ABSTRACT:
South Africa faces an escalating diabetes burden that undermines health, economic productivity, and social equity. Diabetes is the leading cause of death in the country, responsible for 32863 deaths in 2022 (6.8% of all deaths).1 The economic cost is substantial, estimated at R21.8 billion in 2023 and projected to rise to R35 billion by 2030, with half of these costs driven by preventable complications.2 These trends signal a health system failure and broader developmental challenge. The National Strategic Plan for the Prevention and Control of Noncommunicable Diseases (2022–2027) calls for a whole-of-society response and introduces 90–60–50 diabetes targets.3 South Africa is unlikely to meet these targets because of fragmented governance, uneven access to quality care, supply constraints, and slow policy implementation. Reframing diabetes as a societal and governance challenge, rather than just a clinical or individual issue, enables decisive action through cross-government coordination led by the Presidency, parliamentary oversight, sustainable and ring-fenced financing, robust surveillance and evaluation, equitable access to essential medicines and technologies, and community co-produced solutions. Following the 2025 South African Diabetes Summit, which culminated in the Johannesburg Declaration for Accelerated Action on Diabetes, this session advances a clear proposition: diabetes should be formally declared a public health crisis to prompt a coordinated, accountable, whole-of-government response. The session will be a moderated roundtable with representatives from the Presidency, National Department of Health, Parliament, South African Medical Research Council, and civil society. The discussion will: (1) present the civil society case for a crisis declaration, why now, and what problem it addresses; (2) outline what such a declaration should entail in practice, including governance, accountability, financing, data, and equity safeguards; and (3) examine implications for national and provincial government, research institutions, and society, laying the foundation for a whole-of-government, whole-of-society response to diabetes.