October Health – 2025 Report

Chronic illness in South Africa

Leading cause: Poverty and socioeconomic inequality, particularly unemployment and financial hardship, are the primary population-level drivers of chronic-illness–related stress in South Africa. Rationale: High inequality, job insecurity, rising healthcare costs, and gaps in access amplify stress for people living with chronic illnesses (e.g., HIV, TB, hypertension, diabetes). Stigma and limited healthcare support further compound stress at the population level. Workplace considerations: - Financial and health benefits: provide affordable healthcare access, medication support, sick leave, and financial planning resources. - Mental health support: offer confidential counselling and digital group sessions (e.g., October) to employees managing chronic illness. - Flexible, supportive work policies: promote flexible scheduling, reduce stigma, and train managers in mental health awareness.

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Chronic illness Prevalence
8.46%
Affected people
4,653,000

Impact on the people of South Africa

Effects of chronic illness-related stress on health and personal life

Health effects

  • Physical health: can worsen disease activity, increase fatigue, disrupt sleep, and decrease medication adherence.
  • Mental health: higher risk of anxiety, depression, and burnout.
  • Cognitive effects: difficulties with concentration, memory, and decision-making.
  • Pain and symptom perception: amplified pain and discomfort.
  • Health behaviors: tendency toward unhealthy coping (poor diet, alcohol/substance use) and reduced physical activity.

Personal life effects

  • Relationships: increased caregiver burden, conflict, and reduced quality time with loved ones.
  • Work/school: more absenteeism and reduced productivity or performance.
  • Financial strain: medical costs and time off can impact finances.
  • Social life: withdrawal and isolation due to fatigue or stigma.
  • Daily functioning: less energy for chores, social activities, and self-care; lower sense of self-efficacy.

Coping & support

  • Self-care and energy management: prioritize sleep, nutritious meals, gentle activity as tolerated; pace tasks.
  • Social and workplace support: communicate needs with family, healthcare providers, and HR/manager; request reasonable accommodations.
  • Digital resources: October digital group sessions, assessments, and psychoeducation can help cope with chronic illness stress.
  • Local SA resources: SADAG helpline 0800 567 567; Lifeline SA 0861 322 322; in immediate danger call 112 (or 10111).
  • When to seek urgent help: persistent depressive or anxious symptoms, thoughts of self-harm, or rapidly worsening physical symptoms.

Impact on the South Africa Economy

  • Direct costs

    • Higher healthcare spending, disability benefits, and out-of-pocket costs for individuals, which can strain public funds and households in South Africa.

  • Productivity and labor market

    • Increased absenteeism and presenteeism; reduced on-the-job performance; faster skill depreciation and turnover.

  • Growth and fiscal space

    • Slower GDP growth; greater demand on social transfers and debt, reducing fiscal flexibility for investment in other sectors.

  • Equity and social outcomes

    • Widening inequality; greater burden on low-income and informal workers; potential caregiver strain and educational disruption for dependents.

  • Mental health spillovers

    • Chronic stress impairs concentration and decision-making; higher burnout risk, which can amplify productivity losses and reduce innovation.

  • Mitigation strategies

    • Workplace mental health programs, flexible work arrangements, and chronic disease management to sustain productivity. Digital supports (e.g., October) can reduce barriers to care and lessen absenteeism by providing accessible group sessions and assessments, especially in South Africa.

What can government do to assist?

  • Universal, affordable, integrated care for chronic illness and mental health, with clear referral pathways and continuity of care.
  • Routine mental health integration in chronic disease care: regular psychosocial screening, brief interventions, and easy access to counselling.
  • Strong social protection to reduce financial stress: paid sick leave, disability benefits, affordable medications, and transport subsidies for clinic visits.
  • Prevention and health-promoting environments: nutrition, physical activity, tobacco/alcohol controls, and early detection programs.
  • Investment in primary health care and digital health: trained workforce, telemedicine, remote monitoring, and digital group support (e.g., October) for education and peer support.
  • Address social determinants and support community-based care: empower community health workers, focus on SA rural/township disparities, and improve housing, water, sanitation, and food security.

What can businesses do to assist their employees?

  • Policy, privacy, and accommodations: Implement a formal chronic illness policy, protect confidentiality, and provide reasonable accommodations (flexible hours, hybrid work, phased returns).

  • Flexible work and workload management: Offer hybrid/remote options, adjustable hours, paced workloads, and plans for flare-ups.

  • Health and mental health supports: Provide access to occupational health, Employee Assistance Programs (EAP), paid sick leave, and mental health resources.

  • Manager training and return-to-work planning: Train managers to spot stress signals, hold supportive conversations, and create individualized return-to-work plans.

  • Practical accommodations and workplace design: Ergonomic adjustments, regular rest breaks, accessible facilities, quiet spaces, and small anti-fatigue adjustments.

  • Digital tools and October integration: Offer October digital group sessions, assessments, and content on chronic illness stress; ensure privacy and track engagement.