A Golden Opportunity to Change Diabetes in Johannesburg

In 1886 a large gold reef was discovered on a remote African farm setting off a major gold rush that led to the establishment of Johannesburg. As the news spread, the population of the city exploded with people hoping to find the riches and Johannesburg quickly became the largest city in South Africa.1 In fact, the Zulu name for Johannesburg is Egoli which means City of Gold.

Today, Johannesburg is still home to a considerable gold mining industry, and although gold is no longer the main thing drawing people to the city, the wish for prosperity and a better life continues to attract new arrivals. City life offers social and economic possibilities that rural areas cannot, but city life also has its downsides – one being the increased risk of type 2 diabetes.

A Silent – and Costly - Epidemic

Urbanisation often leads to lifestyle changes such as food habits, physical activity, work patterns, smoking, alcohol consumption, leisure-time activities and travelling patterns which all impact health. Many of these factors are associated with an increased risk of diseases such as type 2 diabetes.2 The trend is also seen in South Africa as a whole where more than 2.7 million people have diabetes and 4 out of 5 of these live in urban areas.3

“I do believe diabetes is becoming a silent epidemic in South Africa and there is an urgent need for a coordinated approach to manage it,” says Dr Basu, who specialises in Public Health Medicine, heading up the Public Health Unit at the Department of Community Health of the Charlotte Maxeke Johannesburg Academic Hospital. He is also employed by the university of the Witwatersrand and teaches in a number of universities across the world as visiting faculty.

Diabetes complications not only impact the quality of life of the people affected. They are also costly entailing both direct costs, such as hospital and medication expenses as well as indirect costs, such as work absenteeism and reduced productivity. In South Africa, health expenditures for diabetes in adults are projected to be between 1.1 to 2 billion USD in 2030.4

As the largest city in South Africa, Johannesburg is already feeling the burden of type 2 diabetes and according to Dr Basu, there is a need to better understand the disease and its risk factors in Johannesburg.

“The biggest challenge when it comes to diabetes in Johannesburg is integrated preventive and promotive care based on evidence,” he says. “Although there is a plethora of activities undertaken in both public and private sectors, in primary health care and hospitals, in schools and work places, they are sporadic, not evidence based and not integrated, thereby resulting in poor outcomes for patients.”

Light at the End of the Tunnel

In November 2015, Dr Basu embarked on a trip to Copenhagen, Denmark, where he attended the Cities Changing Diabetes Summit.

Cities Changing Diabetes is a partnership programme to identify and address the root causes of type 2 diabetes in cities founded by Novo Nordisk, University College London (UCL) and Steno Diabetes Center. The summit marked the completion of the world’s largest study on urban diabetes, led by UCL in collaboration with leading researchers in five study cities – Mexico City, Copenhagen, Houston, Tianjin and Shanghai.

The study findings suggest that in cities around the world, social and cultural factors play a far more important role in the spread of type 2 diabetes than previously thought.5

The summit brought together more than 250 international delegates to discuss the findings and share local learnings and experiences. To Dr Basu, the sharing of ideas and success stories was key.

“I saw that cities with less resources than Johannesburg have managed to find ‘light at the end of the tunnel’ through this programme. This raises hope to find a long lasting effective and efficient model for diabetes in Johannesburg and South Africa as a whole.”

At the summit, it was officially announced that Johannesburg will join the Cities Changing Diabetes programme in 2016. The aim is that the knowledge gained in the initial study cities about the social and cultural factors driving type 2 diabetes, can help Johannesburg examine the nature and extent of the challenge here.

An Integrated Approach to Tackling Diabetes

Dr Basu plays an important role as he will be one of the technical leads for the project and form part of the team coordinating activities among the many stakeholders involved.

“Cities Changing Diabetes in Johannesburg provides us a platform to bring together different players to challenge this epidemic,” he says. This is an opportunity to take a multi-faceted integrated approach to tackling diabetes in Johannesburg which has been lacking so far according to Dr Basu.

He expects that the stakeholders involved will include the City of Johannesburg, health and educational authorities, academic institutions, schools, private hospitals, general practitioners as well as civil society organisations.

In the short term, the collaboration will help the city to integrate all activities related to diabetes services, research and training. In the medium term, the project will map diabetes and its risk factors across the district, which should lead to a sustainable plan of action. And in the long run, Dr Basu hopes that it will reduce the mortality and morbidity associated with diabetes through all levels of prevention.

Although he acknowledges that it will be challenging, Dr Basu is confident that the project can make a difference. “I am an ever optimistic person. I am a hawker of dreams. I dream that my country will be the place where people live in peace and harmony and are healthy and gainfully employed. As a public health physician, I am uniquely positioned to achieve my dream.”

In the end, there seems to be a lot of truth to the famous words of Mahatma Gandhi saying that it is health that is real wealth and not pieces of gold and silver.

Footnotes

1. http://www.joburg.org.za/index.php?option=com_content&task=view&id=103&Itemid=9

2. Tellnes G. Urbanisation and health. New challenges in health promotion and prevention. Oslo: Unipub forlag. 2005.

3. IDF. International Diabetes Federation. IDF Diabetes Atlas. 7th edn. Brussels, Belgium: International Diabetes Federation. 2015.

4. Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, et al. (2010) Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pr. 87: 293–301. doi: 10.1016/j. diabres.2010.01.026. Available at: http://www.sciencedirect.com/science/article/pii/ S0168822710000495. The number covers health expenditures for diabetes among adults aged 20–79 (type 1 diabetes, type 2 diabetes and gestational diabetes) years for years 2010 and 2030.

5. For more information about the findings, see press release here