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04 June 2019 | Story Valentino Ndaba | Photo Charl Devenish
Prof Cathryn Tonne
Air pollution not only costs lives, it costs money too. Pictured is Prof Cathryn Tonne presenting a guest lecture on air pollution at the Bloemfontein Campus.

Health effects associated with ambient air pollution (AAP) have been well documented. Subsequently, the relationship between pollution and financial outcomes have also become a focus for case studies globally. An Environmental Research journal article revealed that “low and middle-income countries are disproportionately affected by the global burden of adverse health effects caused by AAP”. 

A high price to pay

In 2012, high concentrations of air pollution caused 7.4% of all deaths, costing South Africa up to 6% of its Gross Domestic Product. According to the recent International Growth Centre study conducted by senior University of Cape Town researchers, this is a direct consequence of the country’s heavy dependence of fossil fuels, a source of health-damaging air pollution and greenhouse pollutants.

Stunted human and economic growth

These South African statistics are attested to by Prof Cathryn Tonne who recently presented a guest lecture on air pollution which was hosted by the University of the Free State (UFS) Business School.

“Air pollution can affect economic development through several pathways, and health is an important one. Air pollution is linked to shorter life expectancy, chronic disease, asthma exacerbation and many other health outcomes that result in absenteeism from work and school. These have large direct costs to the health system.” 

Prof Tonne says that air pollution exposure in children is linked to reduced cognitive development, with important impacts on human capital. As a result, children are not reaching their full potential in terms of neurodevelopment, which has an effect on their income prospects and the economy as a whole. 

Resolving a looming disaster

Technology may be employed to radically clean the air. Cities need to lead in the reduction of air pollution by promoting renewable energy, using active transport such as walking or cycling, and investing in infrastructure to make this safe and attractive. 

With researchers playing a major role in strengthening the case for aggressive air pollution control, the government needs to implement policies in order to control sources of air pollution. This global health and economic issue also requires individuals and communities to play their part to improve air quality.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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