South Africa is impacted by a quadruple burden of disease, including high rates of infectious diseases (ID), non-communicable diseases (NCDs) and mental disorders (MD). South Africa has the largest HIV burden globally with HIV disease accounting for 4.8% of deaths in the country in 2018. The combined burden of HIV with that of NCDs (such as diabetes, hypertension and cerebrovascular diseases) contribute to one third of the deaths in the country per annum.  Additionally, the country’s rates of MD are considered high compared to other international estimates, with 30% of South Africans estimated to develop a mental illness in their lifetime. There is evidence to suggest that these burdens frequently co-occur. People with HIV (PWH) are at higher risk of experiencing psychological distress and the development of mental disorders, including anxiety, mood, and substance use disorders. Additionally, NCDs, such as cardiovascular  disease, have been associated with increased risk of common mental disorders. The relationship between IDs, NCDs and MDs in South Africa is syndemic –The presence of one or other condition increases the risk of other conditions developing.

There is a common thread between these conditions – human behaviour. Over the past four decades, there has been growing recognition of the role of human behaviour in predicting health outcomes, and ever since, has been a targeted as a potentially modifiable factor in healthcare interventions. Subsequently, the field of behavioural medicine has grown rapidly all over the world. Behavioural medicine as a field is characterised by collaboration among many disciplines all focused on the development and integration of biomedical and behavioural knowledge that is relevant to health. In addition, this knowledge is applied in disease prevention, health promotion, diagnosis, treatment, rehabilitation, and care of people.

Given the behavioural risk factors associated with all three of the health crises seen in South Africa, a movement towards evidence-based behavioural medicine interventions is obvious. Yet, the uptake in the field has been slow in South Africa compared to global standards. This is not to say that behavioural interventions haven’t been utilised in South Africa. In fact, far from it. There are decades of research that describe interventions tailored to the improvement of co-occurring mental and physical illnesses. However, these efforts have not been unified under the banner of behavioural medicine, but rather fall under a variety of disciplines, including psychology, psychiatry, public health, and physiotherapy. If we are to effectively tackle the growing burden of mental and physical illness that is co-existing in South Africa, we need to strive for multidisciplinary collaboration by formalising the field of behavioural medicine in South Africa.

Considering the lacuna of clinical programmes that address the intersection of mental health disorders, chronic conditions and health in South Africa, the HIV Mental Health Research Unit within the Department of Psychiatry is launching a new Master of Philosophy in Behavioural Medicine programme in 2023. The proposed Master of Philosophy aims to provide students with advanced skills and knowledge in the prevention and management of multimorbid mental disorders and chronic conditions. The development of this programme and the subsequent development of skills in the field is an important step in defining the field of Behavioural Medicine in South Africa.

For more information, click here. For course and application details, email john.joska@uct.ac.za or stephan.rabie@uct.ac.za.