Leslie London

• Doctor of Medicine
• Head: Division Public Health Medicine at University of Cape Town

Our paper examines the political considerations in the intersectoral action that was evident during the SAR-COV-2 virus (COVID-19) pandemic through case studies of political and institutional responses in 16 nations (Australia, Belgium, Brazil, Ethiopia, India, New Zealand, Nigeria, Peru, South Africa, South Korea, Spain, Taiwan, Thailand, Vietnam,...

Carers were disproportionately harmed in the COVID-19 pandemic. Despite facing an increased risk of contracting the virus, they continued in frontline roles in care services and acted as “shock absorbers” for their families and communities. In this article, we apply an intersectional lens to examine care work and the structural factors disadvantagi...

An under-recognised aspect of the current humanitarian catastrophe in Gaza is the impact of the war on the environment and the associated risks for human health. This commentary contextualises these impacts against the background of human suffering produced by the overwhelming violence associated with the use of military force against the general p...

Academy of Science consensus study publication explores way to improve governance of health system in South Africa

Colonial and apartheid racial segregation led to enormous social inequity and inequality in South Africa and have left a legacy in our social practice, manifested in the persistent use of racial terminology in health sciences research. Everyone has a responsibility towards the decolonisation and transformation of health sciences education and resea...

In 2020 the United Nations Committee on Economic, Social and Cultural Rights published its 25th General Comment on the right to enjoy the benefits of scientific progress (REBSP). The General Comment describes the normative content of the right, including the obligations of the state and the entitlements of rights holders. It addressed the major gap...

Purpose: Suicide and self-harm by pesticide self-poisoning is common in low- and middle-income countries (LMICs). Alcohol is an important risk factor for self-harm; however, little is known about its role in pesticide self-poisoning. This scoping review explores the role that alcohol plays in pesticide self-harm and suicide. Methods: The review...

Previous research on commercial determinants of health has primarily focused on their impact on non-communicable diseases. However, they also impact on infectious diseases and on the broader preconditions for health. We describe, through case studies in 16 countries, how commercial determinants of health were visible during the COVID-19 pandemic, a...

Background: Suicidal behaviour (SB) refers to behaviours, ranging from non-fatal suicidal behaviour, such as suicidal ideation and attempt, to completed suicide. Despite recent advancements in genomic technology and statistical methods, it is unclear to what extent the spectrum of suicidal behaviour is explained by shared genetic aetiology. Methods...

The purpose of this study was to characterize healthcare use for general care and mental health one year before suicidal behavior among individuals with fatal and non-fatal suicidal behavior (NFSB) in Cape Town, South Africa. We linked electronic health records of 484 participants from a case series of 93 completed suicides on whom forensic autopsi...

Objectives The Cardiff Model of data sharing for violence prevention is premised on the idea that the majority of injury cases presenting at health facilities as a result of interpersonal violence will not be reported to the police. The aim of this study was to determine the concordance between violent crimes reported to the police with violence-re...

Despite the fact that several cases of unsafe pesticide use among farmers in different parts of Africa have been documented, there is limited evidence regarding which specific interventions are effective in reducing pesticide exposure and associated risks to human health and ecology. The overall goal of the African Pesticide Intervention Project (A...

The profound health, social and economic impacts generated by the COVID-19 pandemic have necessitated collaboration among societal actors in an unprecedented fashion, elevating the status of the health sector and positioning it to advance intersectoral action on health. This chapter reflects on intersectoral collaboration in the Western Cape prior...

The COVID-19 pandemic has exposed the fragility of local, regional and global health systems and their inability to meet their populations’ health needs. South Africa also experienced severe shortages of health technologies, attributable to a lack of institutional capacity, corruption in supply chain management and procurement, inadequacy of local...

Background: The intellectually demanding modern workplace is often dependent on good cognitive health, yet there is little understanding of how neurocognitive dysfunction related to HIV presents in employed individuals working in high risk vocations like driving. HIV-associated neurocognitive impairment is also associated with poorer long term cogn...

The speciality, Public Health Medicine (PHM), was developed in response to political and health realities in pre-apartheid South Africa (SA), following the lead of the discipline in Britain, SA’s previous coloniser. This article describes a 47-year journey from its origins as Community Health through to current practice, based on reviews of archiva...

Pesticides are a commonly used agent for suicide in many Low- and Middle-Income countries (LMICs). However, accumulating evidence suggests that exposure to organophosphate (OP) pesticide may also increase the risk of suicide. We conducted a hospital-based case-control study to investigate whether prior household, garden or occupational OP exposure...

Background: The intellectually demanding modern workplace is often dependent on good cognitive health, yet there is little understanding of how neurocognitive dysfunction related to HIV presents in employed individuals working in high risk vocations like driving. HIV-associated neurocognitive impairment is also associated with poorer long term cog...

Efforts to adopt public health policies that would limit the consumption of unhealthy commodities, such as tobacco, alcohol and ultra-processed food products, are often undermined by private sector actors whose profits depend on the sales of such products. There is ample evidence showing that these corporations not only try to influence public heal...

Background Community participation is an essential component in a primary health care (PHC) and a human rights approach to health. In South Africa, community participation in PHC is organised through health committees linked to all clinics. Aims This paper analyses health committees’ roles, their degree of influence in decision-making and factors...

Background Health committees are participatory structures providing community input in health systems. Community participation is a critical tenant in the Alma-Ata Declaration and the Right to Health. In South Africa, national and provincial legislation provides for health committees to be established at all primary health care facilities. Aims Th...

Background: This paper assesses changes in the socioeconomic inequality in alcohol consumption by exploring whether alcohol consumption (current and binge drinkers) is more prevalent among the wealthier (pro-rich) or poorer (pro-poor) group over time. Methods: Data come from the 2008, 2010/11, 2012, and 2014/15 waves of the National Income Dynamics...

Access to COVID-19 vaccines has raised concerns globally. Despite calls for solidarity and social justice during the pandemic, vaccine nationalism, stockpiling of limited vaccine supplies by high-income countries and profit-driven strategies of global pharmaceutical manufacturers have brought into sharp focus global health inequities and the plight...

Background: In recent years there have been significant advances in the management of stroke. In particular, reperfusion therapies have been shown to confer significant benefit, with the possibility of reversing ischaemic stroke or reducing disability when administered to suitable patients. However, these therapies also carry significant risk, inc...

Driving ability can be diminished amongst people with HIV with associated neurocognitive impairment (NCI). We explore the relationship between HIV status, NCI and driving ability in professional truck drivers. Forty male professional drivers (20 HIV-positive; mean age = 39.20 ± 7.05) completed a neuropsychological test battery, two driving simulato...

Key messages The Global Health Security Index predicted that the world in general was not well prepared for the pandemic but did not predict individual country preparedness Ten factors seem to have contributed to the index failing to predict country responses, including overlooking political, economic, and social contexts and the role of civil so...

The lack of access to effective diagnosis and treatment for drug-resistant tuberculosis (DR-TB) remains a persistent ethical, human rights and public health challenge globally. In addressing this challenge, arguments based on a Human Rights-Based Approach (HRBA) to health have most often been focused on the Right to Health. However, a key challenge...

Global and national responses to the COVID-19 pandemic highlight a long-standing tension between biosecurity-focused, authoritarian and sometimes militarised approaches to public health and, in contrast, comprehensive, social determinants, participatory and rights-based approaches. Notwithstanding principles that may limit rights in the interests...

Objectives The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly p...

Background The burden of drug-resistant tuberculosis (DR-TB) remains high in South Africa despite ongoing control efforts. DR-TB patients who are infectious and continue to work pose a substantial risk of spreading the disease at the workplace. When such patients refuse or interrupt treatment and are also unwilling to disclose their status at work...

In the midst of an unprecedented public health crisis, extraordinary containment measures must be implemented. These include both isolation and quarantine, either on a voluntary basis or enforced. In the transition from voluntary to mandatory isolation, conflicts arise at the intersection of ethics, human rights and the law. The Siracusa Principles...

Alcohol-related harm has gained increased attention in high-income countries (HICs) in recent years which, alongside government regulation, has effected a reduction in alcohol consumption. The alcohol industry has turned its attention to low-income and middle-income country (LMIC) markets as a new source of growth and profit, prompting increased co...

Suicide rates worldwide are declining; however, less is known about the patterns and trends in mortality from suicide in sub-Saharan Africa. This study evaluates trends in suicide rates and years of potential life lost from death registration data in South Africa from 1997 to 2016. Suicide (X60–X84 and Y87) was coded using the 10th Revision of the...

Background: Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production. Methods: Over the period of 12...

Management of HIV-associated neurocognitive disorders (HAND) is becoming increasingly important with HIV-positive people living normal life spans. We aimed to establish the level of HAND awareness among doctor and nurse occupational health practitioners, screening used to detect impairment, factors limiting screening for HAND, and training needs. O...

Background: Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production Methods. Over the period of 12 mon...

Introduction. In 2016, after the Western Cape Liquor Act was enacted, alcohol outlets were mapped in the six towns from a previous 2008 study to determine: 1) alcohol outlet density; 2) the association between deprivation and alcohol outlet density; 3) geospatial trends of alcohol outlet densities; and 4) the impact of alcohol legislation. Methods....

Background: Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production Methods. A one year hospital based...

Public health (PH) skills are core to building responsive and appropriate health systems, and PH personnel including medical specialists are embedded in many countries' health systems. In South Africa, the medical specialty in PH, Public Health Medicine (PHM), has existed for over 40 years. Four years of accredited training plus success in a single...

The Lancet Respiratory Medicine Commission on drug-resistant tuberculosis was published in 2017, which comprehensively reviewed and provided recommendations on various aspects of the disease. Several key new developments regarding drug-resistant tuberculosis are outlined in this Commission Update. The WHO guidelines on treating drug-resistant tuber...

South Africa (SA) is reforming its health system in preparation for an anticipated national health insurance (NHI) scheme that aims to improve the delivery of affordable, equitable, accessible health care. Public health (PH) language is explicit in the policy and skilled PH professionals would be expected to play a key role in its implementation. I...

Objective This paper assesses the usability of existing alcohol survey data in South Africa (SA) by documenting the type of data available, identifying what possible analyses could be done using these existing datasets in SA and exploring limitations of the datasets. Settings A desktop review and in-depth semistructured interviews were used to ide...

Background: Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production Methods. A one year prospective st...

Introduction: A significant percentage of the workforce comprises people living with HIV. Since HIV-associated neurocognitive disorders (HAND) may impact work productivity, it is important that clinicians recognize HAND symptoms, be able to screen for HAND, and refer presenting patients to appropriate services. Patients should also be aware of HAN...

Background: Existing research suggests that, although people living with HIV (PLWH) currently live near-normal lifespans, HIV-associated cognitive impairment remains prevalent. Because many PLWH maintain employment and occupational status, understanding the effects of HIV-associated cognitive impairment on their workplace functioning is essential....

Background: Existing research suggests that, although people living with HIV (PLWH) currently live near-normal lifespans, HIV-associated cognitive impairment remains prevalent. Because many PLWH maintain employment and occupational status, understanding the effects of HIV-associated cognitive impairment on their workplace functioning is essential....

Background: Globally, alcohol consumption accounts for a substantial burden of disease, which translates into high social and economic costs. To address this burden, several policies (e.g. age and trading hour restrictions, increasing alcohol taxation) were implemented. Despite the existence of these policies evidence shows that alcohol misuse and...

Community participation, the central principle of the primary health care approach, is widely accepted in the governance of health systems. Health Committees (HCs) are community-based structures that can enable communities to participate in the governance of primary health care. Previous research done in the Cape Town Metropole, South Africa, repor...

Background Operations of transnational corporations (TNCs) affect population health through production methods, shaping social determinants of health, or by influencing regulation of their activities. Research on community exposures to TNC practices and policies has been limited. Our research on extractive industries examined Rio Tinto in Australia...

Abstract The response of the World Health Organization (WHO) to the Ebola outbreak in West Africa in 2015 demonstrated that the global health system is unprepared to address what should be its primary mission, control of disease epidemics while protecting health workers. Critics blamed WHO politics and its rigid culture for the poor response to the...

Introduction There is little credible quantitative data on pregnancy histories and outcomes for disabled women in low-income and middle-income countries. The purpose of this study, based in Cape Town, South Africa, was to test the reliability and validity of maternal recall of pregnancy history and service use among a sample of Deaf women who use S...

Participation is recognized as an important contribution to implementing the right to health. It features as a key element of the global movement to achieve universal health coverage. The mobilization of groups into collective action is central in this. In South Africa, universal health coverage has become a feature of health policies, with the cou...

Background: Despite 20 years of democracy, South Africa still suffers from profound health inequalities. Gender roles and norms are associated with individuals’ vulnerability that lead to ill-health. For instance, gender inequality influences women’s access to health care and women’s agency to make health-related decisions. This paper explores gend...

Methodology: this was a prospective cohort study conducted over six months. Participants were recruited from patients living with HIV with CD4 counts of <200 cells/mm3, patients with advanced cancer and patients diagnosed with motor neurone disease. All HIV patients were on anti-retroviral treatment. Participants responded to a questionnaire inclu...

Background: South African physicians can specialise in public health through a four-year ‘registrar’ programme. Despite national health policies that seemingly value public health (PH) approaches, the Public Health Medicine (PHM) speciality is largely invisible in the health services. Nevertheless, many physicians enrol for specialist training. Obj...

The majority of workers worldwide remain without adequate access to Occupational Health Services (OHS), particularly with regard to gaps in implementation, coverage, content, and capacity building. Yet access to OHS is an essential element of the right to health and is recognised in numerous global human rights agreements as being a fundamental hum...

Objective: The purpose of this study was to analyze the impact of easy access to alcohol and exposure to alcohol advertisements on women's alcohol consumption, reproductive history, and health and social outcomes in an urban and rural site in South Africa. Method: Trained fieldworkers conducted face-to-face interviews with 1,018 women of childbe...

Aims and scope This editorial is an introduction to the papers making up the special issue on ’pesticide poisonings in low- and middle income countries’.

Background Acute pesticide poisoning (APP) is a serious problem worldwide. Because the burden of childhood APP is unknown in Tanzania, this study describes the distribution, circumstances, and patterns of APP involving children under 18 years in Tanzania. Methodology A 12-month prospective study was conducted in 10 Tanzanian healthcare facilities...

Background: Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barrier...

Background: Previous epidemiological studies investigating modification of organophosphate (OP) neurotoxicity by xenobiotic metabolizing enzymes (XMEs) polymorphisms have produced inconsistent results. Methods: A cross-sectional study of 301 emerging farmers was conducted. Neurotoxicity testing included forward and backward recall, digit span, a...

Background: Chemical hazard communication is intended to alert users of the potential hazards of chemicals. Hazard information needs to be understood and recalled. Recall of hazard communication is critical when the written form of the information is not available at the time it is required. Methods: A cross-sectional study investigating associa...

Background Modulation of organophosphate (OP) neurotoxicity by genetic polymorphisms of xenobiotic metabolising enzymes (XMEs) has not previously been investigated Objectives To investigate whether XMEs polymorphisms modify OP neurotoxicity among emerging farmers. Methods A cross-sectional study of 301 emerging farmers was conducted. Neurotoxicit...

Background: A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including r...

Background: Women with disabilities are at disproportionate risk for adverse pregnancy outcomes, however, there is limited information on their pregnancy histories. This mixed-methods study focuses on signing Deaf women whose access to health care may be compromised by language barriers related to their disability. Objective: To describe and com...

Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively d...

BACKGROUND Acute pesticide poisoning (APP) is commonly underdiagnosed in Tanzania. Studies in developing countries suggest that a lack of diagnostic skills among health care providers (HCPs) undermines surveillance for APP. This study aimed at characterizing experience and skills of Tanzanian HCPs regarding APP diagnosis and management. METHODOLOG...

Background The adverse health and equity impacts of transnational corporations’ (TNCs) practices have become central public health concerns as TNCs increasingly dominate global trade and investment and shape national economies. Despite this, methodologies have been lacking with which to study the health equity impacts of individual corporations and...

Background Acute pesticide poisoning (APP) is known to cause serious injuries to end users globally but the magnitude of this problem in Tanzania is not well known. This study aimed to determine the extent and pattern of underreporting of APP in Tanzania to inform the development of a surveillance system and appropriate interventions. Methods This...

The potential economic and energy security opportunities of a medium to large shale gas resource could be substantial for South Africa; as are both the potential social and environmental risks associated with a domestic gas industry in the Central Karoo. The development of shale gas using vertical and horizontal drilling and hydraulic fracturing or...

Background: Public health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH qualifications. Objectives: This study identifies their motivation...

Despite availability of methods to control workplace hazards, billions of working people worldwide lack access to a safe working environment. Global trade and economic policies shape the determinants of and the institutional and human resources to deal with workplace hazards. In addition to gender and migrancy, new vulnerabilities related to casual...

Background Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health prof...

To the Editor: On 11 November 2015, the National Department of Health (NDoH) published the National Public Health Institute of South Africa (NAPHISA) Draft Bill 2015 for public comment. The aim of the Draft Bill is: '[t]o provide for the establishment of the National Public Health Institute of South Africa in order to conduct disease and injury sur...

The right to enjoy the benefits of scientific progress (REBSP) is a little-known but potentially valuable right that can contribute to rights-based approaches to addressing multidrug-resistant TB (MDR-TB). We argue that better understanding of the REBSP may help to advance legal and civil society action for health rights. While the REBSP does not p...

Shale gas exploration involving hydraulic fracturing (fracking) has been on South Africa’s energy agenda since 2010 as a potential alternative to coal. Internationally, the desirability of fracking has been under debate, due to increasing evidence of associated environmental and health risks. There is limited research related to the public’s knowle...

Background: Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural locati...

To test the effectiveness of a programme aimed at reducing the risky use of alcohol and alcohol-related HIV risk and increase help-seeking behaviour among a sample of municipal employees in the Western Cape Province, South Africa. A clustered randomised controlled trial was conducted in 2011-2012 among 325 employees. The eight hour intervention, Te...