Section 27 and the overlooked crisis — why healthcare access starts with diabetes action

This year marks three decades since South Africa adopted a Constitution rooted in human dignity, equality, and social justice. Enshrined within Section 27 is a promise: that every person in our country has the right to have access to healthcare services. Yet, as we mark Diabetes Awareness Month this November, we are confronted by a sobering disconnect between constitutional ideals and lived reality. The latest mortality figures from Statistics South Africa tell an unambiguous story. For three consecutive years, diabetes has stood as the leading recorded underlying natural cause of death in South Africa. In 2024, it accounted for more than 6% of all recorded deaths in the country. Every day, nearly 80 South Africans lose their lives to diabetes. Behind these numbers are parents, breadwinners, community leaders, and children. What makes this loss particularly tragic is that many diabetes-related deaths, along with devastating complications such as amputations, blindness, stroke and kidney failure, can be prevented or delayed through timely diagnosis and effective care. When Health Minister Dr Aaron Motsoaledi publicly acknowledged in August that diabetes was already a crisis, it marked an essential shift in political visibility. But an acknowledgement is only a starting point. It does not put insulin on clinic shelves, shorten long diagnostic queues, or equip primary healthcare facilities with the tools required for early detection. For a person living with diabetes, the constitutional right to healthcare is not an abstract concept. For a child developing type 1 diabetes, it means an accurate, timely diagnosis before a manageable condition becomes a life-threatening emergency. For an adult with type 2 diabetes, it means access to regular monitoring, essential medicines, education and ongoing support to prevent severe complications. For millions who rely on the public health sector, it means that access to basic diagnostics and continuity of care should never be determined by economic status or geographic location. When health systems fail to detect diabetes early or struggle to ensure uninterrupted care, the promise of Section 27 remains unfulfilled for far too many people. Early actionThe International Diabetes Federation’s global theme for World Diabetes Day 2026–2027 is Early Action on Diabetes, with a focus this year on early diagnosis and risk reduction. But early action cannot rest solely on the shoulders of individuals. A person can only seek early care when screening services are accessible, healthcare workers are adequately trained, and diagnostic equipment is available at local clinics. Early action is both a personal choice and a public responsibility. It demands investment in primary healthcare, public awareness, and disease surveillance. In response to this imperative, civil society, healthcare professionals, researchers, and patient advocates came together earlier this year to adopt the Johannesburg Declaration for Accelerated Action on Diabetes in South Africa. The declaration calls for high-level political leadership, sustainable financing, strengthened primary care, and systematic accountability. On Thursday, 12 November, the Diabetes Alliance convened its national World Diabetes Day flagship and gathered at Constitution Hill under the banner: From Declaration to Action — Act Early. Act Together. Act Now. We will also launch the Johannesburg Declaration Accountability and Monitoring Framework, a structured tool to track policy commitments, resource allocation, and progress in healthcare delivery over time. Choosing Constitution Hill as the location for this gathering is deliberate. Thirty years after the birth of our Constitution, we must transition from high-level declarations to measurable delivery. Rights written on paper must become care delivered in clinics. Turning the tide on diabetes is not merely a clinical challenge; it is a fundamental test of our national commitment to equity, human dignity, and health justice. The momentum for reform exists; our collective responsibility now is to convert that momentum into lasting, systemic change. DM