Dr Peter Bond – Thursday February 19, 2015

The Dice are Loaded – A snapshot of the state of preventable disease in a South African retail population



In sponsoring this conference, Old Mutual is not endorsing a particular diet or way of eating, but we acknowledge that health crises around the world, including in South Africa show that new approaches are necessary.


We believe that when you get right critical mass behind the topic, you can make big changes and difference. Part of the reason this conference is taking place is the contribution towards a critical mass behind preventative measures which will alter the course of serious non-communicable diseases that affect people in this country.



Sobering messages about the state of people’s health across the globe are coming through: The World Health Organisation (WHO) says: “The world’s most rapidly spreading sustained pandemic is not HIV/AIDS but diseases of lifestyle and diet of which obesity is the most dominant.”

The WHO also says: “It is estimated that at current rates the world’s obese population will outnumber those suffering from starvation by 2025.”

That means 700 million people.


Clearly, in the words of Prof Harry Seftel, “it is time to change our death styles to lifestyles”.


At Old Mutual, we try to estimate the health risk using easily obtained medical information:

In the retail space, about 150 000 clients per annum undergo at least the following:

  • Medical Questionnaire
  • Blood profile
    • Chol
    • LFT
    • Glucose
    • HIV

Of these, about 60 000 per annum undergo a standard or

shortened medical examination by a doctor or a registered nurse.

These include BMI, BP and a urine dipstix.

Failed evaluations (loaded or declined) order of prevalence are from

  1. Diabetes
  2. BMI
  3. CVD

These have immediate financial consequences.

Diabetes and obesity are two major issues in South Africa.

Diabetes is shown to be part of the obesity epidemic, the end result of insulin resistance affecting between 6-8% of population in affluent societies

By our estimate 3.5 million South Africans have type 2 diabetes, and 5 million are insulin resistant or have IFG or IGT.

Approximately 50% are aware of their condition and are often only diagnosed during an insurance examination.

Generally though, diabetes is poorly managed and controlled. Less than 20% of diabetics are shown to be well controlled. The immediate financial consequence is a declined application or 50 -150% extra mortality or morbidity loading per month.


Our obesity research shows that

  • South Africa has the highest overweight and obesity rate in   sub-Saharan Africa [Lancet 2014]
  • 7 out of 10 women and 4 out of 10 men overweight or obese
  • Double the global rate of nearly 30%
  • Namibia (19.8%), Lesotho (24.1%) and Zimbabwe (33.5%)
  • Obesity-driven diabetes across sub-Saharan Africa will double in 20 years (WHO)
  • Not a single country has managed to reduce its obesity rate in the past three decades.


There are many obstacles to fighting obesity in South Africa that are real and relevant, including beliefs and culture around the HIV epidemic. Being fat in some cultures is associated with being successful and being thin a sign of HIV infection.

Remember Dudu Dlamini – the first person to admit she was HIV positive: she was stoned to death. There is still a stigma surrounding HIV infection, with people unable to reveal it safely in their communities.

Startlingly 56% of obese individuals are shown to feel they are perfectly healthy

  • Cardiovascular disease is also a big problem in South Africa:
  • CVD kills 200 people in SA every day = about 13 mini bus loads of people per day! (Heart and stroke foundation)
  • About 130 heart attacks and 240 strokes occur daily in SA
  • For every woman that dies of CVD, 2 men will die
  • Premature deaths caused by CVD in people of working age (35-64yrs) are expected to increase by 40% by 2030
  • 6.3 million South Africans suffer with high blood pressure
  • South Africa has the highest prevalence of hypertension in                                                  population aged over 50 years in the world.



Cholesterol is a well publicised and controversial risk factor for cardiovascular disease but the question is: is isolated raised cholesterol a risk? Research shows that:

  • It’s effect on mortality only appears to be relevant once total cholesterol is above 7.5mmol/L
  • There may be a reduction in CVD deaths below this level but overall mortality is unaffected;
  • 72% of applicants tested for insurance in the retail affluent group have a level above the clinically accepted                                                                  normal level.


Graphs show how very controversial is the conventional medical view of getting cholesterol below a certain level.

There has been big progress on two major health fronts in South Africa: HIV/AIDS and smoking.

The fight against HIV was hampered political statements and controversies that delayed the introduction of ARVs. Since then, ARV rollouts and introduction of the WHO guidelines to treatment have had spectacular effects in reducing death and new infection rates.

Smoking has also declined.

However, non-communicable diseases (NCDs) now predominate as the leading cause of death in SA.


Alcohol is still a problem in South Africa, and South Africans:

  • Approximately 60% of South African men drink alcohol, and approximately 27% of South African women
  • 19% of our clients have one or more elevated transaminase level
  • Yet close to 0% admit to drinking more than 20 units per week

Here’s why are the dice so heavily loaded in South Africa:

  • 1 in 3 males and 1 in 4 females will suffer a cardiovascular event before the age of 60
  • Premature deaths caused cardiovascular disease in people of working age (35-64 years) are expected to increase by               40% between now and 2030.
  • 62% of men and 48% of women 15 years or older follow a sedentary lifestyle
  • 1 million South Africans are currently on                                   treatment for hypertension
  • 1 in 7 South African women have a lifetime risk cancer
  • 1 in 13 South African women will get cancer of the breast
  • 1 in 6 South African men will suffer from cancer of the prostate
  • Obesity is relentless in SA
  • 4% of Old Mutual’s retail affluent clients have a total cholesterol >7.5mmol at/L application
  • 19% have abnormal LFT’s
  • In 2014 4% have glucose levels diagnostic of                                      diabetes, dropping from 5.3% in 2002
  • 1% are HIV reactive


The Department of Health has goals: including:

  • Reduce by at least 25% the relative premature mortality (under 60 years of age)
  • Reduce by 20% tobacco use by 2020;
  • Reduce by 20% the per capita consumption of alcohol by 2020;
  • Reduce mean population intake of salt to <5 grams per day by 2020;
  • Reduce the prevalence of people with raised blood pressure by 20% by 2020
  • Increase the prevalence of physical activity by 10%


Yet the Department’s goal on obesity is to reduce the percentage of people who are obese and/or overweight by only 10% by 2020.


Clearly, obesity is not a priority.

There is clearly a need to elevate preventative medicine to the level it deserves and not only do it, but, more importantly, have the desire to do it

We have clearly failed to date


The mere fact that you have all come here today, from far and wide shows that you have the passion and desire. I hope this is a beginning of a worldwide wave of consciousness and media discussion around preventable illness and not around a particular way of solving it.

That is the main reason why we are involved. We have products, the numbers, the statistics. We need to complete the spectrum by involving ourselves in preventable medicine.


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