Neo-Liberal Economics and Disparity in the South African Health Crisis
While gentle pinks settle on a billowing Atlantic ocean, Apple watches fly through the air on the wrists of the rich and privileged setting off on their usual morning jog on the Sea Point promenade. It is slightly more humid than average – there is no doubt that this will add another 0.2 seconds onto Steven’s lap time which will make for an interesting discussion at the post-jog meet up at Bootleggers. Maybe if he drank Matcha tea instead of experimenting with whey protein he would have been able to match Jonathan’s record of strutting the promenade in under 20 minutes. According to David, whose trainer swears by this, trading in his two year old Nikes for the latest Under Armour running shoes will not only cut his time by 5 seconds but will also sort out that jaunty ankle of his.
The slamming of taxi doors jars the stillness of the cool Langa morning. Thudding along in time, Henry jogs past children getting ready for school and swerves cars refusing to stop at red lights. The shouts and whistles serve as his theme song, no earphones are needed. A set route and a pair of Tekkie Town’s makes his mornings all the better. There is no after-jog coffee waiting for him at home as he has to rush to get onto the train and head off to university. Squashed between a clinically obese woman and a man with a chronic cough, he falls asleep in the train. Balancing his schoolwork and pushing his running time is difficult work but it is something he must do if he hopes to achieve his dream of becoming a Springbok and lifting his family out of poverty.
In a country where a few live in the lap of luxury and the rest in desperate squalor, the definition of a healthy lifestyle is heavily contested. 54% of South Africans survive on an income below 3$ a day while less than 5% of those who work provide more than 50% of personal tax income. Yet, despite these contrasting lifestyles, both sides of the class divide are seemingly plagued by the same non-communicable diseases: heart disease, diabetes and obesity. With deaths caused by hypertension, ischaemetic heart disease and diabetes mellitus steadily on the rise in South Africa, finding a one size fits all solution has proven difficult. Although the government actively targets diseases such as Tuberculosis and HIV Aids effectively, solving the national health crisis is far more complex. Factors such as socioeconomic standing, gender, age and culture create a multitude of facets which each need to be taken into consideration. Even though Sea Point and Langa exist on opposite ends of the spectrum, these diseases affect their residents one in the same.
South Africa adopted a neoliberal economic policy after the fall of Apartheid. While this sounds socialist in nature, it is quite the opposite. Think privatisation, globalisation and deregulation. During Apartheid, policies focused on advancing the economic standing and health of White people who made up less than 10% of the population. When the ANC took power in 1994, many hoped that this would change and that everyone would have access to free quality healthcare. It did not happen. Although there are government hospitals and some medicine is subsidised, to say that it is universally of good quality would be a lie. As Dr Benatar explains, this is because neoliberal economics puts the focus on upgrading the healthy body rather than curing the sick one. As the majority of healthy people in South Africa were White people, neoliberal health policies continued to benefit them. There are few policies in place which actively try to uplift the health of economically disadvantaged Black people and so many are left in a worse situation than before. Consequently, while the government advocates for “healthy lifestyles” in rural and poor areas in multi-million rand campaigns, it is impossible to achieve as the poverty stricken people the government are trying to reach struggle to maintain a below-par health let alone think about the effects of gluten on the body and whether to make their next salad with kale or spinach. How can non-communicable diseases in townships be stabilised if, for such a serious virus like HIV Aids, only 40% of those affected have access to ARVs?
Exercising in South Africa, even in its best areas, can prove to be a challenge. Roads are covered in potholes which blow bicycle tyres, shattered glass left on pavements cut into runners’ shoes and high crime rates make it particularly dangerous for women to exercise in anything but broad daylight. For runners in Sea Point, this fear of crime ran deep. Several were paranoid about being mugged or robbed when running along the promenade at night due to the influx of vagrants. Speaking to Daniel, an avid outdoor gym user in the locale, he told me that when he cycles or runs at night he never takes anything valuable with – no iPhone, Apple Watch or even earphones. The brightly lit side of the street offers the only secure route he says and, in spite of only being 2 metres away, he would never consider running on the darker ocean side. “It is simply not worth the risk”. “When you’re on the promenade at night, you see all the homeless people just watching you from the sides and it feels very threatening”. Two young mothers overheard our conversation and stopped to emphasise Daniel’s point. In quite a thick Sandton accent, they relived a tale about how a woman they knew was followed until the lighthouse when she ran here at night. An article published in Running World exposes how women are constantly told to exercise in groups, not use earphones and to simply avoid running at night because of the threat of violence. In a country where 12 rapes happened a minute on average in 2016, assault is a genuine concern. For the majority of people who work long hours, the evening is the only reprieve to get in their recommended 20 minutes of cardio. However, if they do not feel safe enough to even venture outside, how can they keep fit? While some argue that exercising at home will suffice, it does not carry the same health benefits as running several kilometres in fresh air. South Africans are already amongst the fattest in the world according to a survey done by GlaxoSmithKline. 49% of South Africans do not exercise in any case and that is including at home fitness. If it is the natural beauty of Cape Town which has been cited as the main reason for why people are motivated to run outdoors but then it lacks safety, people will not feel like exercising at all. As the one mother said, “if people aren’t given the easiest way possible and encouraged, they just won’t have the motivation to stay healthy”.
Safety is not just a middle class concern. It hits hard at the heart of fitness in the townships. Gang violence is prevalent and many teenagers get involved in gangs and drugs before they even turn 15. For those wanting to make a better life for themselves through sports and focus on their physical wellbeing, there is a definite pressure on them to be part of the gang culture. Henry, a rugby player for a club in Milnerton, spoke about his concern about this situation. “When I come home from training, I always get tuned for playing rugby. A lot of the guys I went to school with just sit on the roadside and smoke all day and ask me when I’m finally going to quit and join them and be a man. I don’t know hey, I’m worried that I’m going to come home one day and it’ll be the end of it”. Despite the severity of the gang crises in the Cape townships, this is not the only reason for the lack of fitness culture. Unlike Sea Point, which has a variety of outdoor gyms and an impeccably maintained promenade, the townships were hardly created to be a world-class fitness arena. Although much has changed since the fall of Apartheid and many RDP houses now have access to electricity and sanitation, service delivery protests happen regularly. Sewage often overflows onto the streets, shacks are ravaged in uncontrollable fires and the lack of community facilities makes people turn to unhealthy habits to occupy their time. Keeping fit in this environment is, needless to say, difficult.
In the Sea Point metropole, it is a completely different story. With an abundance of niche fitness stores, vegan cafes and winding ocean routes, exercising here is a see and be seen activity. Running at a casual pace were two UCT students who I managed to flag down. At about 6 foot tall and decked out in Apple watches and Nike running gear, they were not exceptionally different from any of the other joggers here in Sea Point. Asked about what exercising in Sea Point is like, I was told that “keeping fit in Sea Point is relatively easy and accessible because you’ve got the outdoor gym by the library and then by the urban park there’s another one”. Asides from the infrastructure, the natural beauty was a highlight for the two. “Living in Sea Point and keeping fit is so easy because everything is on your doorstep. I can go for a lovely run, a cycle to Camps Bay, it’s magical.” With a rosy pink sky and a brisk wind cooling the morning, their awe was not difficult to believe. Groups of matching marchers sprinted past us as we were talking while luminescent pink yoga pants lapped us twice. The full force of Sea Point was out and about buzzing along the promenade enjoying all the fitness benefits it has to offer.
The following morning, the township was also full of energy early in the morning. Rather than shiny running shoes and the scent of post-jog caffeine, people were already on their way to work and packing themselves into taxis jetting off into the city centre. As compared to Sea Point where if you turned your head you would bump into a vegan cross-fitter, the search for a single jogger proved futile. Much to my luck, a 23 year old man wearing a Milnerton rugby outfit was willing to be asked a few questions. “What I like most about exercising here is that there’s more versatile terrain to train on. You don’t think too much in a gym but here anything can happen. It really teaches you to appreciate what you have when you see all the different ways you can use your environment to your advantage.” Looking around, there were no outdoor gyms to be spotted or scenic walkways carved out. Instead, littered grassways hedged onto cracked pathways lining the colourful variety of houses. This does not prove to be a challenge to the young athlete who came up with a cunning plan to circumvent the lack of fitness infrastructure. He and his friends pitch in for membership at the Club Fitness which is put in one of their names and they swap the card around whenever one wants to gym. Luckily for them, they have never been caught doing this.
A combination of physical exercise and a balanced diet would prevent these non-communicable diseases plaguing South Africa. With a solution so easy, why is it not being implemented into people’s daily lives? 79.8% of South Africa is fertile farmland with vegetables and fruits growing plentifully. Surely it would not be any trouble keeping up with the latest superfood diets seeing as there is an abundance of organic home-grown food? The hundreds of KFCs, Chicken Licken and street meat markets in the townships would beg to differ. Why is this the case? Western fast food is cheaper than South African grown products. The comparison between buying dinner for a family of four from Pick ‘n’ Pay to Steers clearly demonstrated this. From Pick ‘n’ Pay, a Werda Three Bean Salad for one costs R22 and four chicken thighs cost R39.50 thus about R127.50. From Steers, four Rave Burgers and Chips, on the other hand, comes to only R107.60. For the 54% earning less than 3% a day, that R20 makes all the difference. It is a taxi fare to work, breakfast money or a train ticket. They do not have the privilege to worry about extraneous details such as how many calories their food contains, its nutritional value or whether it is vegetable fat instead of animal. What they are concerned about is feeding their family enough. Speaking to a young mother with two children running around the Khayelitsha bus stop, she told me that where she lives, the most important thing is waking up in the morning and thanking God that there is some food on their table. She says that as long as her children are not starving and can go to school, she is happy. When asked about whether she considers the nutritional value of the food she makes she laughed and pointed to her children and asked if they looked sick – they did not.
This attitude was shared by many people interviewed in Khayelitsha. However, I stumbled across a hopeful exception. A 50 year old man named Francis told me that he is healthiest on his whole street because his wife makes him good salads and does not buy their meat off the street, as is commonly seen in the townships. His diet at work was an entirely different story. “Every day, I take my lunch at the KFC in St George’s Mall…they have really good wings and it’s quick-quick, no waiting whatsoever.” Many people like Francis stated that they valued the convenience of fast food over the nutritional value of preparing a salad. In their world, money is everything. It determines their sleep schedule, their travel time and even the food they eat. Everything conforms to a money to time ratio. Many domestic workers living in the township have to wake up at 4am to prepare breakfast for their children and bathe them before getting into the taxi to get to the suburbs in time for a 7am start. This leaves little time to plan how many servings of fruit there will be in each of their meals or how many portions of protein they should be consuming if they are working for 8 hours. Fast food alleviates this inconvenience by providing fast, efficient and edible food. For these workers, it is not necessarily the quality that matters but rather that they at least have something to eat during their arduous day. What fast food offers is an immediate satiation that powers workers through and solves the cravings they experience by often doing tough physical labour. Although healthy food would be better in the long run, many of these people are living day by day instead of year by year. To maintain that constant energy balance when eating healthily requires consuming a lot of vegetables, fruit and meat consistently which means taking time to find the right ingredients, prepare, cook and freeze it – all of which takes time these people do not have.
Possibly more numerous than the residents of Sea Point are the artisanal vegan health cafes lining the main road. Although originally known for its grit and working class suburbia appeal, Sea Point was rapidly gentrified in the years after the World Cup and is the pinnacle of the Cape Town food scene. Here, you can find a variety of Asian cuisine, Syrian dishes, kosher cholent and gourmet vegan plates. The benefits of having such a diverse range of food are numerous. First of all, a balanced diet is easy to obtain as you do not have to go out of your way to source different vitamins but instead just have to walk along the main road. Unlike the townships, you are not stuck with what is available but you can select exactly what you want with the assurance that it is organic and good quality. Having access to such a large choice of nutritious food and finding what you enjoy makes keeping healthy so much easier, says Lisa, 24. Since moving to Sea Point 5 months ago, she says she has never been so health conscious. “Being in Sea Point and trying to stay healthy is so much easier than anywhere else. I used to go to McDonald’s all the time and get their chips but now I can go downstairs and just grab a salad from Kleinsky’s instead”. The lack of fast food stores and multiple eco-conscious organic cafes removes the temptation to eat unhealthily – whether it be binge eating or only having McDonald’s for breakfast.
Medicine is no longer about curing, but upgrading. In his best-selling book, Homo Deus, Dr Harari discusses how elites funding medical discoveries are no longer interested in helping the poor have stable health but have turned their focus to upgrading already heathy humans into a form of ‘superhuman’. Why? There is simply no need for masses of people anymore. As armies become smaller and more specialised and factory jobs are outsourced to machines, the working class’ value falls. Why help the masses of little economic value when we can rather create a powerful focused force of an elite few? This is the neoliberal economic thinking which is slowly taking over Western countries, with Obamacare being scrapped and the NHS’ funding being increasingly limited. However, it is not just in the West that this elitist health revolution is taking over but also in South Africa.
Keeping fit and eating clean go hand in hand. It is no wonder then that Sea Point has a thriving culture of quality cuisine and exercise. Wellness Warehouse, one of the newest go-to chain stores for vitamins, smoothies and specialised fitness powders, was bustling as men in cycling shorts carefully scanned shelves for a rare imported protein powder and yoga pants clad mothers chatted away with their iPhones in one hand and their green smoothies in the other. Speaking to one of Wellness Warehouse’s investors, I asked him why this particular store was having phenomenal success. Greg told me that it was due to what the store had to offer – exclusive high quality products. In the community, there is this drive to not simply be healthy or fit but to be the healthiest and fittest they can possibly be and if that means spending R2000 on a box of tablets, they certainly have the means to do it. It is that neoliberal economic push to specialise to the point of perfection which affects the fitness culture of Sea Point. Numerous runners who grace the promenade each morning spend over R20 000 on specialised running kit which claims to maximise their capabilities and enter every single marathon Cape Town offers, seemingly every weekend.
The government has not yet come up with a solution to balance these extremes. Rather, coming up with concrete solutions has been left to entrepreneurial citizens to open affordable gyms in townships and to organise free trail runs like Park Run to encourage all backgrounds to participate. Tumi Masite’s gym in Alexandra is one of the success stories. Transforming his home into an affordable gym where members only pay R100, he has transformed his community. Not only is he helping rehabilitate numerous stroke sufferers but he has also trained young delinquents who have gone on to get jobs in the security sector. The gym is not simply a place to work out, but also a basis for promoting a healthy lifestyle. It is run by a member of the community, in the township and it is so close-knit that “sometimes [he] [uses] money from [his] child's pocket to help people". Despite all the government bureaucracy limiting small economic enterprises, Masite is having far greater results than government health campaigns as he has made fitness and health education accessible and personal for the community members. Instead of the standard issued posters explaining the benefits of a balanced diet and staying active painted on every clinic wall, he actually provides the resources the community would otherwise not have had access to.
Similarly, Parkrun aims to bring people from all backgrounds together by offering free, safe and organised 5 kilometre runs. Professional athletes to college students to mothers with prams participate in these runs which take place all over Cape Town. By offering a welcoming and safe environment, it encourages many people to exercise. Robyn, 20, and Megan, 21, spoke about their love for Parkrun. “I’ve always wanted to run outside of the gym but I’ve never felt safe enough to do so. Parkrun gives me the chance to explore my city and keep fit without having to worry about anyone following me or if I’m in a safe area”. “Not a lot of my friends can afford to join the Virgin Active with me so Parkrun is where we can really help each other get our summer bodies on and support each other”. Just like Sea Point’s culture of health and fitness encourages new residents to also follow the trend, Parkrun’s ideology of community spirit inspires people to take up a healthy lifestyle as everyone else seems to being doing it. Having a viable support network is important for leaving behind a sedentary life. When you are running and feel tired, the other runners give you a pat on the shoulder to motivate you to finish. The extremely fit runners who finish in 14 minutes often stay behind to give advice and to offer insider information into the world of extreme fitness and health. These aspects of Parkrun promote a healthier lifestyle as maintaining a healthy lifestyle no longer becomes about you but about the community. As Will, 22, says “you are no longer accountable to just yourself but to the group”. Although he was always a runner, he says he would find himself stopping at the Creamery after each jog to get a waffle which would set his fitness goals right back. However, since he began Parkrun 4 months ago, he has lost 5 kilograms as, instead of stopping at the Creamery, he relaxes at Bootleggers with a cup of coffee, surrounded by his fellow runners.
Whether these types of initiatives are what will get South Africans up and moving is irrespective in the face of the larger health crisis. As organic food becomes increasingly expensive and the poor are left behind because of the elite’s growing indifference towards the masses, non-communicable diseases are not going to be stopped. More people are going to suffer because of their compulsive sedentary lifestyle and death rates because of preventable diseases like diabetes and hypertensions are going to rise. Unless the government is able to somehow merge together both fitness communities and create an intergrated solution, these blatant inequalities are going to fester into a far greater health crises affecting not just individuals, but the economy as a whole.
