South Africans are the world’s unhealthiest nation, with the critically ill status of the public health system being fingered as the main reason for the poor state of citizens’ mental and physical health.
The latest Indigo Wellness Index is one of the first comprehensive global wellness indices to be published, covering over 150 countries and focusing on 10 key metrics, such as blood pressure and alcohol use.
According to the index, South Africa’s poor scores on all the above-mentioned indices places the country below nations like Haiti and Iraq in terms of overall health.
Nicole Breen from the South African Federation for Mental Health, an advocacy group seeking to protect and uphold the rights of people with mental illness, psychosocial disability and intellectual disability, said South Africans suffer tremendously with poor mental health.
“This poor mental health can well lead to poor overall physical health and those who, for example, use alcohol in excess, are more likely to suffer from mental health conditions such as depression. In turn, people in a poor state of mental health may use alcohol to self-medicate,” said Breen.
“As an organisation focused on mental health, we cannot comment on health as a whole, but South Africans live in a country where there is a woeful lack of services available to them. If proper interventions were available, our country would not be in such dire straits.”
Breen said mental health formed a minuscule part of the health budget. As a result, there are inadequate facilities, stockouts of medication and a lack of support at community level, which is why SA fares so poorly.
“It would be unfair to blame South Africans while the system is failing. Many South Africans are in a crisis situation and have nowhere to turn.”
Family medicine professor at Stellenbosch University Bob Mash said about 80% of South Africa’s population depended on the public sector’s primary care services. But access to this primary care in the public sector was often limited by the sheer number of patients.
“It’s also restricted by opening times that do not cater for people who are working or become sick during evenings,” said Mash.
He said SA had developed a policy to implement national health insurance (NHI) to ensure improved access to primary care for the whole population.
“However, many general practitioners in the private sector are worried the government will not be able to effectively implement and efficiently manage NHI. Access is also not enough. The care that’s offered must be of a good quality,” he said.
The NHI proposals were not the only plans developed to try and provide good primary care to all South Africans.
He said the discipline of family medicine was doing a great deal.
“Family physicians are qualified doctors that have completed additional training to become specialists in family medicine and primary care. South Africa is now finally seeing family physicians entering the health system in increasing numbers and joining primary care teams.”
He said a recent study of both nurses and doctors in Cape Town found that in 90% of consultations, they made no attempt to understand the patient’s perspective.
“This poor provider-patient relationship is a fundamental problem that fuels poor clinical outcomes,” Mash said.
What the index uses
The Indigo Wellness Index draws on findings as diverse as the World Health Organisation, the World Happiness Report and public health data. The index focuses on ten key metrics:
- Blood pressure
- Blood glucose
- Alcohol use
- Tobacco use
- Healthy life expectancy, and
- Government spending on healthcare.
Canada scored highest in the ranking, with Iceland, the Netherlands, Norway and Sweden following closely behind.
How the bottom 5 scored:
The bottom five countries scored the worst in all the metrics:
South Africa – Scoring poorly on all measures, its scores on obesity, drinking, and life expectancy, in particular, make South Africa the most unhealthy country in the world in 2019.
Saint Lucia – Binge drinking, blood pressure, and blood glucose scores made Saint Lucia the second most unhealthy country in the world.
Kiribati – Obesity is the biggest concern here, putting the Oceanic country in third place.
Bulgaria – Sunny Beach may look like the perfect holiday spot, but Bulgaria is the fourth-most unhealthy in the world due to blood pressure, depression and drinking.
Micronesia – Obesity, drinking and low government spending on health put Micronesia tied in fifth place with:
Barbados – It may seem idyllic, but this Caribbean country had alarming scores across a wide range of categories, including blood pressure, depression, obesity, inactivity, and binge drinking.