**9. Fossil fuel, sedentary life unsafe places**

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...* 

**6. Conditions in which we are conceived, born, grow, live and work** 

24 years since independence apartheid in South Africa has persisted in an economic form [18]. Many families live in airless hovels constructed using splintered boards and metal sheets [18]. Post-apartheid, land is still largely in the hands of the white elites with most black South Africans still living in the townships [18] and one needs political ties to survive and thrive in business [18], closing this door to many. Health is determined by the conditions in which we are born, grow, live and work [19]. We take this a step further and say health is determined by the conditions in which we are **conceived**, born, grow, live, work etc. One South African domestic worker said;

*"Our children are being born in the same situation I was born" [18] - Credit Jao* 

In rural settings, people often have land, are surrounded with friends and neighbours, have time, have spiritual groups usually and the environment is less crowded and less filthy. Many have access to seasonally available fruit and vegetables. In the urban setting, many blacks have no access to land, live in crowded unsanitary, unsafe environments and neighbourhoods, isolated and often cannot practice spirituality, and many live from hand to mouth-informal sector. The usual diets are

The impact of former apartheid policies on the health system have been documented and these inequalities have grown along class rather than racial lines recently [20] and these issues still have effects on children being conceived under these conditions to date. The well to do have access to quality health care services from the private health sector, while 80 percent access health care from the overburdened public health sector [21]. Rapid urbanisation is also partly to blame for the increase in coronary heart and artery disease and metabolic disorders [22]. Some people moved from a shack during apartheid to another shack [18] post-apartheid. The living conditions have not changed much. Several hours a day are spent commuting [18] to places of work making them time poor. A foetus conceived while mum is in poor health, malnourished etc., will be affected by these conditions even later on in life -health consequences. The health of the mother affects the heath of the baby. A healthy mum is predictive of a healthy infant. This might

**affect our health**

*Silvia, New York Times.*

high in carbohydrates and saturated fats.

**7. Conditions in which most south Africans live**

sound like chicken egg debate, which was first-and health is the chicken.

No land no collateral [18], is another glaring issue in South Africa. Many South Africans have no access to land. Investment in ensuring that people have access to land, ensuring safe water supplies through digging more wells, boreholes and improving sanitation- the very conditions that promote people to be and stay healthy is fundamental. Land ownership is one instrument that is pivotal in addressing both rural and urban poverty [16]. In good health people can then access education, employment etc.

*"We never dismantled apartheid. The patterns of enrichment and impoverishment* 

*are still the same." Ayabonga Cawe, former economist Oxfam [18].*

**6**

**8. Access to land**

Causes of cardio vascular diseases (CVDs) in SA are high BP, smoking, drinking, poor eating habits, obesity and lack of physical activity [22, 23] and psychosocial stress (depression, anxiety, hostility) [24]. Cardiovascular risk factors disproportionately affect the socio-economically disadvantaged [25] and we can speculate how this comes about.

People use fire for cooking, breathing in fumes, barefoot they walk on ground littered with broken glass, needles, tins and daily they exchange armed robbery updates [18]. Is this conducive for health? Police frequently descend on these informal settlements tearing down these shacks without warning [18]. In some settlements human waste forms puddles [18]. While in some predominantly white areas toilets are stocked with soap, toilt paper, staffed with janitors and security guards [18], many townships are ghettos of isolation [18]. Diet, sedentary life, loneliness and stress and how people deal with it e.g., drinking and smoking are prevalent issues in townships. People often do not know where to get the next meal and the insecure environments prevents physical activities like walking forcing people to take taxis home or to school (no safe places to walk). Attending worship is also affected by these unsafe places. Some services are in the evening. Spirituality has been proven to give meaning and purpose to stressful life events leading to more positive emotions like well-being, happiness, optimism and fewer negative emotions. The psychological benefits of spirituality affect immune, inflammatory, endocrine and even autonomic functions. These unsafe contexts further deprive people of these benefits further affecting heart health [24].
