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Urgent course correction needed on climate change, economic policy and NHI

Urgent course correction needed on climate change, economic policy and NHI
The worsening climate crisis poses a threat to women and girls and their access to healthcare in the country. (Photo: Black Star / Spotlight)
Louis Reynolds
By Louis Reynolds
17 Mar 2023
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Unless we get ahead of both the climate crisis and the current levels of pervasive injustice, we will never be able to catch up – even if the National Health Insurance project achieves what it originally intended.

Kedibone Mmupele (27), her two children Onkarabile (2) and Nkune  (6), and her younger siblings Mapule (7) and Sebengu (9) had not had a decent meal in weeks, media reports at the time showed. It was 2011. There was no food in their home near Verdwaal, a small place in North West, so she decided to walk to a farm 18km away to find food. On that Thursday in October 2011, the temperature rose to 32°C.

When Kedibone returned later, the four children were missing. The dead bodies of the two younger children were found in a field three days later. Two weeks later, the older children were found. An autopsy showed that all four had died of hunger and dehydration, made worse by the sweltering heat.

In the same year, Fiona Godlee, editor-in-chief of the British Medical Journal, wrote that “the greatest risk to human health is neither communicable nor noncommunicable disease – it is climate change”. She added: “Saying this – putting climate change at the top of the list of things to worry about is hard when faced with the daily challenges of clinical care.”    

Godlee’s editorial and the tragic story of the Mmupele children bring into stark focus the most critical challenges humanity faces today – enormous injustice and inequality in the context of rapid global heating, human-induced climate change and fossil-fuel pollution.

Climate change makes all our failures worse


Climate change intensifies a range of global and local emergencies that we have known about for decades but have not addressed effectively. These intertwined emergencies include growing inequality within and between nations; unemployment; poor physical, spiritual and mental health; inadequate access to education; homelessness; growing food insecurity; and interpersonal conflict and violence against children and women. Drought, intense heat, floods, loss of livelihoods, and conflict over resources force millions of people to migrate. At the time of writing, a prolonged drought across Somalia, Ethiopia and Kenya was threatening the lives of more than 20 million children through hunger, thirst, war and food insecurity. Climate change exacerbates political instability and war, turning many thousands into refugees. New parts of the planet will become uninhabitable by people within the lifetimes of children born today.

The environmental crisis aggravates health risks across the spectrum of childhood disease, including allergies, heart disease, skin disease and immune disorders. (Photo: Black Star Images / Spotlight)



Closer to home, two reports commissioned by the Centre for Environmental Rights in 2021 indicate that southern Africa is particularly vulnerable to climate change and that warming in the interior is advancing at about twice the global average rate. South Africa will experience “enormous negative physical, socioeconomic and ecological impacts”. These include severe heat stress, extreme weather events, sea level rise, coastal damage, water stress and crop failures. This will reduce food security and the availability of fresh water and increase the risk of severe storms, droughts and heatwaves. In addition, we can expect more disease outbreaks, various forms of economic collapse, social conflict and mass migration to informal settlements around urban areas, the report stated.

Children are highly vulnerable


Due to biological, developmental and socioeconomic factors, children are highly vulnerable to these impacts throughout the life cycle. The health risks start before they are born, with complications of pregnancy. Later, the environmental crisis aggravates health risks across the spectrum of childhood disease, including allergies, heart disease, skin disease, immune disorders, infections with new organisms, acute and chronic malnutrition, kidney disease, mental health problems, respiratory disease, neurodevelopmental problems and violence.

Read more in Daily Maverick: “NHI Bill must still clear many hurdles to ensure adequate medicine access”

About 12,000 children will be born in South Africa this week (based on Stats SA numbers). Fifty-six percent of them (about 7,500) will be taken into households living below the upper poverty line of R1,227 per month. About 380 are expected to die before their fifth birthday. On average, however, the life expectancy of children born in South Africa today is about 64 years. This means many will still be alive in 2080 unless things change.

But things will change.

Due to biological, developmental and socioeconomic factors, children are highly vulnerable to climate impacts throughout the life cycle. (Photo: Black Star / Spotlight)



As we have seen, climate change is changing the world dramatically in many ways. And this is happening with a temperature increase of 1.1°C since pre-industrial times. The aim of the UN Framework Convention on Climate Change process to limit the warming to 1.5°C is unlikely to succeed. The impact on today’s children and future generations will be profound. In the years to come, the tragic story of the “Verdwaal” children will be repeated many times in many forms.

Could the NHI have prevented the deaths of the four Verdwaal children?


The answer depends on action in two interconnected areas: what kind of health service the National Health Insurance project delivers and whether the government effectively addresses the inequalities and social injustices that lead to poor health. 

First, regarding the health service, the process must deliver universal healthcare through an equitable, green, and sustainable national health system. To achieve Universal Health Coverage (UHC) as intended in the NHI Bill, it must interpret the “C” as the right to care rather than market-driven insurance coverage. This is the only way to reverse the currently operating Inverse Care Law, where those who need healthcare most have the least access.



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It is also essential to move the central focus of health services from hospitals to high-quality, team-based care in community settings, extending to the household level. For example, if a well-trained, well-supported community health worker who knows the community around Verdwaal had visited the Mmupele home, identified the problems early and taken appropriate action to relieve the family, these children’s deaths could have been prevented. It’s not hard to imagine that their life course would also have changed substantially for the better.

Moving the focus of healthcare to communities should make healthcare more accessible and allow for community participation in issues related to health. Meaningful community participation, where local health services are accountable to the community, could improve the service, make it more relevant to the specific community, reduce corruption and build trust. More community-based health services should also reduce the system’s greenhouse gas emissions.

The aim of the UN Framework Convention on Climate Change process to limit the warming to 1.5°C is unlikely to succeed. (Photo: Black Star / Spotlight)



Second, improving the health services alone will not entirely prevent more Verdwaal deaths because it will not change the underlying conditions under which children live, fail to thrive and die. Concerted, collaborative intersectoral action beyond the Health Department is necessary to ensure equitable access to the social, economic and commercial determinants of health.

Human and children’s rights must be at the centre. These are laid out clearly in the UN Convention on the Rights of the Child and in our Bill of Rights, as in other legislation. Economic justice and social solidarity are central. We have to make a decisive break with neoliberal capitalism and trickle-down economics. We need a wealth tax to pay for a universal basic income as a citizens’ right.

The worsening climate crisis poses a threat to women and girls and their access to healthcare in the country. (Photo: Black Star / Spotlight)



All of this depends on whether the NHI project achieves what it originally intended. An opportunity like this to develop the health system we need comes around about once in a generation. But the process is non-transparent and appears to be bogged down in conflicts of interest, poor governance, political stalemates, endemic corruption and a deep trust deficit.

This time, we don’t have the luxury of time. Unless we get ahead of both the climate crisis and the current levels of pervasive injustice, we will never be able to catch up.

Finally, we have to recognise children’s agency. Young children around the world are becoming more active in this, sometimes in ways we might not like. But they need our endorsement and support. No one has a bigger stake in dealing with climate change than those born today. MC/DM

Professor Louis Reynolds is a retired paediatric respiratory and ICU specialist and Associate Professor in the Department of Paediatrics and Child Health at UCT, where he is a member of the Advocacy Committee. He is a member of the Steering Committee of the People’s Health Movement.

This article was published by Spotlight – health journalism in the public interest.

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