The Heart and Stroke Foundation South Africa was shocked to read of Pali Lehohla’s comments as he reported to parliament’s portfolio committee on various studies on 11 September 2013, and refutes his poorly-judged statements. Lehohla argued that hypertension-related illnesses such as strokes and heart attacks kill many more whites than blacks, and that the reason for this is because many whites are not happy.

CEO of the Heart and Stroke Foundation South Africa, Dr Vash Mungal-Singh, said: “These comments by Lehohla are not only inaccurate, but they also reflect a complete misunderstanding of the causes of hypertension, one of the biggest killers in our country across all race groups. In addition, his comments about the innate happiness of black people are highly offensive and naïve.”

The true facts reflect that cardiovascular disease (CVD), or heart disease and stroke, is the second leading cause of death in South Africa, after HIV/AIDS, and is having devastating effects across all races, cultural groups and economic brackets. There is strong research which shows that all South Africans are at risk.

Lehohla made the claim that hypertension was ‘a disease of not being happy’. However, this ignores the truth that the causes of hypertension and cardiovascular disease are usually a series of compounded risk factors, all of which may contribute to ill health.

“It is dangerous to make such a statement – many risk factors work together to put an individual at risk, and it is not wise to place the blame on one individual risk factor. Besides family history and genetics being risk factors for hypertension, unhealthy lifestyle factors, such as poor diet, being overweight, smoking and being physically inactive, are major problems in South Africa, and increase the risk of hypertension and CVD”, said Dr Mungal-Singh.

Those risk factors are prevalent across all cultural and economic groups in South Africa. Lehohla blamed white South Africans’ diets, high in fats and lack of exercise, as well as ‘cultural habits’ for their levels of hypertension. But the fact is that many South Africans are consuming a poor diet – one that is low in fruits and vegetables, and high in fat and sugar.  The salt intake of most South Africans is also too high – about an average of 11 g of salt per day – almost double the recommended amount of less than 5 g (1 teaspoon) of salt a day, and it is well established that high salt intakes can raise blood pressure. A recent study by the Human Sciences Research Council (the SA-NHANES 1 study) showed that nearly one in three men and two in three women are overweight or obese. Physical inactivity was also shown to be a serious problem – almost half of women and one quarter of men are not physically active.

Lehohla asserted that levels of hypertension are highest amongst the white population. However, Dr Mungal-Singh challenged the validity of this research, saying:

“Hypertension occurs more frequently in older people, and the white population group tends to have a longer life expectancy. Thus, if the majority of this data was derived from the older age group, this might possibly explain the higher prevalence of hypertension seen in this population group. However, the available data of the prevalence of hypertension in South Africans 15 years and older does not show significant differences for the various race groups.”

Data obtained from death notifications can be unreliable, and it is important to interpret these statistics with caution, due to the inequality of health services that is still a significant problem in South Africa. This could result in hypertension being underdiagnosed in certain groups that have little access to medical services or are not aware of their condition.

Lehohla claimed that “closer cultural relationships and equality between black South Africans” was protective against hypertension, and that the disease was a result of “not being very comfortable and happy with life.”

Dr Mungal-Singh says: “With this statement, Lehohla ignores the terrible hardship and inequality that a great proportion of South Africans face, as a direct result of our country’s history. It is extraordinary that he can make this kind of broad-sweeping statement, especially as he says that he has no study to back up his viewpoint.”

Whilst stress is known to be a contributing factor for CVD, and can impact on other risky behaviours, such as smoking, excessive use of alcohol and unhealthy eating practices, no research has been conducted to investigate different levels of stress or happiness in the various population groups in South Africa.

Dr Mungal-Singh said: “It is important to remember that hypertension is a silent killer, and the only way someone will know if there is a problem is if they get tested. Suggesting that a particular group of people is safe from this condition is misleading and dangerous to the public.

“All South Africans are at risk, and we should all be striving to lead healthier lifestyles.”