Unique research unit puts African evidence at the centre of healthy ageing
- Wits University
Prof. Lisa Micklesfield’s SAMRC unit to investigate how health is shaped across the life course and in changing urban African environments.
The Wits-based SA Medical Research Council (SAMRC) Ageing African Adult Research Unit (A3RU) will investigate the health challenges facing Africa’s ageing populations and generate evidence to support more appropriate interventions, public health strategies and health policies.
A3RU is the only unit in the SAMRC’s current research portfolio dedicated specifically to understanding ageing in African populations.
Based in Soweto at the Chris Hani Baragwanath Academic Hospital, researchers will address the health challenges associated with ageing by examining chronic diseases such as cardiovascular and musculoskeletal disease, the lifestyle and environmental factors that contribute to them, and how co-designed interventions can be effectively implemented to support healthy ageing.
Its recognition as a SAMRC extramural research unit comes as life expectancy is increasing and more people are living into older age, often with multiple chronic diseases, reduced physical function and a growing need for healthcare.
“People are going to be living for longer, but not necessarily in a healthy state,” says Professor Lisa Micklesfield.
Ageing in a changing urban environment
A3RU’s base in Soweto gives researchers an important vantage point from which to investigate ageing in a rapidly changing African city. Healthy ageing is also understood alongside urbanisation, inequality, unemployment, changing diets, infectious diseases and uneven access to healthcare.
Climate change is adding another layer. Soweto lies within an urban heat island, where built-up areas can experience higher temperatures than their surroundings. A3RU is beginning to investigate how heat may affect health, particularly among ageing adults and women going through menopause who may already be living with chronic illness or struggling to access healthcare.
Air quality is an additional emerging area of research. Micklesfield wants to expand the unit’s use of wearable technology to measure physical activity, sedentary patterns and sleep, as well as environmental exposures.
“We can start to understand far more about the impact of air quality on health, as well as on health behaviours,” she says.
Wearable devices could help researchers capture what people encounter as they move through their daily lives, rather than relying only on measurements taken at clinics or fixed environmental monitoring sites.
A3RU’s urban research will be strengthened through collaboration with researchers working in different environments. Comparisons with the SAMRC/Wits Rural Public Health and Health Transitions Research Unit in Agincourt, Mpumalanga, could help show how rural and urban settings shape ageing differently.
Current collaborations in Zimbabwe, The Gambia and elsewhere will allow researchers to compare populations living in different climates and with different infectious-disease burdens, lifestyles and levels of urbanisation.
Building evidence for African ageing populations
Much of the scientific evidence used to assess ageing comes from research conducted in Europe, North America and other high-income settings.
The measurements and thresholds developed through this research are frequently used to assess disease risk in Africans, even when they may not reflect local populations or identify risk accurately.
“We have always measured risk by using international cut-points,” says Micklesfield. “We are realising that those are not applicable in our setting.”
Bone and muscle health provide a striking example.
Black Africans have historically been considered at relatively low risk of bone fractures. Emerging research suggests that the picture is more complicated. Some people may be living with vertebral fractures without knowing that they have them, while conventional assessments may not fully capture vulnerability in areas such as the lumbar spine.
Poor bone health can increase the risk of fractures, with serious consequences for mobility, independence and quality of life in older age.
“We need to know what the risk of fracture is in an African setting,” says Micklesfield. “Many of the traditional risk factors identified in other settings may not be applicable in ours.”
International tools commonly focus on factors such as age, smoking, alcohol consumption and physical activity. While these remain relevant, A3RU will investigate how they interact with genetics, HIV, other chronic diseases, nutrition and the environments in which people live.
“We need to understand people’s physiology and genetics, as well as their lifestyle factors,” she says.
Ageing begins long before old age
Although A3RU has a strong focus on older adults, its research stretches across the life course.
“We’re all ageing. It doesn’t matter what age we are,” says Micklesfield.
The unit’s studies include adolescents, women before and during pregnancy, adolescents, and ageing adults. This enables researchers to investigate when disease risks first emerge, how they accumulate over time and how they may be transferred between generations.
The unit’s long-running Soweto cohorts are particularly valuable. Some of the women in its middle-aged Soweto cohort were among the original caregivers of children enrolled in the Birth to Forty study. They are now around 60 years old and have been followed by researchers for decades.
From DPHRU to A3RU
A3RU has evolved from the SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), led by Professor Shane Norris for 15 years.
DPHRU itself grew from earlier foundational work, particularly the SAMRC/Wits Mineral Metabolism Research Unit and the landmark Birth to Ten cohort study (now known as Birth to Forty), which began following children born in Soweto in 1990.
The unit’s work helped establish a central idea: adult health is shaped by exposures and experiences that begin much earlier in life.
A3RU inherits these cohorts, research platforms, collaborations and strong research culture while directing them towards the health challenges of ageing.
Micklesfield says her task is to continue the scientific and training legacy built under previous directors while giving the unit a clear identity in African ageing research.
Moving from evidence to action
A3RU aims to move beyond documenting patterns of disease to co-designing and testing interventions that can improve health.
The unit already has trials focused on adolescents who are underweight or overweight, as well as interventions with women before pregnancy. The intention is to extend this into its ageing work.
But effective interventions cannot be designed around physical activity and nutrition alone.
Mental health, household responsibilities, gender-based violence, unemployment, poverty, safety, and access to healthy food all influence whether people can make changes in their lives.
“We can’t begin to make those changes until we understand what else people are dealing with and managing in their day-to-day lives,” says Micklesfield. “Mental and physical health are so closely entwined, as is the context in which a person is living.”
A3RU will use interdisciplinary, mixed-methods research and work with communities and other interest holders to co-design interventions. The unit has around 100 staff members, including researchers, nurses, research assistants, a radiographer, postgraduate students and postdoctoral fellows. Its SAMRC status brings national recognition and creates further opportunities for collaboration across the council’s research network.
“Everybody should care about ageing,” she says. “We need to understand how we can age more healthily, continue to function much later into life and improve quality of life as we age.”