Health Disparities in South Africa: Breaking the Cycle through Ecological Health Promotion

IntroductionSouth Africa is currently facing unprecedented challenges. There is an increasing magnitude, rate and scale of social, economic and environmental problems, all of which are linked to a wide range of health complications. Poverty continues to reign throughout much of the country revealing the multitude of disparities that govern our society's social structure (1). Lack of education, low socio- economic development, population mobility, gender inequality, low literacy levels and high levels of sexual assault all contribute to and reflect an escalating health crisis.Indeed, despite pockets of progress in South Africa since 1994, disparities in health and wealth are amongst the highest in the world: The Gini co- efficient, a measure of income inequality, increased from 0.6 in 1995 to 0.679 in 2009; maternal mortality increased from 150/100,000 pregnancies in 1998 to 650/100,000 in 2007 (2). Low socio-economic status is associated with a wide range of health problems, including low birth weight, stunting of growth, Tuberculosis (TB), cardiovascular disease, hypertension, diabetes and cancer (3).One of the greatest indicators of low socio- economic status is the unyielding prevalence of HIV/AIDS in South Africa. South Africa comprises almost 17% of the world's population living with HIV/AIDS (2). South Africa has the highest prevalence of HIV/AIDS compared to any other country in the world with 5,6 million people living with HIV, and 270,000 HIV related deaths recorded in 2011 (4).Epidemiology tells only part of the story; hardships and suffering for those infected and their families, begins long before people die (4). Limited access to clinics, waiting lists for ARV treatment and eligibility criteria for ARV access, means that many become seriously ill prior to accessing treatment. Loss of income when a breadwinner becomes sick merely exacerbates the cycle of poverty and places an extra burden upon family members. This ultimately impacts on access to adequate nutrition, which further compromises health status.Health disparities amongst children in South AfricaHealth promotion recognizes the important role that settings play in influencing health. Schools are a key setting for health promotion as they influence a critical developmental life phase and establish preferences, habits and attitudes around food which can have long-lasting impact on an individual's life.Schools in South Africa are fertile ground for vast health disparities and are aggravated by drug abuse, teenage pregnancy, poor nutrition, lack of sanitation, high prevalence of HIV/AID and sexually transmitted diseases. Access to adequate healthcare, specifically for school learners and adolescents, should be a high priority policy objective in South Africa. Health services, including sexual and reproductive services, need to be easily accessible to learners and the barriers to access need to be overcome.These disparities are not only a burden on South Africa's already-overstretched healthcare system, but they influence society as a whole and are formidable adversaries in the pursuit of sustainable development. Indeed, the World Health Organization stipulates that reducing health inequalities in schools is an ethical imperative (5).Food security and nutritionFood security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. Whilst there is a general consensus that the presence of food security and nutritional status can mitigate disease, 50% of South Africans - many of whom are unemployed and living in poverty - are food insecure (6). Food insecurity is also increasingly being recognised as an urban challenge, with 77% of poor city dwellers in southern Africa reporting food insecurity (7-9). When a large proportion of poor people in a major metropolis such as Cape Town or Johannesburg (10) report food insecurity, this implies adverse health impacts for millions of people (10), especially people living with HIV and AIDS (11). …