipolar disorder. Investment in training healthcare professionals in mental health is essential for enhancing diagnosis and treatment strategies. Improving the integration of mental health services within primary care can provide individuals with seamless access to support. This approach can reduce the stigma associated with seeking specialised mental health treatment. Data collection and research into the specific needs of those with bipolar disorder in South Africa can inform policies. Tailoring interventions to the local context is crucial for improving effectiveness and ensuring successful outcomes. For information on mental health, or assistance please go to: Websites National Department of Health: Mental Health Masiviwe SADAG
SA Federation for Mental Health List of helplines Mental Health Information Line: 0800 567 567 LifeLine National Counselling Line: 0861 322 322 Suicide Crisis Helpline: 0800 567 567 Healthcare Workers Care Network Helpline: 0800 21 21 21, SMS 43001 SADAG: 011 234 4837 List of Whatsapp helplines Cipla Mental Health: 076 882 2775 Maybelline BraveTogether: 087 163 2030 Ke Moja Substance Abuse: 087 163 2025 Have Hope Chat Line: 087 163 2050
by Reuel Singh at 01:40 PM 26 March 2025 By Willemien Jansen (HST Copy and Content Editor)
  How long have you been with HST and which position/s have you occupied? I have occupied a number of positions since starting with HST in September 2015. I started as a Research Intern for one year and thereafter I was a Junior Researcher as an independent contractor until April 2017. In April 2017, I filled the position of Fleet Intern for approximately four months, and thereafter I was appointed as Fleet Controller and Team lead up until June 2019. In June 2019, I relocated from Kwa-Zulu Natal to Gauteng to occupy the Administrator position based at the Pretoria Office. I managed and maintained the office upkeep up until the effects of Covid-19 led to the office closure in September 2021. I was primarily responsible for ensuring all office equipment was carefully packaged, labelled and couriered to our head office in Durban. In October 2021, I occupied a dual position of Administrator for the Community Health Worker Think Tank (CHW TT) Secretariat led by the National Department of Health, as well as Office Administrator based at the Midrand Office. In September 2023, I was in a hybrid role filling a third position of Acting Business Development Assistant. In June 2024, I was appointed Business Development Officer and still currently occupy the position. Please share some information about what your current role entails. In my role as Business Development Officer, I engage in regular professional communication with donors, partners, and internal teams, ensuring timely and effective interactions on a daily, weekly, or monthly basis as needed. I support Business Development Unit (BDU) meetings, maintaining up-to-date donor and partner profiles within the CRM database. My professional interaction extends to collaborating with other units within HST, contributing to the development of proposals. I support the proposal budgeting process, including drafting budgets, sourcing quotes, managing budget templates, and updating them as necessary. Additionally, I assist in financial due diligence, ensuring the collection of required documents such as annual financial statements, proof of banking, tax clearance, BEE certificates, and references for completed projects. I play a key role in identifying live and forecast funding opportunities that align with HST's areas of expertise and interests. To ensure timely access to relevant opportunities, I maintain an up-to-date resource list for opportunity research, as well as subscriptions to various platforms that support opportunity identification. My role includes submitting due diligence requirements for each proposal and providing administrative support for business development activities, such as meeting co-ordination, minutes, and travel arrangements. Lastly, I actively seek out relevant training opportunities to enhance the performance of the unit. Administrator for the CHW Expert Working Group (EWG) Secretariat: Under the guidance of the National Department of Health (NDoH) and the EWG Technical Work Stream (TWS) chairpersons, I provided essential support for the EWG's work plan. This included facilitating communication among team members, co-ordinating meetings, and preparing necessary documents such as agendas, attendance registers, minutes, and reports. These tasks were carried out in alignment with the objectives and timelines set forth in the EWG work plan, ensuring smooth and effective operation of the work stream. What influenced your decision to be in the development/NGO sector? NGOs, particularly in the health space, create a feeling of togetherness. People come together with a common goal and work efficiently to reach their goals. This strengthens your ties to the community and provides a sense of fulfilment in seeing a tangible effect on the livelihoods of people. Joining an NGO exposes you to different types of people and helps you develop social skills whilst retaining your authentic personality; its culturally uplifting. How do you spend your time away from work? For the greater part of my life I had spent a lot of my time playing sports and keeping active. During my time in Durban I facilitated an indoor soccer game every Wednesday for the HST colleagues based at the Head office, to encourage team building, trust and strengthen relationships. Since June 2022, my wife and I welcomed our baby daughter into the world and I spend most of my time doing family activities. In the evenings, I enjoy online gaming. What gives you motivation? My greatest motivation is my family. Particularly my parents and my daughter. What is the best advice you've ever received in your life? (personal or professional) Wasted of all days is one without laughter. Any future aspirations? My short term aspiration is to do my Masters in Public Health. Long term I would like to contribute to cancer research. What are you reading at the moment? Mostly health-related publications and the latest news on current affairs.
by Reuel Singh at 02:41 PM 19 March 2025 By Siyabonga Gema (HST Communications Officer) and Reu'el McAllister Singh (Communications Intern)
HST's Communications and Multimedia duo, Communications Officer Siyabonga Gema and Communications Intern Reu'el McAllister Singh are shaking things up in the digital space, with a fresh new perspective on engaging content. This continues to elevate HST's work, while ramping up our online presence. Having joined HST almost exactly a year apart, they have made their presence felt through their contributions with expertise. They share their journey with HST thus far, and profile some of their work. Siyabonga Gema Give us a brief background in terms of your work experience I joined HST in June 2023, fresh from the corporate sector where I gained valuable experience in corporate communications in my previous role as Communications Practitioner for the pulp and paper manufacturer Sappi. Before then, I worked in the public health sector as Public Relations Officer at Wentworth Hospital, a position I didn't hold for too long before the corporate bug bit. When I joined HST, I was no stranger to the NGO space as I had acquired some experience during my internship at an NGO called The Association for the Aged (TAFTA) based in Durban central. I hold an Advanced Diploma in Public Relations and Communications Management from the Durban University of Technology, and am a registered Public Relations Practitioner (PRP) with the Public Relations Institute of South Africa (PRISA). What does your current role entail? Some of my duties entail - Writing and distributing content to promote the organisation's brand, activities and products.
- Acting as a liaison between the organisation, the public, and the media.
- Supporting our internal and external communications strategy, writing and disseminating publicity material, responding to inquiries from the public and media, and co-ordinating promotional events, including campaigns such as for CCPAC and 3HP-TPT
- Managing the organisation's social media communications – although this function was taken over by our Communications Assistant, I still play a support and supervisory role.
- Conference co-ordination and upselling HST such as at the World Pharmacy Congress and for PHASA and the G20 summit
What makes your job fulfilling? I am always inspired when I get the chance to join my HST colleagues from our various programmes in the field and seeing first-hand the immense contribution made by our organisation in changing people's lives through the work that we do. It makes me extremely proud of being part of this organisation. It is always exciting to tell the wonderful stories of our colleagues and to shine a light on their dedicated work; this makes my work fulfilling. Who/what had the biggest influence in your decision to choose this career? My grade 3 teacher played a major role in actually making me realise that I have a gift for writing and storytelling. She is the one who encouraged me to write, and even made me enter a school writing competition – which I won! That year I received an award for Literacy which was a big deal for my mother. She even gave me my very first book. So throughout my schooling I always knew that I wanted to pursue a career in communications because that is where my strength lies. What valuable lesson has your work taught you? In my line of work, it is very important to be a good listener; that is the biggest thing I have learnt in my career. We are expected to be a credible source of information, so for us to relay accurate and factual information we must first have a clear understanding of it otherwise we run the risk of misleading our audience, which is a major reputational blow. What are your future aspirations? I have a big passion for strategic communications so I see myself transitioning more into developing compelling business communications strategies for major corporates and organisations. I believe I have gained enough experience in implementing strategies and would like to now get exposure in crafting them. So I see myself as a top executive at a JSE listed company in future, driving and providing its strategic communications direction. Reu'el McAllister Singh When did you join HST and what does your role entail? I joined Health Systems Trust in August 2024 as a Communications Intern, where I contribute to the organisation's media and public engagement efforts. My role involves crafting compelling content, managing digital platforms, and ensuring that HST's communications are clear, engaging, and impactful. A significant part of my work focuses on supporting HST's campaigns and events through photography and videography. Whether capturing key moments at health events, documenting staff at work, or producing visual content that enhances our storytelling, I help bring HST's initiatives to life through dynamic and engaging media. I contribute by: - Writing engaging blog articles to drive awareness and engagement.
- Creating health observance content for social media, ensuring informative and visually appealing posts.
- Managing and optimising social media platforms, including overseeing the Health Systems Trust YouTube channel.
- Designing web banners and visuals for various campaigns.
- Uploading job ads and blog posts to the HST website, ensuring content remains current and accessible.
- Updating and maintaining key contact and media lists to support consistent and timely communication.
- Responding to social media queries, fostering professional and timely engagement with followers.
- Conducting web analytics to track engagement metrics and refine content strategies.
- Maintaining and curating the organisation's image and video library, ensuring high-quality visual assets for future use.
What do you love about your role? I enjoy the creative aspect of the communications unit, transforming health topics into content that resonates with people. Whether it's writing an article, designing a social media post, putting together a web banner, or creating a captivating video that showcases the important work our colleagues at HST are doing in the field, I find fulfilment in making health information accessible and engaging. I also appreciate the dynamic nature of my role. One day, I might be working at the office; the next, we're travelling to a different district to support a campaign or event. This variety keeps me motivated, always learning, and continuously improving my skills. What are your challenges and opportunities for growth? Like any role, working in the communications unit comes with its challenges. Balancing multiple projects at once while ensuring deadlines are met can be demanding. Covering events or managing time-sensitive campaigns requires quick thinking and adaptability. However, these challenges push me to be more creative, resourceful, and strategic in my work. I see myself growing further in the communications and media space, particularly in digital content creation and storytelling. Whether it's expanding my expertise in social media, video production, or exploring audio-visual storytelling, I want to keep evolving. I also hope to merge my passions in a way that allows me to work on creative projects that make a real impact, whether in media, sound, or health communication. The possibilities are endless, and I'm excited to see where this journey takes me.
by Reuel Singh at 12:40 PM 14 March 2025 By Mandisa Dlamini (HST Communications Assistant)
The kidneys are vital organs responsible for filtering waste and excess fluid from the bloodstream, excreting them as urine. They play a crucial role in regulating blood pressure, maintaining electrolyte balance, and producing red blood cells. The proper functioning of the kidneys is essential for overall health and well-being.
Risk Factors There are various reasons why someone might get kidney disease. Common causes are high blood pressure and type 2 diabetes, the major causes of kidney damage. Other contributing factors are family history, obesity and age. Observable Effects The symptoms of kidney disease are usually hidden until the disease progresses. In advanced stages, people start showing symptoms like feeling very tired, throwing up, swelling in the legs and for some people, confusion and decreased appetite. These symptoms can indicate various medical problems and so it is important to visit a doctor regularly for check-ups. A Healthy Lifestyle and Prevention You can avoid kidney disease by making healthy lifestyle choices. The key activities are: - Drink enough fluids: Adequate fluid intake is good for your kidneys.
- Balanced Diet: A healthy balanced diet like the DASH diet can help maintain blood pressure and promote kidney health.
- Regular Exercise: Engaging in regular exercise increases circulation and aids in managing body weight, blood pressure and blood glucose levels.
- Body Weight: Maintaining a healthy body weight helps reduce the risk of chronic kidney disease and its complications.
- Blood sugar control: Diabetes is a major cause of chronic kidney disease; therefore, it is critical for people with diabetes to monitor and control their blood sugar levels.
- Control blood pressure: Blood pressure should remain in the normal range to prevent kidney damage.
- Smoking cessation: Stopping smoking decreases risk for kidney disease and enhances overall health.
Identification and Treatment Kidney disease must be identified early in order to be effectively managed. The diagnosis is typically the same: blood tests for anemia, imaging studies like an ultrasound, and urine tests for the functioning of the kidneys. These treatment strategies, either directly or indirectly, aim to manage chronic conditions through medication recommendations and lifestyle adjustments. For example, this may involve dietary changes in cases of hypertension and a reduction in physical activity levels for individuals with diabetes. However, in the late stages, dialysis or kidney transplantation may be necessary. 2025 Campaigns Supporting World Kidney Day The International Society of Nephrology (ISN) offers an "Are Your Kidneys Healthy?" quiz designed to educate the public on health assessments, promoting both proactive and reactive approaches to raising awareness about kidney health. It is important to have knowledge of kidney health and the implementation of prevention. Regular visits to a physician, active participation in healthy initiatives and other preventive measures can help control the loss of kidney function. For more information visit: https://www.theisn.org/initiatives/world-kidney-day/
References - 6 Tips to Be Water-Wise for Healthy Kidneys.
- NKF Nutrition Coach
- 5 Low-Impact Kidney-Friendly Exercises to Try During National Kidney Month
- Healthy weight
- Diabetes
- High Blood Pressure
- Smoking and Your Health
by Reuel Singh at 02:00 PM 12 March 2025 By Reu’el McAllister Singh (HST
Communications Intern)
Glaucoma is one of the leading causes of blindness worldwide,
including in South Africa. Regrettably, many individuals remain unaware of
their condition until they experience vision impairment. This progressive
disease develops silently, without noticeable symptoms, affecting approximately
80 million people globally. What is Glaucoma? Glaucoma refers to a group of eye conditions that cause a build-up of pressure
in the eye, which can ultimately damage the optic nerve, leading to permanent
vision loss or blindness. While it can develop for various reasons, many cases
can be managed with treatment. Staying informed about the risk factors and
having routine eye check-ups can help safeguard your vision. Types of Glaucoma Various forms of glaucoma exist, which can generally be
classified into several distinct categories:
- Open-Angle Glaucoma: This represents the most prevalent type. The drainage angle between the iris and cornea remains open, but
the drainage system doesn’t work properly, causing fluid build-up and
increasing eye pressure over time.
- Angle-Closure Glaucoma: In this type, the iris blocks the drainage area, causing a sudden
rise in eye pressure. This can lead to severe pain, blurred vision, and
requires immediate medical attention.
- Secondary Glaucoma: This
occurs when another condition, such as an eye injury or certain medications,
increases the eye pressure, leading to glaucoma. Conditions like diabetes
or inflammation in the eye can also cause secondary glaucoma.
- Congenital Glaucoma: A
rare form of Glaucoma that babies are born with due to abnormal
development in the eye’s drainage system during pregnancy. Early treatment
is crucial to prevent permanent vision damage.
Recognising Symptoms and Risk Factors
What to Look Out for: - Gradual loss of peripheral (side) vision is often the first sign.
- Blurred or hazy vision.
- Eye pain or pressure.
- Frequent headaches, particularly around the eyes.
- Sudden vision loss (a symptom of angle-closure glaucoma requiring
immediate medical attention).
- Seeing rainbow-colored halos around lights, particularly when accompanied
by nausea or vomiting.
Key
Risk Factors to Consider:
- Being over 40, with
risk increasing over the age of 60.
- A family history of
glaucoma.
- Higher prevalence
in people of African or Asian descent.
- Elevated eye
pressure.
- Medical conditions
such as diabetes, high blood pressure, and heart disease.
- Eye injuries or
surgeries.
- Long-term use of
steroid medications.
Recognising these symptoms and understanding the risk
factors are crucial steps toward early diagnosis and treatment. Regular eye
exams are key, even if you don’t experience symptoms. The Importance of
Early Detection and Treatment for Glaucoma Early detection through routine eye examinations are essential, as
it helps identify the condition in its earliest stages before irreversible
damage occurs. Comprehensive eye examinations can measure eye pressure, assess
the optic nerve, and track changes in the visual field, all key factors in
diagnosing glaucoma early. Although the damage from glaucoma cannot be reversed, early
diagnosis allows for treatment to slow or prevent further vision loss, helping
people maintain their quality of life. Treatment typically focuses on lowering eye
pressure to protect the optic nerve, with options including medicated eye
drops, oral medications, laser therapy, and, in some cases, surgery. Lifestyle
changes, such as maintaining a healthy diet, regular exercise, and managing
underlying health conditions like diabetes and high blood pressure, can also
help manage the condition effectively. Resources and
Support The South African
Glaucoma Society (SAGS) is
dedicated to providing essential information and support to individuals
affected by glaucoma. Additionally,
SAGS collaborates with international glaucoma organisations, such as the World Glaucoma Association (WGA) and The International Agency for the Prevention of
Blindness (IAPB), to raise
awareness and promote research aimed at preventing vision loss. Glaucoma is often called the "silent thief of
sight" because it can progress without noticeable symptoms until
significant damage has occurred. Early detection through regular eye exams is
crucial in preventing irreversible vision loss. Being proactive about eye
health, individuals can take the necessary steps to protect their vision and
maintain quality of life.
For information on glaucoma or assistance, please visit: E: webmaster@dipity.co.za
E:
info@worldglaucoma.org
by Reuel Singh at 01:27 PM 04 March 2025 by Judith King (Health Systems Strengthening Copy and Content Editor / PhD candidate: Public Health) 
In South Africa ‒ which has the highest prevalence of obesity in Africa ‒ weight-related non-communicable diseases (NCDs) have eclipsed tuberculosis (TB) and HIV as leading causes of morbidity and mortality, and conditions such as diabetes, stroke and heart disease account for three of the top four causes of death nationally.1 Current rates of obesity in South Africa are 11% among men (with another 20.3% being overweight), and 41% among women (with another 26.6% being overweight).2 This is a social and economic risk for the country. The causal link between sugar consumption and diet-related NCDs Consumption of the high sugar content in sugar-sweetened beverages (SSBs) ‒ while not the only cause of excess body weight and obesity ‒ is strongly linked to weight gain among adults and children in South Africa.3,4,5 In a large prospective study conducted in 2019, such consumption was significantly associated with the risk of overall cancer and breast cancer.6 Liquid sugar is especially harmful, with data showing that just one sugary drink per day raises an adult's likelihood of being overweight by 27%, and that of a child's by 55%, while increasing anyone's risk of developing type 2 diabetes by 25%.7,8 The added sugars in these drinks are rapidly absorbed by the body, and pose a significant health risk by raising blood sugar, heightening insulin production, and affecting cholesterol levels and metabolism, which can cause hypertension and inflammation, with a high potential for NCDs such as diabetes, cardiovascular disease, tooth decay, gout, liver disease, and certain cancers. Describing sugar as a "chronic toxin", Myers, et al.9 provide a comprehensive view of the link between sugar consumption and diet-related NCDs, highlighting how this creates a 'poverty spiral' in which "poor health and disability lead to a labour force with diminished capacity" and in turn, slower economic growth. Yet, as noted by the World Health Organization's Civil Society Working Group on NCDs at the 73rd World Health Assembly in 2020: "… even in the midst of a public health emergency of international concern, companies that produce harmful products, [including] sugar-sweetened beverages, continue to spread misinformation and deny the link between the harmful effects of their products … to protect their markets."10 Changing systems for healthier lives 'Changing systems – healthier lives', as the theme for this year's World Obesity Day, signals that to curb the prevailing NCD epidemic, our focus should be trained on where 'behaviour change' begins and ends, and who and what has to change. This stems from the idea that while individual consumers are exhorted by sugar industry actors to reduce their weight and risk of cardio-metabolic diseases by changing their lifestyle choices, it is also these corporate citizens whose profit-driven stance and aggressive marketing of unhealthy products must change. Moreover, the legal and economic structures enabling corporate profit at the expense of public health should be transformed. The rationale for the Health Promotion Levy NCD prevention and control cannot rely solely on public health information and education campaigns, nor on biomedical interventions alone. Obesity is a complex disease brought on and sustained by many factors which are beyond the individual's control.11 South Africa was the first country on the continent to recognise this by introducing the Health Promotion Levy (HPL) in 2018 ‒ an anti-obesity measure designed to reduce consumption of sugar-sweetened beverages (SSBs) by instituting a tax of approximately two cents per gram of sugar per litre, payable by the manufacturer. Similar to the model used for regulating tobacco and alcohol consumption, sugar taxation is endorsed by the World Health Organization, and has been shown in many countries to be successful in facilitating healthier diets and saving on NCD-related healthcare costs, while generating government revenue.12 In 2020 – apart from the associated burden on our health system – the cost of these NCDs to the South African economy via health expenditure was R33 billion.13 Industry opposition to the HPL However, prior to its promulgation, sugar industry actors and SSB manufacturers formed an alliance to strongly oppose the HPL, and deployed various tactics to "delay, dilute and delegitimise" this policy.14 These strategies included questioning the integrity of scientific evidence supporting the tax; disseminating their own funded studies with findings that refute the link between SSB consumption and obesity; and lobbying to influence government policy-makers with claims of the HPL leading to massive job losses and the decimation of South Africa's cane-growing and sugar milling industry.15 These corporate responses succeeded in weakening the rate of the Levy from the proposed 20% to 10%. Data from Statistics South Africa's Quarterly Labour Force Survey do not corroborate the industry's claims that the HPL had resulted in the loss of 16 000 jobs16, and there is no independently researched and peer-reviewed evidence that the tax has measurably induced the sugar industry's fall in revenue. There are no verifiable data showing that the HPL has generated job losses in the production, distribution and sale of SSBs, nor triggered a decline in SSB producers' profits. In fact, reliable empirical research findings indicate that the sugar industry's losses and suppressed market demand can be attributed to several operational factors within and around it, such as climate change and COVID-19 affecting production, corruption within some of its companies, cheap sugar imports, and ever-escalating input costs.17 In 2021, a review of research found that the HPL had led members of urban households – particularly in lower socio-economic settings – to buy almost 30% fewer sugary beverages, thereby almost halving the amount of sugar they consumed from these drinks.18 The announcement of the HPL also incentivised SSB manufacturers to reformulate their products for lower sugar content (albeit so that they could sustain their profit margins rather than in support of public health goals). Yet despite these gains, the industry's anti-HPL campaign continues unabated, perpetuating the falsehood that there are no credible studies linking the tax to positive public health outcomes. The outcome of industry interference in evidence-based health policy As a result, an increase in the tax announced in February 2022 was postponed to 1 April 2023, and then deferred again in the February 2023 Budget Speech for a further two fiscal years. In real terms, this signifies a year-on-year reduction in the HPL, which enables greater affordability, and hence greater consumption, of SSBs. This erosion of the Levy's power as a mechanism to address the NCD burden plays directly into the hands of companies that seek only to preserve and increase their profit margins. On 14 February 2025, the CEO of the South African Sugar Association (SASA) called for "the extension of the two-year sugar tax moratorium to 2030 … in keeping with the lifespan of the Sugarcane Value Chain Master Plan 2030" to enable the industry's diversification and restructuring.19 Even more concerning is a media report suggesting that – on the grounds of SASA's claim that the HPL has "cost the industry R1.2 billion and threatened the loss of 300 000 jobs" – the 2025 Budget will propose cancelling an increase in the HPL that was due to come into effect on 1 April this year, "to allow the industry time to restructure its response to regional competition".20 How increasing the HPL will support physical and economic health As our country faces the urgency of deploying domestic financing options to address recent cuts in international aid for health, an increase in the HPL would be an obvious and easy contribution. In the five years since its inception, the HPL has raised more than R10 billion in revenue.2,21 Here are some key recommendations for a whole-of-society, evidence-based response and the changes in governance of our food system needed to counteract these corporate assaults on public health promotion: Ø To adjust for inflation and ensure that South Africa's sugar taxation fulfils its intended health-promotion aim, National Treasury should increase the percentage of the HPL to 20% per litre, and lower its 4g/100ml sugar content threshold to 2g/100ml without delay.
Ø Income derived from the HPL should be ring-fenced for financing of robust, properly costed and budgeted NCD responses and chronic disease prevention, rather than having it flow into the National Revenue Fund for ad hoc allocation. From the platform of multisectoral action, prioritised HPL funding could be specifically earmarked for research programmes aimed at improving South Africa's diabetes response, for example.
Ø Widespread awareness of nutrition and understanding of the forces that shape people's health should be catalysed through public health measures such as clear, accessible front-of-package labelling. The influence of corporate power on the nation's health should be disarmed by making it legally binding for companies to comply with evidence-based policies to counter the commercial determinants of health. Through regulation, legal reform and advocacy, industry actors should be accountable for recalibrating their business models and corporate governance in support of a sustainably healthy populace and planet. ---------------------------------------------------------------------------------------------------------------- The diet-related NCD burden affects all of us, and health as a human right means that we deserve protection from harmful commercial practices.
To change systems for healthier lives:
Ø Related reading: Goldstein S, Mahomedy S. Commercial determinants of health and cancer prevention in South Africa. In: Moeti T, Padarath A, Parkes J, Singh S, Ruff P, editors. South African Health Review 2023 – Strengthening cancer services. Durban: Health Systems Trust; 2024. URL: https://sahr.hst.org.za/article/120643-commercial-determinants-of-health-and-cancer-prevention-in-south-africa Ø The Healthy Living Alliance (HEALA) is running a petition to support a stronger HPL at: https://awethu.amandla.mobi/petitions/call-on-finance-minister-and-deputies-to-increase-and-expand-sugary-drinks-tax _________________________________________________________________________ References 1. Chandiwana N, Venter WDF. Obesity is South Africa's new HIV epidemic. S Afr Med J, 2024;114, e1927. URL: https://doi.org/10.7196/SAMJ.2024.v114i4.1927 2. Hofman KJ, Goldstein S. Diabetes is South Africa's second biggest killer disease: hiking the sugar tax would help. The Conversation, 20 October 2023. URL: https://theconversation.com/diabetes-is-south-africas-second-biggest-killer-disease-hiking-the-sugar-tax-would-help-216456 3. Okop KJ, Lambert EV, Alaba O, Levitt NS, Luke A, Dugas L, et al. Sugar-sweetened beverage intake and relative weight gain among South African adults living in resource-poor communities: longitudinal data from the STOP-SA study. Intl J Obes, 2019; 43: 603–614. URL: https://doi.org/10.1038/s41366-018-0216-9 4. Tugendhaft A, Manyema A, Veerman LJ, Chola L, Labadarios D, Hofman KJ. Cost of inaction on sugar-sweetened beverage consumption: Implications for obesity in South Africa. Public Health Nutr, 2015; 19:13, 2296‒2304. DOI: 10.1017/S1368980015003006 5. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007; 97:4, 667‒675. DOI: 10.2105/AJPH.2005.083782 6. Chazelas E, Srour B, Desmetz E, Kesse-Guyot E, Julia C, Deschamps V, et al. Sugary drink consumption and risk of cancer: results from NutriNet-Santé prospective cohort. BMJ, 2019; 366. DOI: https://doi.org/10.1136/bmj.l2408 7. University of the Witwatersrand. Facts about SSBs and obesity in South Africa. URL: https://www.wits.ac.za/news/latest-news/research-news/2016/2016-04/ssb-tax-home/sugar-facts/ 8. Morenga LT, Mallard S, Mann J. Dietary sugars and body weight: Systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ, 2013; 346:e7492. DOI: 10.1136/bmj.e7492 9. Myers A, Fig D, Tugendhaft A, Mandle K, Myers J, Hofman KJ. Sugar and health in South Africa: Potential challenges to leveraging policy change. Glob Public Health, 2017; 12:1, 98‒115. DOI: http://dx.doi.org/10.1080/17441692.2015.1071419 10. World Health Organization Civil Society Working Group on NCDs. Statement on Item 3. 73rd World Health Assembly (WHA73) COVID-19 Response: Reducing risk of COVID-19, cancer and other NCDs, 18 May 2020. URL: https://ncdalliance.org/resources/73rd-who-world-health-assembly-statement-on-item-3-covid-19-response-reducing-risk-of-covid-19-cancer-other-ncds 11. Ryan D, Candeias V, Fruergaard Jorgensen L. We need to change the narrative around obesity – here's why. World Economic Forum, 17 May 2018. URL: https://www.weforum.org/stories/2018/05/we-need-to-change-the-narrative-around-obesity-heres-why/ 12. Lee, K, Freudenberg N. Public Health Roles in Addressing Commercial Determinants of Health. Annual Review of Public Health, 2022; 43, 375‒395. URL: https://doi.org/10.1146/annurev-publhealth-052220-020447 13. Boachie MK, Thsehla E, Immurana M, Kohli-Lynch C, Hofman KJ. Estimating the healthcare cost of overweight and obesity in South Africa. Global Health Action, 2022; 15:1. URL: https://doi.org/10.1080/16549716.2022.2045092 14. López González L. 'Delay, dilute, delegitimise': How the food industry shapes what you eat — and what you weigh. Daily Maverick, 15 October 2021. URL: https://www.dailymaverick.co.za/article/2021-10-15-delay-dilute-delegitimise-how-the-food-industry-shapes-what-you-eat-and-what-you-weigh/ 15. Du M, Tugendhaft A, Erzse A, Hofman KJ. Sugar-sweetened beverage taxes: Industry response and tactics. Yale J Biol Med, 2018; 91:2, 185‒190. 16. Dare C, Boachie MK, Goldstein S, Thsehla E. The association between the Health Promotion Levy and employment in South Africa: an interrupted time series analysis. BMC Nutr, 2025; 11:1, 28. DOI: 10.1186/s40795-025-01012-6 17. Mbalati N. Scrapping of the sugar tax will not save the sugar industry from its own woes. Business Report, 17 October 2024. URL: https://www.iol.co.za/business-report/economy/scrapping-of-the-sugar-tax-will-not-save-the-sugar-industry-from-its-own-woes-3c805d9d-e24b-478b-adbd-62e71afe38fc 18. Hofman KJ, Stacey N, Swart EC, Popkin BM, Ng, SW. South Africa's Health Promotion Levy: Excise tax findings and equity potential. Obesity Reviews, 2021; 22;9, e13301. URL: https://doi.org/10.1111/obr.13301 19. Pillay Y. Sugar industry unveils diversification plan amid crippling sugar tax crisis. Business Report, 17 February 2025. URL: https://www.iol.co.za/business-report/economy/sa-sugar-industry-unveils-bold-diversification-plans-amid-crippling-sugar-tax-crisis-8708eecf-b190-4390-880c-931c76f5f92c 20. Magubane K. Enoch Godongwana's postponed budget cancels sugar tax hikes. TimesLIVE, 20 February 2025. URL: https://www.businesslive.co.za/bd/national/2025-02-20-enoch-godongwanas-postponed-budget-cancels-sugar-tax-hikes/
21. National Treasury. National Assembly, Parliament of the Republic of South Africa. Question for written reply: Question Number 1300 [NW1493E] and Reply. URL: https://www.treasury.gov.za/publications/other/MinAnsw/2021/PQ%201300%20-%20Wilson%20-%20NW1493E.pdf _________________________________________________________________________
by Reuel Singh at 12:55 PM 21 February 2025 By Mandisa Dlamini (HST Communications Assistant) 
Breast cancer is a major health issue affecting many people world-wide.
World Prevalence and Mortality According World Health Organization (WHO) data, breast cancer was diagnosed in over 2.3 million women, and resulted in the deaths of 670 000 women globally in 2022. Breast cancer is the most common cancer among women and accounts for one in eight cancer cases. It exceeded other harmful conditions; with 2.26 million new cases in 2020, breast cancer became the leading cancer type surpassing other types. The International Agency for Research on Cancer has predicted that there will be more than three million new breast cancer cases every year from 2040, and more than one million breast cancer-related deaths; a 40-50% increase in the number of these deaths. Risk Factors According to WHO, breast cancer risk is increased by a number of factors: Age and Gender: The two main risk factors are being older and being a woman.
Genetic Predisposition: Although many people with breast cancer have no known family history, a family history can increase the risk. Lifestyle: Obesity, alcohol consumption, tobacco use, and postmenopausal hormone therapy are risk factors.
Detection and Prevention of Cancer Lifestyle changes such as maintaining a healthy weight, reducing alcohol consumption and quitting smoking are the cornerstones of preventive interventions. The outcomes of treatment have improved significantly, thanks to the early detection via routine screenings like mammograms and ultrasounds. To enhance access to early detection and treatment, the World Health Organization stresses the significance of including breast cancer control within national health programmes. The 2023 edition of the South African Health Review (SAHR) explores the pressing challenges, successes, and gaps in cancer care within the South African healthcare system. The edition features three articles on breast cancer. They examine the effectiveness of breast cancer policies in South Africa, the factors influencing uptake of breast cancer screening to inform public health interventions, and the advantages of expanding breast cancer genetic counselling services to outreach clinics. In the editorial, Moeti et al. reiterate that "despite well-intentioned guidelines and policies aimed at facilitating and expediting screening, early diagnosis and treatment, significant delays prevail due to logistical and resource constraints. Articles illustrate the necessity of re-evaluating implementation strategies to better align practice with government policy and highlight gaps in policy regarding the needs of vulnerable populations, inequities in access to timely oncology diagnostic and treatment services and particularly medication, service fragmentation, and communication breakdowns." The National Department of Health (NDoH) introduced the Breast Cancer Prevention and Control Policy (2017) to raise treatment accessibility and advance early diagnosis capabilities while providing awareness support. Breast cancer prevention policy through national departments uses strategic methods to strengthen screening tests, and secure equal treatment access and add palliative care to healthcare delivery. The results of the SAHR assessment show systemic problems regarding financial constraints combined with inadequate healthcare services and insufficient policy enforcement, which negatively affect these implementation measures. The National Department of Health continuously tries to develop infrastructure in the public health sector, along with stakeholder collaboration and resource allocation improvements to ensure the policy delivers meaningful outcomes to breast cancer patients. Successfully fighting this illness necessitates broad strategies focusing on defensive procedures as well as rapid diagnosis methods and dependable ongoing treatment methodologies. For more information visit: South African Health Review 2023 The three articles pertaining to breast cancer in the latest edition of the SAHR are: In paper 9 of the 2023 SAHR, Peresu et al. explore the factors influencing uptake of breast cancer screening. See an overview of their paper here https://web.facebook.com/watch/?v=2355776991422372&rdid=sg3nkRjcEsTwbXUU
The urgency of ensuring prompt diagnosis and treatment of breast cancer in South Africa remains. Botha et al. explore the effectiveness of breast cancer policies in South Africa. View the overview of their paper here https://web.facebook.com/watch/?v=500751769608209&rdid=QyXvPzVlKDOJ6WYf
by Reuel Singh at 12:43 PM 11 February 2025 By Willemien Jansen (HST Copy and Content Editor)
How long have you been with HST and which position have you occupied?
I recently joined the Health Systems Trust (HST) on 1 July 2024 as a Research Associate under the Research and Implementation Science Unit (RIS). Please share some information about what your current role entails. As a Research Associate my role entails being involved in various projects and being assigned to various tasks. I work closely with researchers in implementing research projects and that entails the following duties: - Participant Recruitment: Ensuring ethical guidelines, Good Clinical Practice, and study protocols are followed during the recruitment and informed consent process of study participants. Assist with the development of interview guides and transcription of interviews
- Data Collection and Analysis: Conducting interviews and analysing the data using the relevant software.
- Training: Assisting with the training of data collectors.
- Record Keeping: Maintaining accurate records of data and other research activities.
- Report Writing: Helping researchers translate research findings into reports.
- Communication: Handling project-related communication as needed.
- General Assistance: Supporting researchers with various other research duties as assigned.
What influenced your decision to be in the development/Non-governmental organisation (NGO) sector? Before joining HST, I worked on projects focused on tuberculosis care within the private sector in the eThekwini district. This experience deepened my dedication to addressing health challenges. Motivated by this, I shifted my academic focus to public health, aspiring to build a career in this field. I also hoped it would open opportunities to work with organisations like HST, which shares my vision of improving South Africa's health outcomes. How do you spend your time away from work? Taking time to relax and recharge is important and I love to do so with the loved ones. I love spending time with my family and friends, whether it is a casual hangout or special occasion, or exploring new places on a weekend getaway What gives you motivation? My aspiration to learn new skills, knowledge and advance my career What is the best advice you've ever received in your life? (personal or professional) The advice that has stuck with me is from my late grandmother, who said "Perseverance is the mother of success". Personally and professionally I grew to learn that indeed perseverance is a key ingredient for achieving success as it teaches us to stay committed to our goals even when faced with challenges and setbacks. This mindset helps build resilience and determination, which I can attest to in my journey as mother and as a professional. Any future aspirations? I aim to continuously expand my knowledge and skills through ongoing education, training and professional development opportunities. Thereafter, I hope to progress to a senior research position and continue being part of research opportunities that contribute to improved health outcomes, particularly in resource limited settings, and that lead to publications and presentations. I also aspire to lead my own research team and mentor junior researchers.
by Reuel Singh at 10:17 AM 06 February 2025 By Willemien Jansen (HST Copy and Content Editor) 
How long have you been with the Health System Trust (HST) and which position do you occupy?
I have been with HST for close to a year and I am a Researcher in the Research and Implementation Science Unit (RIS). Please share some information about what your current role entails. In my current position I lead various projects, which entails protocol development, stakeholder engagements as well as seeking for ethical, district and provincial approvals. I facilitate training workshops with fieldworkers and other Researchers, co-ordinating data collection and analysis. Moreover, I am responsible for writing study related reports, and dissemination of research results through different channels such as feedback sessions with the sub-committee, stakeholders and funders such as National Department of Health (NDoH), as well as attending conferences. What influenced your decision to be in the development/Non-governmental organisation (NGO) sector? I have always been passionate about public health on a broader spectrum. I have observed that in the health sector we focus primarily on the symptoms and not the root causes of the problems. As a Researcher, my responsibility is to investigate and identify the various causes of the many health related challenges. Using the data collected, we analyse and formulate technical recommendations that will mitigate the burden of diseases on the healthcare sector. I felt that the best way my abilities and expertise will be utilised effectively is through an NGO such as HST, which is people-centred and focuses immensely on the health and wellbeing of communities. How do you spend your time away from work? I am fascinated with nature and as a result, I travel and explore new places. Hiking is also one of the activities that is close to my heart as it brings me close to the mother nature. I enjoy cooking and preparing delicious meals for myself and my family. During my spare time, I also dedicate a portion of my time visiting and helping the vulnerable, particularly children in various charity homes. What gives you motivation? I draw strength from strong African women who have walked the path before me, as I perceive myself as a strong African woman who has encountered different adversities that I have conquered. A quote that keeps me going and I live by is one by Maya Angelou: 'I can be changed by what happens to me. But I refuse to be reduced by it'. What is the best advice you've ever received in your life? (personal or professional) The best advice that I have received is that we are never granted opportunities that are beyond our capabilities. Therefore, I should always look at a situation that I am facing as a challenge that I need to grow from and conquer. Any future aspirations? My future aspiration is to grow professionally and excel in my area of expertise.
by Reuel Singh at 12:35 PM 03 February 2025 By Willemien Jansen (HST Copy and Content Editor)  Ntombifuthi Blose is a passionate data scientist who loves a challenge. We recently sat down with her to get to know her better. How long have you been with HST and which position/s have you occupied? I joined Health Systems Trust (HST) on the 1 February 2024 in the position of Data Scientist for the Research and Implementation Sciences (RIS) unit, so it's been one year since I joined the organisation. Please share some information about what your current role entails. My role involves capturing, quality-controlling, and analysing national, provincial, and district-level health statistics from various reports and the District Health Information (DHIS) to inform policy, support evidence-based decision-making, and guide priority setting. Specifically, I contribute to the production of the Indicators Chapter of the South African Health Review and the District Health Barometer. I also lead a project aimed at developing an innovative data communication strategy to enhance evidence-based decision-making in public health. This project focuses on debunking misinformation on HIV and TB using various analytical approaches, with the final product being a user-friendly, public-facing dashboard and website. Additionally, I provide support for several UNICEF, National Department of Health, and South African Medical Research Council-funded projects, contributing to data-driven insights that shape public health interventions. What influenced your decision to be in the development/non-governmental organisation sector? My passion lies in working with real-life data to generate insights that directly impact healthcare resource allocation in South Africa. By analysing health trends and system gaps, I aim to support evidence-based decision-making that strengthens our healthcare system. Being in the development/NGO sector allows me to bridge data with action—ensuring that resources are directed where they are needed most to improve health outcomes, particularly for vulnerable populations. This alignment between data, policy, and impact (in bold, I'm very passionate about this one) is what drives my work. How do you spend your time away from work? When I'm not working, I spend my time in two ways—either immersing myself in other research or making memories with my kids. On my own, I love staying up-to-date with the latest in public health and epidemiology news—yes, I'm a typical academic and a bit of a nerd! I also really enjoy going to the gym, though I wish I had more time to go more often. With my kids, we love being out and about—whether it's a day at the beach or discovering new restaurants. As Durbanites, exploring Cape Town has been such a fun adventure for us, especially visiting different play parks and trying out new spots to eat. What gives you motivation? I find motivation in being consistently challenged—whether at work or in other aspects of life. The opportunity to tackle complex problems, learn, and grow keeps me driven and eager to push forward, no matter what. Challenges spark curiosity, resilience, and innovation, and that's what keeps me inspired to keep going. What is the best advice you've ever received in your life? (personal or professional) Personal advice: Work can wait, because your children won't remember you as a professional—they'll remember you as an absent parent. Make time for your loved ones; those moments matter the most. Professional advice: Being an asset isn't just about mastering one thing—it's about knowing a little about everything. A broad understanding across different areas makes you adaptable, resourceful, and invaluable in any field. Any future aspirations? Looking ahead, I aspire to continue shaping public health policy through data-driven insights, ensuring that research translates into real-world impact. I want to contribute to building stronger health systems, particularly in how we address HIV and TB. Academically, I aim to complete my PhD and expand my research on the evolving behavioural factors influencing health outcomes in hyper-endemic rural settings. I also want to engage more in science communication to make public health knowledge more accessible. On a personal level, I am committed to nurturing both my career and family life, ensuring that I grow professionally while also creating cherished moments with my kids.
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by Reuel Singh at 10:15 AM
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