PRETORIA, Gauteng — In a stark shift for the nation’s public health profile, diabetes has officially overtaken tuberculosis as South Africa’s leading natural cause of death. The metabolic condition claimed nearly 28,000 lives in 2023, signaling a rapid epidemiological transition that health officials are now scrambling to address through aggressive preventative legislation and public health campaigns.
According to the latest 2026 data from the National Department of Health, the burden of illness in the country has pivoted heavily toward non-communicable diseases (NCDs). Today, more than half of South African adults are living with at least one chronic condition, prompting Health Minister Dr. Aaron Motsoaledi to declare the situation a full-blown national crisis.
The “Five by Five” Epidemic
Dr. Motsoaledi explained that South Africa, much like the rest of the world, is in the middle of a fast-moving epidemiological transition. While the country historically battled infectious and communicable diseases like HIV, AIDS, tuberculosis, and malaria, the leading causes of mortality are now lifestyle-driven. These include diabetes, high blood pressure, strokes, kidney diseases, and cancer.
To simplify the crisis, the Health Minister categorized the current health landscape as the “diseases of five by five,” identifying five primary NCDs and five corresponding risk factors driving them.
The five dominant diseases are diabetes mellitus, cancer, cardiovascular diseases, mental health disorders, and chronic respiratory diseases. They are fueled by five core risk factors: cigarette smoking, excessive alcohol consumption, poor diets heavy in sugar and salt, sedentary lifestyles lacking exercise, and adverse environmental factors.
Targeting the Commercial Determinants of Health
Emphasizing that prevention and health promotion must take precedence over mere early detection, Dr. Motsoaledi pointed to the World Health Organization’s (WHO) concept of the “commercial determinants of health.” This refers to health crises driven by private industry profits rather than public well-being.
The government is currently battling powerful commercial sectors on multiple fronts:
- Tobacco and Vaping: South Africa was a global pioneer in tobacco control legislation in 1999, resulting in significantly cleaner public air. However, Dr. Motsoaledi noted that the industry found loopholes through electronic cigarette delivery systems and vaping. A new, more stringent tobacco control bill is currently before Parliament to combat these modern threats, despite ferocious pushback from the cigarette industry.
- Alcohol Advertising: The Minister highlighted the aggressive marketing of alcohol to minors, noting that the alcohol industry spends an estimated R1 billion annually on advertising—a massive budget that the state simply cannot match with counter-messaging.
- Sugar and Salt Interventions: The controversial sugar tax was implemented primarily to discourage the consumption of dangerous sugary drinks, rather than merely to generate state revenue. Conversely, the government has found immense success cooperating with the food industry. Since 2016, the state worked silently but effectively with manufacturers to reduce sodium levels in everyday staples, including bread, chicken brine, soups, cereals, and snacks.
The Affordability of Health and the Treatment Cascade
Addressing public concerns regarding the cost of living, a recent audience poll revealed that 84% of citizens feel healthy eating is far too expensive for ordinary households. Dr. Motsoaledi validated this sentiment, acknowledging that highly processed, nutritionally void junk food is cheap and ubiquitous, while nutritious food remains costly.
He outlined the grim, four-stage global cascade of diabetes treatment:
- Dietary Control: Managing the condition through a normal, balanced diet.
- Lifestyle Intervention: Combining diet with exercise when diet alone fails.
- Medication: Relying on daily pills.
- Injections and Surgery: Escalating to insulin injections (up to three times a day), which can ultimately lead to severe organ failure requiring kidney transplants or amputations.
Dr. Motsoaledi stressed that the second stage—exercise—does not require expensive gym memberships. A brisk, 30-minute walk at least three times a day is a highly effective and entirely free intervention.
The Push for Systemic Dietary Change
Responding to viewer inquiries about the disease destroying families and killing young adults, the Department of Health continues to recommend varied, high-fiber diets, including whole wheat options. However, the Minister admitted a difficult cultural reality: healthy foods are rarely perceived as “tasty” compared to junk food. The public generally knows what they should be eating, but affordability and taste remain massive barriers.
To combat this, the Department of Health is currently in discussions with the departments of trade, industry, and finance. The goal is to implement policies that make essential healthy foods, like milk, highly affordable while artificially increasing the cost of fizzy, sugary drinks.
Despite the ongoing friction with deep-pocketed commercial industries, the government maintains that curbing the commercial drivers of poor health is the only viable path to reversing the tide of preventable deaths sweeping across the nation.
