Health checks – which ones you need, and how often

High blood pressure, high blood sugar, high cholesterol and HIV all share one property: for years, they cause no symptoms at all. By the time they announce themselves — with a stroke, a heart attack, a foot ulcer or an opportunistic infection — much of the damage is done.

That is the entire argument for checking. It is not about anxiety or over-medicalising a normal life; it is that these particular conditions cannot be felt, and are straightforward to treat once found.

• Blood pressure — the single highest-value check in South Africa. At least every couple of years if it has always been normal, and more often if it has ever been raised, if you are over 40, or if it runs in your family.
• Blood glucose — for anyone overweight, over 45, with a family history of diabetes, or who has had diabetes in pregnancy.
• HIV test — recommended for everyone, repeated regularly for anyone with ongoing risk. It is free, quick and confidential at any clinic.
• Weight and waist measurement, which tell you more together than either does alone.
• Cholesterol, from around 40, or earlier where there is a family history of early heart disease.
• TB symptom screening — a cough for more than two weeks, night sweats, unexplained weight loss or fever should always be checked, at any age.
• Eyes and teeth, both of which quietly deteriorate without pain until late.

• Cervical screening from age 30 in the public sector, or earlier and more often for women living with HIV — see the cervical screening article.
• Breast awareness at any age, and mammography where a doctor advises it based on age and family history.
• Folic acid and a check-up before pregnancy rather than after it is confirmed.
• Blood pressure at every pregnancy visit, which is how pre-eclampsia is caught.

South African men see a clinician far less often than women do, and present later with almost everything. The symptoms worth acting on rather than waiting out are covered in the men's health article; the routine checks are blood pressure, glucose, cholesterol and HIV, on the same schedule as anyone else.

Prostate checks are a decision to discuss rather than a blanket recommendation, because the test can lead to treatment for cancers that would never have caused harm. From around 45 to 50 it is a conversation worth having with a doctor, earlier if there is a family history.

1. 1Write the numbers down, or record them in an app. A blood pressure reading is far more useful as a trend than as a single figure.
2. 2Ask what the number means and what the target is. 'It's fine' is not a result you can act on later.
3. 3Ask what happens next, and when to come back. A follow-up that nobody scheduled usually does not happen.
4. 4Take your medicine list with you, including anything bought over the counter, herbal or traditional.
5. 5If you are told to come back for results, go — a normal result is worth knowing and an abnormal one is worth acting on early.