South African youth (individuals aged 18 to 34) make up a third of our people. With an estimated population of just under 60 million, we’re talking about 20 million lives. We are – by nature and by numbers – a “young country”. It stands to reason, then, that prioritising youth development is not only a social imperative, but an economic one for our country.

Being in the health industry, we started to ask ourselves what we could see from the vast amount of data we have on South Africans’ health and, particularly, youngsters’ health. Are South African youth becoming sicker or healthier? In short, the answer is no to the latter. Our data, in fact, was indicative of a disconcerting trend – youth health is on the decline, with almost every graph we have on hand showing increasing numbers associated with chronic illnesses.

Let us pause to consider the statistics:

• Chronic disease: Over the past 10 years, the proportion of young people with one or more chronic disease has more than doubled, from 2.5% in 2011 to 5.1% in 2020.
• Asthma and allergies: Our youth are potentially more afflicted by asthma and allergy-related conditions, which make up 49% of all youth chronic registrations in 2020. Since 2011, the prevalence of these two conditions increased by 87%:

• Mental health: Of the three conditions that showed the largest percentage increase in prevalence since 2011, two of these relate to mental health – bipolar mood disorder, which showed a 214% increase in prevalence among the youth, and depression, which saw a 130% increase in prevalence among young people.
• The top five hospital admission categories we saw among youth in 2019 were for:

o    intestinal infectious diseases (17% of all youth admissions),

o    tonsil/adenoid procedures (12% of all youth admissions),

o    pneumonia (12% of all youth admissions),

o    caesarean deliveries (11% of all youth admissions), and

o    mental health admissions (11% of all youth admissions).

• Over the past nine years, the admission category with the largest increase in numbers is mental health admissions, which has increased by 71% since 2011 (note: 2020 was excluded due to the drop in non-emergency elective admissions experienced across the industry as a result of COVID-19).

Our statistics paint a vivid picture of a youth in crisis: not only do we have an unemployment problem to worry about, but we also potentially have future health crises brewing too.

Unfortunately, as concerning as this picture is, it is not altogether surprising, given the rise in prevalence of sedentary lifestyles within our world. Are the rises in asthma and allergy conditions perhaps attributable to environmental issues? Issues around global warming, climate change and environmental degradation are making frequent appearances in public discourse.

One study[1] suggests that air pollution can have a greater effect on health under extreme weather conditions. And in a country where temperatures are predicted to rise dramatically due to climate change and growing water scarcity in the next few decades, South Africa should take heed. Another study[2] published in the SA Journal for Child Health (SAJCH) conducted in Durban, for example, reached the conclusion that children living in areas where there is a high level of outdoor air pollution can present more asthmatic symptoms than children in other areas. This is surely no coincidence.

The numbers around mental health are alarming too. An increasing number of celebrities and well-known public figures talking publicly about their mental health has done wonders to raise awareness of illnesses such as depression, bipolar mood disorder and generalised anxiety disorder. Not only can we attribute the rise in mental health issues to this awareness drive, but we look to external stressors, such as the unprecedented level of youth unemployment in the country, as a potential cause.

Mental health issues not going away

And, in the context of the pandemic, mental health may as well be another silent pandemic that is crippling us, as almost every metric shows a significant rise in mental health issues.

Sadly, this is and was to be expected. Uncertainties around one’s COVID status, the social and economic pressures caused by the national lockdown, and the increased mortality rate and loss of loved ones have all contributed to a more stressed, more depressed youth. Although the trauma of losing a loved one is tough to deal with, I believe it is even harder and more traumatic in a COVID-19 world, where many people cannot observe their preferred or traditional burial rights because of the lockdowns, and have had to grieve in isolation. Support from friends, family and the community has been limited to virtual or telephonic means.

Dr Victor Tseng, a notable American pulmonary and critical care physician, who specialises in COVID-19, has said that the predicted direct and indirect impacts of the pandemic on healthcare systems will be “profound and sustained”. Particularly, he foresees a sustained period related to mental illness, burnout and economic injury. These are the kind of challenges that health providers will need to focus on in the post-COVID-19 world.

While mental health issues and possible environmental illnesses may be avoidable, type 2 diabetes is directly related to lifestyle. An increase in this shows that South African youth are not making the healthiest choices around their health. We look to increased urbanisation as a possible cause for the rise in the prevalence of sedentary living. Today’s youth is desk- or couch-bound, living in an increasingly digitised reality where aspects like physical exercise and healthy dietary choices play second fiddle to other concerns. And, for most part, the pandemic has just exacerbated this already existing trend.

As advocates for better health, we have a mammoth task ahead of us. We need to prioritise ways in which we can motivate our young people to get outdoors, get their bodies moving and their hearts pumping. Now, more than ever, when screen time is taking precedence over self-care time, we must intervene. If we do not intervene now and change behaviours, South Africa will not be improving its burden of disease.

Medical schemes and affordability

The decline in health among South African youth of course has a direct impact on the medical aid sector. Our membership trends suggest that affordability has been the main determinant of the choices that young people make around medical cover.

On average, adults below the age of 34 apply for basic hospital plans or plans that do not cover day-to-day expenses. But the approach of keeping one’s medical aid contribution as low as possible has a downside: costly hospital admissions as a result of poor health maintenance (which correlates with a lack of access to day-to-day benefits) is one such factor. For medical aid schemes, innovative product designs around primary care are the key to providing a viable and sustainable way forward. For society at large, a fuller reckoning is needed.

If the pandemic has taught us anything in the health sector, it’s that youth issues are not just of national concern. Members of the South African youth are global citizens. Their health and wellbeing are, therefore, of global concern. The solution, it seems, must come from the collective.

Ahmed Banderker is the CEO of AfroCentric Group, owner of Medscheme.