Healthy Active Kids South Africa Report Card

In June 2007, Prof. Vicki Lambert was introduced to the concept of the Active Kids Canada Report Card, which is an advocacy and benchmarking initiative of the Canadian government in partnership with the private sector. As a result, she proposed to Discovery Vitality and the Sports Science Institute of South Africa to underwrite a similar initiative in South Africa. These institutions joined forces in September 2007, bringing together nine scientists from six tertiary institutions, to evaluate the current best evidence available on the four major risk factors placing South Africa’s children and youth at risk for chronic diseases:

  1. Tobacco use
  2. Poor diet
  3. Lack of physical activity
  4. Obesity


The goal of the report card is to evaluate the evidence, and provide recommendations to various stakeholders, to improve the health and well-being of South Africa's most important asset, its children. To this end, grades were awarded on the basis of the quality of scientific evidence and by consensus with an A for example, denoting “best practice to promote health and prevent chronic disease with excellent reach and/or impact, or those at lowest risk” and a D reflecting “practices which are insufficient to adequately promote health and prevent chronic disease due to unequal reach or adoption and impact”. The grade assignments are based on the analyses of the most recently available (within past 8 yrs) data sources. The assessment was performed by a scientific advisory panel comprised largely of academics who were directly or indirectly responsible for much of the data on which this report card is based and include: Prof. Priscilla Reddy (Health Promotion Research and Development Unit of the South African Medical Research Council, Prof. Yoga Coopoo, (Exercise Science and Sports Medicine) and Dr. Shane Norris (Dept of Paediatrics) of the University of the Witwatersrand, Prof. Thandi Puoane (School of Public Health, University of the Western Cape) Prof. Salome Kruger (School of Physiology and Nutrition, North West University, Assoc. Prof. Mike Lambert, Prof. Vicki Lambert and Dr. Tracy Kolbe-Alexander (Exercise Science and Sports Medicine, UCT), Dr. Nelia Steyn (Chronic Diseases of Lifestyle Research Unit of the South African Medical Research Council), and Ms Kathy McQuaide (Health Promotions, Sport Science Institute of South Africa).

The four major risk factors were graded as follows:


Tobacco use: Grade D

  • South African adolescents have the highest reported smoking prevalence amongst African health surveys
  • 30% have smoked a cigarette in their lifetime
  • 21% are current smokers (smoked one or more days in the past month)
  • Nearly 7% are frequent smokers (smoke 20 or more days in a month) and
  • 6% smoked their first cigarette before the age of 10

Legislation to prevent smoking received an A grading. South Africa was the first country in the world to declare nicotine an addictive drug by the Education Ministry. Anti-smoking legislation and taxation, the banning of tobacco advertisements, prohibiting of smoking in public places and health warnings on all cigarette packaging are all effective controls to discourage smoking in children.



Physical inactivity levels: Grade C

  • Physical fitness in South African urban youth is declining
  • About 40% of children and youth are getting little or no moderate to vigorous activity each week
  • Vulnerable groups are girls (aged 16-19) and children from disadvantaged communities


A sports participation culture is clearly lacking amongst adolescents. In fact the most commonly reported leisure time activity is cell phone use. An increase in screen time (television, PC’s, console games) adds fuel to the fire. High levels of crime also affect activity levels as the fear for personal safety inhibits the ‘walkability’ in communities.


Overweight, obesity: Grade C and stunting: Grade D

  • More than 30% of adolescent girls and nearly 10% of boys are either overweight or obese
  • There is also the paradox of obesity coupled with stunting and early nutritional deprivation that is found in our children
  • In a sample of children younger than nine years of age, 17% were overweight or obese and stunting was present in 19% of the same sample
  • Children from rural areas are at greater risk for stunting while those from urban areas run the risk of obesity
  • Furthermore, the risk for obesity in stunted children was twice as high with potential of long-term health risks


 Unhealthy eating: Grade D

The report found that children are not eating enough fruit and vegetables but consuming plenty of sugary foods and drinks. Other factors influencing this behaviour are the high cost of healthy foods as well as access, availability and knowledge. Legislation addressing food labels and misleading advertising is in the pipeline and should help to address some of the issues. Most children are able to identify healthy snacks, but they are twice as likely to bring unhealthy foods from home and 70% of children also make unhealthy choices when buying from the tuck shop. Of concern is that many of the schools rely on these shops as a source of additional funding.


Specific short term recommendations by the panel

  1. Engagement with adolescents, parents and teachers to explore knowledge, attitudes and practices.
  2. Development and evaluation of promising interventions focused on barriers to healthy eating, physical activity and tobacco control.
  3. Recognising that the prevention of chronic disease requires a life-course approach and that early life under nutrition may increase the susceptibility of children to later life risk.
  4. Ensuring that the promising legislative initiatives are implemented “on the ground” in a meaningful way, by ongoing monitoring.

The panel plans on submitting the process of the report card for peer-review, and broadening the consultative base going forward, focusing more on solutions.