- Diabetes now kills more women and working-age adults than any other natural cause.
- South Africa’s inequality is driving new diabetes cases.
- The health system is focused on treatment, not prevention.
South Africa is facing an escalating diabetes crisis. For the past three years, diabetes has been the leading natural cause of death, outstripping historical drivers of mortality like tuberculosis and HIV.
An estimated 4.2 million people live with diabetes, half of whom are undiagnosed.
The conversation around diabetes is centred around the numbers, and what happens after the diagnosis-treatment, medicine stockouts, the complications. But not enough attention is paid to what’s driving the rising number of diabetes cases, and what can be done to prevent it.
Diabetes is positioned as a lifestyle-related disease, but evidence suggests the rise is driven less by individual choices than by the environment in which people make them.
Health-e News has reported widely on the social determinants of health – the socioeconomic conditions in which individuals work, live, and age – and how they play a substantial role in influencing health outcomes.
Diabetes is a primary example of how upstream factors like lower education, lower income, physical environment and food insecurity are risk factors for diabetes.
The rise in diabetes cases is partly attributed to the rise in urbanisation (migration from rural to urban areas) post-democracy. It’s framed as an urban luxury, a metabolic crisis driven by sedentary desk jobs, fast-food convenience, and an individual’s failure to make better lifestyle choices. But that picture is changing.
The Eastern Cape, one of South Africa’s poorest provinces, has seen a steady rise in new diabetes cases in largely rural districts.
At the heart of this is persistent health inequality, both historical and current, shaped by the social and commercial determinants of health.
