In the first peer-reviewed study to examine the potential risks and benefits of teen skin-care routines posted on social media, scientists at Northwestern Medicine found girls ages 7 to 18 are using an average of six different products on their faces, with some girls using more than a dozen products. These products tend to be marketed heavily to younger consumers and carry a high risk of skin irritation and allergy, the study found.
The findings are published in the journal Pediatrics.
Each teen daily skin-care regimen costs an average of $168 (which the authors estimate typically lasts a month depending on the size of the products), with some costing more than $500, the study found. As the summer nears, the study authors cautioned that only 26% of daytime skin care regimens included sunscreen – arguably the most important skin care product for any age range, but particularly for kids.
The top-viewed videos contained an average of 11 potentially irritating active ingredients, the study found, putting the content creators at risk of developing skin irritation, sun sensitivity and a skin allergy known as allergic contact dermatitis. Prior evidence has shown that developing such an allergy can limit the kinds of soaps, shampoos and cosmetics users can apply for the rest of their lives.
“That high risk of irritation came from both using multiple active ingredients at the same time, such as hydroxy acids, as well as applying the same active ingredient unknowingly over and over again when that active ingredient was found in three, four, five different products,” said corresponding author Dr. Molly Hales, a postdoctoral research fellow and board-certified dermatologist in the department of dermatology at Northwestern University Feinberg School of Medicine.
For example, in one video included in the study, the content creator applied 10 products on her face in six minutes.
“As she’s applying the products, she begins to express discomfort and burning, and in the final few minutes, she develops a visible skin reaction,” said senior author Dr. Tara Lagu, adjunct lecturer of medicine and medical social sciences at Feinberg and a former Northwestern Medicine hospitalist.
Videos ‘emphasized lighter, brighter skin’
“We saw that there was preferential, encoded racial language in some cases that really emphasized lighter, brighter skin,” Lagu said. “I think there also were real associations between use of these regimens and consumerism.”
These videos offer little to no benefit for the pediatric populations they’re targeting, the study authors concluded. What’s more, given how the algorithms work, it’s nearly impossible for parents or pediatricians to track exactly what children or adolescents are viewing. Lastly, there are dangers beyond skin damage, Hales said.
“It’s problematic to show girls devoting this much time and attention to their skin,” Hales said. “We’re setting a very high standard for these girls. The pursuit of health has become a kind of virtue in our society, but the ideal of ‘health’ is also very wrapped up in ideals of beauty, thinness and whiteness. The insidious thing about ‘skin care’ is that it claims to be about health.”
Studying teens in the TikTok environment
In the study, Hales and another researcher each created a new TikTok account, reporting themselves to be 13 years old. The “For You” tab was used to view relevant content until 100 unique videos were compiled. They collected demographics of content creators, number and types of products used and total cost of regimens and then created a list of products used and their active and inactive ingredients. The Pediatric Baseline Series used in patch testing was used to identify ingredients with elevated risk of inducing allergic contact dermatitis.
Diffusion tensor imaging shows corpus callosum fibre tracts in two adolescents: One with traumatic brain injury (TBI; G and H) and one with an orthopaedic injury (E and F). At 3 months post-injury (E, G), early degeneration and loss of fibre tracts are visible, especially in the TBI case. At 18 months (F, H), some recovery or reorganisation occurs, but persistent loss and thinning of tracts remain, particularly in the frontal regions, indicating lasting white matter damage after TBI.
By Kathy Malherbe
A silent but devastating brain disease is casting a shadow over contact and collision sports, particularly rugby. Traumatic Brain injuries (TBIs) as a result of an impact to the head, cause a disruption in the normal function of the brain. Repeated TBIs are linked to an increased risk of neurodegenerative diseases like early-onset dementia which has the highest prevalence and is the most concerning. Others include Parkinson’s disease, Alzheimer’s and Chronic Traumatic Encephalopathy, better known as CTE.
How head injuries happen
Dr Hofmeyr Viljoen, radiologist at SCP Radiology, says that there are several types of head injuries common in rugby. ‘The most frequent being TBIs which occur when the impact and sudden movement results in the brain shifting rotationally, sideways or backwards and forwards within the skull. This stretching and elongation causes damage to nerve fibres as well as blood vessels. Surprisingly, a direct blow isn’t always necessary. Rapid acceleration and deceleration, such as during a tackle or fall, can also result in an injury. More severe head injuries may include skull fractures, bruising or bleeding around the brain, all of which require urgent diagnosis and intervention.’
Riaan van Tonder, a sports physician with a special interest in sports-related concussion and radiology registrar at Stellenbosch University, explains that concussions and, even more so, repetitive sub-concussive impacts, result in a cascade of changes at a cellular level, gradually damaging the nervous system.
Although rugby is notorious for heavy tackles and collisions, it took a lawsuit to prompt more widespread awareness. A class-action suit filed in the High Court in London, by former union and league players, accused World Rugby of failing to implement adequate rules to assess, diagnose and manage concussions. Steve Thompson’s, the legendary English hookers, early onset dementia has been one of the sports’ biggest talking points. He was diagnosed in 2020 with this neurodegenerative disease, purportedly as a result of repeated trauma to the brain. The claimants argue that the governing bodies were negligent and that their neurological problems stem from years of unmanaged head injuries. The outcome of this case to be heard in 2025, could significantly reshape the legal and medical responsibilities of sports organisations globally.
What is Chronic Traumatic Encephalopathy (CTE)
CTE is a progressive neurodegenerative condition strongly linked to repeated head impacts. It has been implicated in memory loss, mood disturbances, psychosis and, in many cases, premature death. It can only be diagnosed after death at autopsy, where researchers examine brain tissue for abnormal protein deposits and signs of widespread degeneration. Despite this limitation, mounting evidence is forcing sports organisations, including rugby authorities, to confront uncomfortable truths about how repeated head trauma can alter lives permanently.
Uncovering the extent of the problem
In 2023, the Boston University CTE Centre released updated autopsy findings from its brain bank. Of 376 former NFL player’s brains studied post-mortem, 345 had been diagnosed with CTE, a staggering 91.7%. While brain banks are inherently subject to selection bias, the results remain alarming. For comparison, a 2018 study of 164 randomly selected brains revealed just one case of CTE.
This brain disease isn’t new. Its earliest descriptions date back to Dr Harrison Martland in 1928, who studied post-mortem findings in boxers and coined the term ‘punch drunk’ to describe their confusion, tremors and cognitive decline. What was once confined to boxing is now known to affect athletes in rugby, football, ice hockey and even military personnel exposed to repeated blast injuries.
Radiology’s role in determining head injuries
Although Computed Tomography (CT) scans are not designed to specifically diagnose concussions, they are crucial to imaging patients with severe concussion or atypical symptoms. ‘CT scans rapidly detect serious issues like fractures, brain swelling and bleeding, providing crucial information for urgent treatment decisions,’ explains Dr Viljoen.
‘Magnetic Resonance Imaging (MRI) is used particularly when concussion symptoms persist or worsen. It excels in identifying subtle injuries, such as microbleeds and brain swelling that may have been missed by CT scans,’ he says.
‘CTE is challenging because currently, it can only be definitively diagnosed after death,’ he explains. ‘However, ongoing research aims to develop methods to detect CTE in living patients, potentially using advanced imaging techniques like Positron Emission Tomography (PET).’ Most research is focused on advancing non-invasive methods to see what is happening inside the brain of a living person and to track it over time.
Advanced imaging methods
Emerging imaging techniques, such as Diffusion Tensor Imaging (DTI), show promise for better understanding and management of head injuries, especially the subtle effects of concussions. ‘DTI helps identify damage to the brain’s white matter, potentially guiding return-to-play decisions and treatment strategies,’ notes Dr Viljoen.
The biomechanics of brain trauma
Former NFL player and biomechanical engineer, David Camarillo, explains in a TED talk that helmets, although effective at preventing skull fractures, do little to stop biomechanical forces from affecting the brain inside the skull.
Camarillo highlights that concussions and the stretching of nerve fibres are more likely to affect the middle of the brain, the corpus callosum, the thick band that facilitates communication between the left and right brain hemispheres. ’It’s not just bruising,’ he says, ‘we’re talking about dying brain tissue.’
Smart mouthguard technology in rugby
‘Presently,’ says Van Tonder, ‘smart mouthguards are mandatory at elite level. These custom-fitted mouthguards contain accelerometers and gyroscopes that detect straight and rotational forces on the head. Data is transmitted live to medical teams at a rate of 1 000 samples per second.
‘If a threshold is exceeded, an alert is triggered, prompting an immediate Head Injury Assessment (HIA1). Crucially, the system can identify dangerous impacts, even when no symptoms or video evidence is apparent. This is an essential shift in concussion management,’ says van Tonder. ‘It allows proactive assessments rather than waiting for visible signs.’ World Rugby has committed €2 million to assist teams in adopting this technology and integrating it into HIA1.
Brain Health Service
The really good news is that in March this year, World Rugby and SA Rugby launched a new Brain Health Service to support former elite South African players. It’s the first of its kind in the world and South Africa is the fourth nation to establish this system that supports players to understand how they can optimise management of their long-term brain health. It includes an awareness and education component, an online questionnaire and tele-health delivered cognitive assessment with a trained brain health practitioner. This service assesses players for any brain health warning signs, provides a baseline result, advice on managing risk factors and signposts anyone in need of specialist care.
Super Rugby and smart mouthguards
Super Rugby has revised its smart mouthguard policy, no longer requiring players to leave the field immediately for a HIA when an alert is triggered. The change follows criticism from players and coaches, including Crusaders captain Scott Barrett, who argued the rule could unfairly affect match outcomes. Players must still wear the devices but on-field doctors will assess them first; full HIAs will be conducted at half-time or full-time, if necessary. Further trials are planned to improve the system before reinstating immediate alerts.
Where to from here?
Researchers continue to explore ways to reduce brain movement inside the skull during collisions. One innovative idea includes an airbag neck collar for cyclists, which inflates around the head upon impact. It’s closer to the goal of reducing the brain’s movement – and therefore the risk of concussion. However, regulatory hesitation remains a barrier, with no formal cycling helmet approval process currently in place.
The evidence linking repetitive head impacts to long-term brain degeneration is too compelling to ignore. Rugby, like other contact sports, must continue evolving its protocols, technology and player education to protect athletes at all levels … starting at schools.
While innovations such as smart mouthguards mark significant progress, much remains to be done: From regulatory reform to changing the sporting culture that once downplayed the severity of concussion. Van Tonder notes, ‘We’re behind, but it’s not too late to catch up.’
In rugby, the HIA protocol now consists of three stages:
HIA1: Immediate, sideline assessment during the match.
HIA2: Same-day evaluation within three hours post-match.
HIA3: A more detailed follow-up, typically done 36-48 hours later.
The Health Funders Association (HFA) has launched a legal challenge against the National Health Insurance (NHI) Act. The organisation filed its application on the 4th of June in the Pretoria High Court, challenging the Act on constitutional grounds. This marks the sixth legal challenge against the Bill, with others being brought by professional medical associations and other healthcare funding associations.
“South Africa needs a healthcare system that delivers equitable, quality care to all. We fully support that vision,” said Thoneshan Naidoo, the HFA’s chief executive. “However, in its current form, and without private sector collaboration, the NHI Act is fiscally impossible and operationally unworkable, and threatens the stability of the economy and health system, impacting everyone in South Africa.”
Prior to this, the Board of Health Funders had launched its own legal effort to have President Cyril Ramaphosa make public his decision-making process for approving the NHI Bill. So far, he has refused, arguing that opponents would lead to a courtroom “fishing expedition” in search of flawed reasoning.
HFA pointed to research that it had commissioned from economic consultancy Genesis Analytics. The Genesis report showed that unsustainable tax increases were necessary to fund NHI, while also reducing healthcare access for members of medical schemes.
NHI unaffordable even with generous assumptions
Assuming a cost efficiency of 45.5% from state-centralised healthcare funding, R15 432 per capita expenditure would be required, which works out to R941 billion for South Africa’s 61 million. (For comparison, the 2024 budget for US space agency NASA was R440 bn.) This is a 77% increase over SA’s total of R532.2bn for public and private healthcare expenditure in 2022, making healthcare 33% of the budget. Personal income tax rates would rise to over 40% for even the lowest income bracket – more than doubling from 18.5%. The highest income bracket would increase from 45% to 68.4%. Those earning R92 000 a year would have R10 000 less income – if they were already paying for medical aid. If not, that would be R21 000. [One wonders how South Africa can afford this when we cannot easily replace the US$500 million worth of US aid for HIV and other healthcare programmes under PEPFAR. – Ed.]
“Such tax increases are fiscally impossible, particularly given South Africa’s narrow personal income tax base of 7.4 million taxpayers,” the HFA said.
The HFA also argued that the NHI is not a reasonable solution to the constitutional requirement for progressive realisation of the right to healthcare. By making private healthcare only valid for conditions not covered by the NHI, its much-maligned Section 33 infringes on individuals’ healthcare access. Legislative authority is delegated to the Minister of Health, violating the constitutional separation of legislature and executive power. It is fertile ground for tenderpreneurs, as discussed by Jeff Wicks in a News24 article (paywalled). The HFA also notes that the government has admitted in legislation brought by Solidarity that no thorough NHI costing was performed.
Healthcare quality impacted
Even if South Africa were to find the money for NHI between the couch cushions, there have to be skilled people who can provide the services. Nearly 300 000 healthcare professionals would be required, and given the time needed to train new ones, there would be a huge strain.
Worse, analysis shows that the NHI will make things even worse than they currently are. According to Naidoo, “what NHI will do actually is worse than healthcare for the uninsured because combining your medical scheme population, who are older, within a single risk pool, will actually usurp more funds and actually disadvantage the vulnerable.”
But the country is not without options and inherent advantages, Naidoo says, citing the strengths of its private healthcare system. “We can bring to the table the skills, the knowledge and experience on how to build a sustainable funding solution for the entire country. So that’s what we can bring, and we want to make sure we build this country for everyone.”
By Damian McHugh, Chief Marketing Officer, Momentum Health
In his 2025 Budget Speech on 21 May, Finance Minister Enoch Godongwana reaffirmed government’s commitment to strengthening South Africa’s healthcare system, announcing a R20.8 billion boost to provincial health budgets. This includes hiring 800 post-community service doctors, addressing shortages of essential goods and services, and settling unpaid obligations.
While this is a welcome step toward easing pressure on healthcare workers, especially in underserved areas, it also presents a vital opportunity for public-private collaboration. The question now is whether this investment will be enough to tackle the deeper, systemic challenges facing our healthcare workforce and infrastructure.
In the ever-evolving landscape of healthcare in South Africa, the rising demand for healthcare services, coupled with a shortage of skilled workers, creates a complex challenge. There is an urgent need to not only support but also empower healthcare workers across the country.
According to the World Health Organisation (WHO), the shortage of skilled health professionals in South Africa is projected to be 97 000 by 20251. This challenge not only disrupts the delivery of quality care but also impacts the overall wellbeing of communities. As advocates for more accessible healthcare for more South Africans, we believe that innovative solutions are key to closing the gap, valuing and retaining current talent, and by doing so, edging us closer towards a healthier nation.
The growing need for healthcare workers is largely driven by factors such as our aging population, increased prevalence of chronic disease, and an uneven distribution of healthcare workers across provinces, with rural areas being particularly underserved2 . In these areas, patients often experience long wait times and reduced access to specialised care. Additionally, healthcare professionals across provinces often face burnout and job dissatisfaction due to excessive workloads and inadequate support. Together, these challenges add pressure to an already strained system.
Embracing Greater Collaboration and Innovation
To address local needs and support healthcare professionals in delivering quality services, a multi-faceted approach is necessary. The first step is greater collaboration between the public and private sectors. These partnerships can address systemic challenges and drive meaningful improvements, thus strengthening infrastructure and expanding affordable health insurance.
In recent years, technology has emerged with strong promise to bridge various divides. We’ve seen first-hand through our Hello Doctor offering and Momentum App how technologies such as telemedicine and emerging technology can enhance care delivery, efficiency and accessibility. These technologies can bridge geographical barriers, enabling healthcare professionals to provide remote consultations, monitor patient progress and access critical health information in real-time.
Building on the promise of technology, emerging technologies like AI can play a significant role in aiding healthcare professionals with decision-making, diagnostics, and patient management. AI-powered solutions can analyse vast amounts of data quickly, identify patterns, and provide recommendations to support evidence-based care. This can lead to more accurate diagnoses, personalised treatment plans, and improved patient outcomes.
Building a Sustainable Workforce
South Africa’s healthcare sector is one of the most stressful in the world, with the public sector particularly under severe strain. Staffing shortages exacerbate this stress, and so supporting healthcare professionals in their roles is just as important as implementing innovative technologies. Fostering a positive work environment and ensuring job satisfaction are key focus areas to improving care delivery. A supportive workplace culture not only enhances employee retention but also promotes better patient outcomes.
Prioritising Mental Health and Wellness
In addition to structural and technological improvements, we must also recognise the critical role of mental health and wellness in sustaining our healthcare workforce. Chronic stress, emotional fatigue, and trauma exposure are daily realities for many healthcare workers. Without adequate mental health support, these pressures lead to burnout, absenteeism, and crippling fatigue.
In recent years, it has become clear that wellness extends beyond physical health. As a result, a visible shift has occurred across the healthcare sector to provide wellness solutions that offer counselling services, resilience training, and mindfulness programmes tailored to the unique challenges faced by healthcare professionals. By embedding mental wellness into the core of workforce support strategies, we not only protect the individuals who care for our nation but also enhance the quality and consistency of the care they provide.
Retaining healthcare professionals is not only critical to the future of healthcare delivery in South Africa, but also to the future health of its people. Healthcare institutions must implement proactive strategies that prioritise the wellbeing of their staff.
Bridging the healthcare workforce gap in South Africa requires investing in innovation, training, and supportive work environments. Building a sustainable healthcare workforce capable of meeting the needs of our nation will take our collective effort to support and empower the sector. Together, we can create a healthier South Africa for generations to come.
