Tag: unemployment

Categories : Mental HealthTags :

SA Has the Third Highest Suicide Rate in Africa – There are Steps We can Take to Tackle it

On By ModernMedia
Photo by Alex Green on Pexels

By Vincenzo Sinisi

South Africa has the third highest suicide rate in Africa and Africa has higher rates of suicide than any other continent. In the wake of World Suicide Prevention Day on September 10th, clinical psychologist Vincenzo Sinisi asks what can be done to bring down suicide rates.

Africa is currently the region with the highest suicide rate worldwide, according to the World Health Organization (WHO). This is driven by a combination of factors, including poverty, unemployment, and untreated mental health issues.

South Africa, with a suicide rate of 23.5 per 100 000 people, ranks third worst on the continent. South Africa is closely followed by Lesotho and Eswatini – countries where limited access to mental health services exacerbates the issue.

Age and gender impact suicide risk. In South Africa, for instance, suicide has been rated as the fourth leading cause of death among people aged 15 to 24, reflecting the devastating mental health toll on young people. The gender disparity is stark – men are four to five times more likely to die by suicide than women. However, women tend to report twice as many suicide attempts as men, indicating a significant gap in prevention efforts targeting both genders

Why is it happening?

While suicide is a global challenge, it manifests differently across Africa due to a variety of factors – these include economic hardship, mental health stigma, and the scarcity of healthcare resources.

Mental healthcare in Africa is severely underfunded. Many African countries have an insufficient number of mental health professionals – sometimes as few as one psychiatrist per 500 000 people. This is compounded by widespread mental health stigma, which prevents many people, particularly men, from seeking help. In some African cultures, suicide is stigmatised to the extent that it is linked to supernatural beliefs, such as curses or sorcery. These deep-seated cultural beliefs often lead to underreporting of suicide cases and contribute to delayed intervention.

In addition to cultural taboos, socioeconomic stressors like unemployment, poverty, and housing insecurity further drive suicide rates across the continent. In South Africa’s townships, the levels of indebtedness and joblessness create a cycle of despair that feeds into psychological distress, ultimately increasing the risk of suicide.

In South Africa, the impact of socioeconomic instability on mental health is evident, particularly in rural and impoverished urban areas. The link between unemployment and mental health distress is well-documented, and for many, this distress leads to thoughts of suicide. In economically deprived areas, suicide prevention efforts are often undermined by poor access to healthcare and low mental health literacy. As economic hardship worsens, so does the mental health of affected populations.

What to do?

Preventing suicide in South Africa and on the African continent more broadly requires a multi-level strategy, combining grassroots initiatives with government support. Many successful interventions have originated from community-based programmes tailored to local needs and cultural contexts – there are after all large differences between countries and, for example, between urban and rural areas.

As a starting point, community involvement is crucial in creating a supportive environment for those at risk. By training community leaders, including traditional healers and faith-based leaders, to recognise signs of mental health struggles, these communities can provide immediate support. Peer support networks have also proven effective, especially in areas with limited access to formal healthcare services. Such networks empower individuals to check in on one another and provide emotional support in times of crisis.

For example, the South African Depression and Anxiety Group (SADAG) runs mental health education programmes across rural South Africa, equipping local leaders and volunteers with tools to recognise and respond to signs of suicide. These efforts are helping to reduce stigma and encourage early intervention in communities often overlooked by national healthcare systems.

While community-led efforts are invaluable, government policy is essential for creating systemic change. South Africa’s National Mental Health Policy Framework (2023-2030) aimed to integrate mental health care into the primary healthcare system. Still, its implementation has been slow, particularly in rural areas. Expanding this framework and ensuring proper funding for mental health initiatives must be a priority. (Spotlight previously reported on expert responses to the new mental health policy.)

Governments can also collaborate with NGOs and the private sector to expand mental health services.

Telehealth and digital solutions have for example emerged as potential tools for addressing mental health challenges, particularly in areas where access to mental health professionals is limited. Telehealth services enable patients in remote and underserved areas to consult with mental health experts without travelling long distances. This is especially helpful for individuals who might otherwise be unable to access support due to geographic or financial barriers. One such initiative I am involved with is TherapyRoute.com, a platform that connects people with therapists and psychologists across Africa and  that maintains a database of South African community health clinics.

Such a digital approach, though promising, still faces challenges. Internet access remains inconsistent in many parts of Africa, and telehealth services must continue to evolve to ensure they are accessible to most of the population. Increasing investment in digital infrastructure will be a critical part of expanding access to mental health services.

Practical strategies

Meanwhile, there are practical things we can do now. Suicide prevention is after all not the responsibility of healthcare professionals alone – everyone can contribute.

We can all be on the lookout for the warning signs. Sudden withdrawal from social activities, mood changes, declining self-care and hygiene, and expressions of hopelessness or helplessness (e.g., “I can’t go on” or “Everyone would be better off without me”) should never be ignored.

If someone you know appears to be at risk, ask direct questions about their mental health. Don’t be afraid to ask if they are considering suicide. Studies show that directly asking about suicide can reduce the risk of an attempt by giving the person a chance to talk about their feelings.

We can also respond as a community. We can organise peer support groups where people can check in on one another. Training community leaders, traditional healers, or local volunteers to recognise suicide risk and provide mental health first aid is another effective way to support those at risk. Running community-wide campaigns to raise awareness about mental health issues and reduce stigma can help normalize seeking professional help.

Governments also have a critical role to play. They must prioritise mental health by increasing funding for prevention and treatment programmes, particularly in rural and underserved areas. The success of such programmes depends heavily on their accessibility to people from all economic backgrounds.

In South Africa, government should focus on implementing the National Mental Health Policy Framework, ensuring it reaches the rural areas that are most in need. By integrating mental healthcare into primary healthcare services, as envisaged in the policy framework, more people will have the chance to receive timely care.

Ultimately, suicide prevention requires a multi-level approach, with involvement from individuals, communities, governments, and the private sector. By recognising warning signs, reducing mental health stigma, and expanding access to care through both in-person and telehealth services, we can make meaningful strides in reducing the suicide rate across Africa.

*Sinisi is a clinical psychologist and psychoanalyst in private practice in Cape Town. He is also a faculty member of the South African Psychoanalysis Association, The South African Psychoanalytical Initiative, and the Centre for Group Analytic Studies.

People in need of help can contact SADAG on the following helplines:

  • 0800 21 22 23 (8am to 8pm)
  • 0800 12 13 14 (8pm to 8am)
  • SMS: 31393

Also see this webpage for a longer list of helplines.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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Categories : Hospitals Medical IndustryTags :

Rising Health Care Prices Result in Non-healthcare Job Cuts

On By ModernMedia
Photo by Inzmam Khan

Rising health care prices in the US are leading employers outside the health care sector to lay off employees, according to a new study co-authored by a Yale economist.

The study, published June 24 as a working paper by the National Bureau of Economic Research (NBER), found that when health care prices increased, non-health care employers responded by reducing their payroll and cutting the jobs of middle-class workers. For the average county, a 1% increase in health care prices would reduce aggregate income in the area by approximately $8 million annually.

The study was conducted by a team of leading economists from Yale, the University of Chicago, the University of Wisconsin-Madison, Harvard University, the US Internal Revenue Service (IRS), and the US Department of the Treasury.

“When health care prices go up, jobs outside the health care sector go down,” said Zack Cooper, an associate professor of health policy and of economics at Yale University. “It’s broadly understood that employer-sponsored health insurance creates a link between health care markets and labour markets. Our research shows that middle- and lower-income workers are shouldering rising health care prices, and in many cases, it’s costing them their jobs. Bottom line: Rising health care costs are increasing economic inequality.”

“Rising prices are hurting the employment outcomes for workers who never went to the hospital.”

Zack Cooper, Yale economist

To better understand how rising health care prices affect labour market outcomes, the researchers brought together insurance claims data on approximately a third of adults with employer-sponsored insurance, health insurance premium data from the US Department of Labor, and IRS data from every income tax return filed in the United States between 2008 and 2017. They then used these data to trace out how an increase in health care prices, such as a $2000 increase on a $20 000 hospital bill, flows through to health spending, insurance premiums, employer payrolls, income and unemployment in counties, and the tax revenue collected by the federal government. 

“Many think that it’s insurers or employers who bear the burden of rising health care prices. We show that it’s really the workers themselves who are impacted,” said Zarek Brot-Goldberg, an assistant professor at the University of Chicago. “It’s vital to understand that rising health care prices aren’t just impacting patients. Rising prices are hurting the employment outcomes for workers who never went to the hospital.”

Hospital Mergers Raised Prices

For the new study, the authors used hospital mergers as a vehicle to assess the effect of price increases. From 2000 to 2020, there were over 1000 hospital mergers among the approximately 5000 US hospitals. In past work, the authors found that approximately 20% of hospital mergers should have been expected to raise prices by lessening competition, according to merger guidelines from the Department of Justice and the Federal Trade Commission. These mergers, on average, raised prices by 5%.

“We can use our analysis to estimate the effect of hospital mergers,” said Stuart Craig, an assistant professor at the University of Wisconsin-Madison Business School. “Our results show that a hospital merger that raised prices by 5% would result in $32 million in lost wages, 203 lost jobs, a $6.8 million reduction in federal tax revenue, and a death from suicide or overdose of a worker outside the health sector.”

The study also showed that because rising health care prices leads firms to let go of workers, a knock-on effect of hospital mergers is that they lead to increases in government spending on unemployment insurance and reductions in the tax revenue collected by the federal government.

“It’s vital to point out that hospital mergers raise spending by the federal government and lower tax revenue at the same time,” said Cooper. “When prices in the US health sector rise, it’s actually a net negative for the economy. It’s leading to fewer jobs and precipitating all the consequences we associate with workers becoming unemployed.”

Source: Yale University

Categories : CancerTags :

Unemployed People Missed Out on Cancer Screenings

On By ModernMedia
Source: National Cancer Institute

In a recent study, unemployed individuals in the US were less likely to have health insurance and be up to date on getting recommended cancer screening tests. Analyses published in the journal CANCER revealed that their lack of health insurance coverage completely accounted for their lower screening rates.

During the COVID pandemic, unemployment rates in the United States have risen to levels not seen since the Great Depression. To examine associations between unemployment, health insurance, and cancer screening, Stacey Fedewa, PhD, of the American Cancer Society, and her colleagues analysed information from adults under age 65 years who responded to a nationally representative annual survey of the general population.

Unemployed adults were four times more likely to lack insurance than employed adults (41.4% vs 10.0%). A lower proportion of unemployed adults had received up-to-date cervical (78.5% vs 86.2%), breast (67.8% vs 77.5%), colorectal (41.9% vs 48.5%), and prostate (25.4% vs 36.4%) cancer screening. These differences were eliminated after accounting for health insurance coverage.

“People who were unemployed at the time of the survey were less likely to have a recent cancer screening test and they were also less likely to be up-to-date with their cancer screenings over the long term. This suggests that being unemployed at a single point in time may hinder both recent and potentially longer-term screening practices,” said Dr. Fedewa. This can increase a person’s risk of being diagnosed with late-stage cancer, which is more difficult to treat than cancer that is detected at an early stage.

“Our finding that insurance coverage fully accounted for unemployed adults’ lower cancer screening utilisation is potentially good news, because it’s modifiable,” Dr Fedewa added. “When people are unemployed and have health insurance, they have screening rates that are similar to employed adults.”

The findings highlight insurance coverage’s importance in access to recommended cancer screening tests and indicate that insurance needs to be extended to all people, regardless of their employment status.

Source: Wiley