Improving wellness: Overview of the Burden of Disease Western Cape Wellness Summit

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Improving wellnessOverview of the Burden of
DiseaseWestern Cape Wellness Summit

• Tracey Naledi
• Director Health Impact Assessment
• Western Cape Government Health
• 8 November 2011

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Some definitions from WHO

• Health
• a human right far more than the absence of
  disease
• resource for everyday life, not the objective of
  living
• a consequence and a pre-requisite for development
  
• Wellness
• the optimal state of health with two components
• Realisation of ones fullest potential
  (physically, psychologically, socially,
  spiritually and financially)
• Fulfilment of ones role expectations in the
  family, community, work, school, other settings

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What puts us at risk of ill health, e.g. violence
Biological
Behavioural
Societal
Structural

• Examples
• Inequalities
• Norms that support violence
• Availability of means
• Weak police/criminal justice

• Examples
• Demographic factors
• Psychological and
• personality disorders

• Examples
• Poor parenting
• Marital conflict
• Friends who engage in violence
• History of violent behaviour
• Experienced abuse

• Examples
• Concentration of poverty
• High residential mobility
• High unemployment
• Social isolation
• Local illicit drug trade

Source TEACH VIP www.who.int/violence_injury_prev
ention/publications/violence/en/index.html
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Development can also be a negative consequences
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What does our burden in WC look like?
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What does our burden in WC look like?
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What does our burden in WC look like?
Injuries
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What does our burden in WC look like?
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What does our burden in WC look like?
Source Western Cape BOD reduction project using
StatsSA data
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Child Mortality is decreasing
Source Western Cape BOD reduction project using
StatsSA data
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Infections and perinatal causes are our major
problems
Source Western Cape BOD project
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Social determinants for child health
Infant mortality rate per 1000 live births, South
Africa
Source L. Lake Childrens rights to health
presentation to WC Premiers wellness summit, 8
November 2011. Department of Health (2002) South
African Demographic and Health Survey 1998.
Pretoria DoH World Health Organisation (2007)
World Health Statistics 2007. Geneva WHO. Both
in Bradshaw D (2008) Determinants of Health and
their trends. South African Health Review.Durban
Health Systems Trust.
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Life course approach South Africa
Source Saving children
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Pre-school
Pre-School
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Womens Health

• MDG 4 5 gender inequalities
• increase women and children vulnerability to ill
  health
• Intimate Partner Violence indicator for gender
  inequality
• IPV results in high levels of mental health
  problems especially depression, anxiety, PTSD
  and substance abuse
• Teenage pregnancy, school completion, economic
  empowerment, crime and violence aggravated by IPV
  and rape

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Community-based randomly selected sample of adult
men and women in Gauteng Province South Africa
With permisssion Prof. Rachel Jewkes, Director
Gender Health Research Unit, Medical Research
Council of South Africa
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Community-based randomly selected sample of adult
men and women in Gauteng Province South Africa
Context of families and social environment
important to consider
With permisssion Prof. Rachel Jewkes, Director
Gender Health Research Unit, Medical Research
Council of South Africa
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Injuries, WC 2009
18.1
Source Western Cape BOD project
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Alcohol is an important risk factor
Source Western Cape Provincial Injury Mortality
Surveilance System January December 2008
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Violence is CONCENTRATED
Suburbs Zero Positive Unknown Total
Khayelitsha 313 (15) 527 (21) 303 (8) 1143 (13)
Gugulethu 97 (5) 169 (7) 143 (4) 409 (5)
Nyanga 121 (6) 161 (7) 149 (4) 431 (5)
Kraaifontein 73 (3) 124 (5) 92 (2) 289 (3)
Philippi 110 (5) 125 (5) 143 (4) 378 (4)
.  . .  .  .
Total 2135 (100) 2460 (100) 3902 (100) 8497 (100)
Approx. 50 of alcohol-related violence occurs
in 5 areas
Source PIMMS (DoP analysis)
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REDUCE SUPPLY OF ALCOHOL
DECREASE DEMAND FOR ALCOHOL

• EXAMPLES
• Targeted implementation
• of Liquor Act
• Community Mobilisation
• around liquor act and
• licensing

• EXAMPLES
• Brief Interventions
• Counter-messaging
• Education
• Recreation
• Skills development
• ECD
• Mental Health
• Social Cohesion
• Urban upgrading

CREATE SAFER DRINKING ENVIRONMENTS

• EXAMPLES
• Social mobilisation for
• Safer drinking environments
• Traffic calming
• Infrastructural improvements
• Urban upgrading

ME FOR OUTCOMES AND TARGETING OF INTERVENTIONS

• EXAMPLE
• Detailed trauma
• surveillance

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HIV/AIDS AND TB
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New cases of HIV
Source ASSA 2011
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Siamese twins HIV and TB in areas of deprivation
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NON COMMUNICABLE DISEASES
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• We are more overweight
• We smoke more
• We are less active

Adolescents
Adults
AND The trend is getting worse
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Unhealthy food imports growing exponentially
Presented with permission from David Sanders
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Unhealthy choices
in tuck shops
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The right choice Is not the easy choice

• Healthy foods prohibitively expensive, processed
  foods exceedingly cheap
• There is a shortage of healthy low-fat food and
  little fresh fruit and vegetables in the
  townships.
• Perceptions that fried fast foods tastier, more
  civilised
• Supermarkets make healthy foods available BUT
• low prominence
• Promotions unhealthy foods
• Advertising to children unhealthy foods
• Unsafe communities decreased opportunities for
  physical activity

Chopra M, Puoane T. Diabetes Voice 2003 48
246. Temple, et. al., "Price and availability
of healthy food A study in rural South Africa."
Nutrition Journal 1 (2010) 1-4. Farley et. al..
"Measuring the Food Environment Shelf Space of
Fruits, Vegetables, and Snack Foods in Stores."
Journal of Urban Health 86.5 (2009) 672-682
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These complexities present opportunities

• Whole government, whole society action
• Advocacy role of health sector for inter sectoral
  collaboration
• Development of innovative systems for
• Governance to manage partnerships and alliances
  beyond contractual arrangements
• Evidence based inter-sectoral delivery and
  financing
• Accountability
• Strategic use of information for inter sectoral
  planning and ME
• Monitoring outcomes
• Proactive rather than reactive response
• Provincial Transversal Management System
• Great opportunities to harness ideas and
  resources of all sectors

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Thank you