CAPE TOWN, April 24 — Cape Town mayor Geordin Hill-Lewis suggests that the city’s HIV/AIDS success can offer a good guide on how cities globally can tackle the growing burden of non-communicable diseases (NCDs).
Recognising the urgency of the HIV/AIDS crisis, the Western Cape province in South Africa, where Cape Town is situated, was the first to offer free antiretrovirals (ARVs) in 2004 to the public before nationwide programmes were fully established.
“There was an opportunity for a city or a province to lead the way in a public health issue. While there were still unhelpful and lengthy debates taking place at the national level, you could get on and do it in a smaller context.
“I think that demonstrates that, in some contexts, cities can move quicker and be at the forefront,” Hill-Lewis told reporters at the Partnership for Healthy Cities Summit 2024 here last March 6.
Hill-Lewis also recalls the city’s “relentless” communication efforts to educate the public about safe sex and HIV prevention.
“We used to have a thing where every single public speaking engagement had to start with the first two or three minutes being spent talking about HIV/AIDS. It didn’t matter whether you were on TV, in public meetings, everywhere. It literally was kind of a rule in the early 2000s, and so that really made a difference at the time,” Hill-Lewis said.
Like many cities across the world, Cape Town’s health challenges include rising rates of NCDs such as diabetes, cancer, chronic respiratory diseases, and heart diseases.
Factors like urbanisation, sedentary lifestyles, poor dietary habits, tobacco use, and rising obesity rates have contributed to this trend.
Data from Statistics South Africa shows a steady increase in deaths due to cardiovascular diseases in South Africa from 12.9 per cent in 2008 to 17.6 per cent in 2018, making it one of the country’s “biggest killers”, alongside stroke, after HIV/AIDS.
Hill-Lewis said Cape Town spends roughly 600 million rands (RM151.3 million) annually to manage NCDs, particularly in distributing free medication for chronic diseases.
“One of the most common chronic medications that we distribute are for diabetes and high blood pressure. We spend hundreds of millions of rands, tens of millions of pounds, a year on that medication, so that’s a very significant cost to the state,” Hill-Lewis said.
The majority of the city’s funding comes from internal sources, supplemented by limited health grants from provincial and national governments. “However, they do not begin to cover the cost of the health care we provide. The vast majority of it is funded by the city.”
In addition to distributing free chronic medications, Cape Town’s health care budget also covers preventive health care initiatives.
These include the establishment of outdoor gyms and after-school programmes, such as swimming classes for primary and high school children, aligning with government strategies to promote physical activity.
Cape Town is host to this year’s Partnership for Healthy Cities’ annual summit, supported by Bloomberg Philanthropies, the World Health Organization (WHO), and Vital Strategies. The partnership covers a global network of 74 cities that represent over 300 million people.
With the majority of the world’s population residing in urban areas, cities and their leaders are well positioned to lead the fight against NCDs and injuries, reducing preventable deaths through evidence-based policies.
Currently, Cape Town is focusing on identifying and addressing the socio-economic factors that affect health in the city. This includes planning infrastructure, providing services, and creating jobs to improve health outcomes.
“This is a marathon and not a sprint, and hopefully it will be the blueprint for the metropole into the future. Cape Town has a very high burden of NCDs and other preventable deaths.
“While we have a good understanding of the various factors that contribute to that burden, this programme will provide crucial information that can help determine strategies going forward,” said City of Cape Town councillor Patricia Van der Ross.
“Metropolitan areas are growing, and Cape Town is no different. It is imperative that our future planning takes place through a public health lens.”
