Hofman wins gold medal for health interventions

University of the Witwatersrand (Wits) Professor Karen Hofman was awarded the Science for Society Gold Medal in October for work to improve the health of South Africans.

Hofman was involved in the implementation of the sugar-sweetened beverage tax in South Africa, and in proving that decreasing salt in bread could reduce strokes and deaths.

Hofman, a research professor and the founding director of the South African Medical Research Council (SAMRC) for Health Economics and Decision Science at Wits, said she was honoured and privileged to receive the Science for Society Gold Medal from the foremost academy of sciences on the continent, the Academy of Science of South Africa (ASSAf).

Hofman received the medal for her application of scientific thinking in the service of society. The academy awards a maximum of two Science for Society Gold Medals annually in recognition of outstanding achievement in this area.

“This award showcases the issues around population health,” says Hofman, a Waverley Girls High School alumnus. “Receiving it was a thrill for me because I’m a Wits Medical School graduate and this award was made in Wits’s centenary year, so it felt particularly relevant.”

Fellow Wits professor, Achille Mbembe, was the other beneficiary of the medal at ASSAf’s annual awards ceremony in Pretoria on 19 October.

Hofman says the highlight of her career was returning to the Wits School of Public Health in 2009 after a successful 25-year career in America, and establishing the SAMRC in the same year. Since then, Hofman has led policy research to evaluate interventions inside the health system and in other sectors that provide the biggest return on investment for health.

“I think about prevention – preventing illness and disease,” she says.

“We have done quite a lot of work to prioritise where the government can get good return on investment, particularly in maternal and child health, child nutrition, and non-communicable diseases. We document how much money we spend on diabetes and high blood pressure in the public sector. We also do a lot of work related to the return on investment in terms of the sugary beverage tax and salt regulations.”

Hofman says she and her team at the SAMRC also think about the impact on the country of the research they undertake. “We engage with policymakers in South Africa before the research even begins, during the research, and once the research is complete, so that we’re not doing this in isolation. My role is important as a knowledge broker between researcher and policymaker.”

She says one of the biggest issues South Africa faces is an epidemic of conditions associated with being overweight and obese alongside simultaneous malnutrition. “Liquid sugar in the form of carbonated beverages and fruit juice has been known for decades to cause major health problems including obesity-related conditions like high blood pressure and diabetes. Looking for ways to combat this at a population level, we began in 2012 by writing a grant to evaluate the potential impact of a possible sugary beverage tax. This had been shown to be useful globally, and was recommended as one of several ‘best buys’ to combat obesity by the World Health Organization. Our analyses confirmed that, indeed, it would be useful in South Africa.”

Hofman spent the next few years presenting their data repeatedly to policymakers, parliamentarians from all parties, and the Davis Tax Committee. She also engaged with the media. “In 2016, Parliament voted to tax carbonated sugary beverages at a rate of 20%,” she recalls. “This was delayed because of industry interference. In 2018, the sugar-sweetened beverage tax, now called the health promotion levy, was finally passed at a watered-down rate of 10%. Our subsequent evaluation of the tax showed that it’s working, but has not been increased to adjust for inflation.”

The concept of tikkun olam – making the world more just, tolerant, and equal – is what drives Hofman’s passion for public health. “It has shaped the way I think. It motivates me to provide evidence for policy that will shift the needle and improve life expectancy for all South Africans.”

Professor Sharon Fonn, who also works in the Wits School of Public Health and facilitated Hofman’s transition at the university in 2009, describes Hofman as tenacious for a good cause.

“You can, obviously, as a clinician, achieve individual change – you can make somebody better. But if you can create change at a societal level, you actually can have an impact on the life and health of millions of people. Karen has done this by looking at the policies that can change things in society. For example, the work she did proved that by decreasing salt in bread, you could decrease strokes and death from strokes related to high blood pressure. It’s the same with the sugar tax – instead of saying, ‘Don’t eat so much salt, don’t have sugar,’ she looked at ways to make the right choice the easy choice, thus stopping industry from behaving without consideration of health outcome.”

Fonn marvels at the way Hofman works. “It’s not an individual effort, she runs a fantastic team,” she says.