According to health experts at a Peoples’€™ Health Movement conference in Cape Town, last week, poverty and high unemployment rates are some of the barriers that prevent people from accessing quality health care. Director of the School of Public Health at the University of the Western Cape, Professor Dave Saunders, says child mortality in South Africa is still high and it has a direct link to the levels of unemployment and rising poverty.

‘€œOur child mortality rate is coming down slowly, if at all. This is because of huge inequalities, HIV, of course and new-born deaths. But 60% of children who die are under-weight and a third is severely malnourished. And even in Cape Town, which is one of the richest cities in this country, we have huge inequalities’€, Saunders says.

Professor Saunders says the profile of the country’€™s disease burden is very similar in both adults and children who live in poor areas such as the informal settlements of Khayelitsha, outside Cape Town, for example.  

‘€œWe have four epidemics happening at the same time. There are chronic diseases, injuries and, of course, HIV/AIDS.  We have very high levels of under-nutrition in this country. About 20% of children are too short for their age, which reflects a poor diet over a long time, and this hasn’€™t changed much. When we look at what food they are eating, we find that both adults and children have poor quality diets leading to anaemia, vitamin A deficiency, and all of these contribute to high levels of stunting and poor growth’€.

He says exclusive breast-feeding of babies will give children a higher chance of survival within their first five years of life and will protect them from many child-hood illnesses.  

‘€œExclusive breast-feeding is a very important intervention and, probably, the most important child survival intervention that can reduce under-five mortality by 13%. But, in this country only eight percent of infants under six months are exclusively breast-fed. I think this is the lowest in the world and that is because we have allowed the infant formulae companies to get right inside our health services. We have gone as far as giving out infant formulae in our health services for a long time now’€, says Professor Saunders.

Dr Tracey Naledi of the Western Cape Health Department says improper nutrition has become common across the population. She says an increasing trend of unhealthy eating patterns is reducing the quality of health that people can possibly have.  

‘€œIn the Western Cape we are more over-weight, smoke more, we are less active – both adults and adolescents – and this trend is increasing and getting worse. As a country developing we know that there is a trend of unhealthy foods that have been imported into South Africa. Cold drinks are cheaper and remain cheaper if you compare it to fresh fruits and vegetables, etc. Also, if you look at the calories that children have been taking in over time from milk… (They) have been decreasing and those taken in from sweetened beverages have been increasing’€, Dr Naledi says.

However, she says the right choice of food is not always the easy choice to make. This is due to factors, including accessibility and affordability.

‘€œWe know that our children make unhealthy choices in tuck-shops.   Just because of availability of these things they choose soft drinks and pies, etc. What is important to note is that the right choice is not necessarily an easy choice to make. As health workers we say you need to exercise, you need to eat healthy. However, research done shows us that healthy foods are more expensive and in poorer areas they are not readily available. For example, low fat milk is not readily available in townships’€.

She adds that those living in better off areas have a greater advantage of meeting their health needs.

‘€œWe know that in terms of chronic diseases, if you are from a rich quintile you are more likely to be aware of your hypertension, you are more likely to be on medication and you are more likely to be controlled versus if you are from a poor area’€, says Dr Naledi.

Professor Dave Saunders says the health system needs to respond to the challenge, particularly to address the nutritional needs of babies. Saunders recommends that South Africa needs a primary health care model that is driven by a large team of community health care workers.  

‘€œThey can promote healthy behaviours such as hand washing and breast-feeding. They can do more complex tasks like managing more acute illnesses such as pneumonia and helping with empowering communities.   Community health workers can promote immunisation uptake, TB cure and breast-feeding. They can correctly manage diarrhoeal disease in children’€, says Professor Saunders.