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Improving wellness: Overview of the Burden of Disease Western Cape Wellness Summit. Tracey Naledi Director: Health Impact Assessment Western Cape Government Health 8 November 2011. Some definitions from WHO. Health a human right; far more than the absence of disease

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improving wellness overview of the burden of disease western cape wellness summit

Improving wellness:Overview of the Burden of DiseaseWestern Cape Wellness Summit

Tracey Naledi

Director: Health Impact Assessment

Western Cape Government Health

8 November 2011

some definitions from who
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 one’s fullest potential (physically, psychologically, socially, spiritually and financially)
      • Fulfilment of one’s role expectations in the family, community, work, school, other settings
what puts us at risk of ill health e g violence
What puts us at risk of ill health, e.g. violence
  • Behavioural
  • Structural
  • Societal
  • Biological
  • Examples:
    • Inequalities
    • Norms that support violence
    • Availability of means
    • Weak police/criminal justice
  • Examples:
    • Concentration of poverty
    • High residential mobility
    • High unemployment
    • Social isolation
    • Local illicit drug trade
  • Examples:
    • Poor parenting
    • Marital conflict
    • Friends who engage in violence
    • History of violent behaviour
    • Experienced abuse
  • Examples
    • Demographic factors
    • Psychological and
    • personality disorders

Source: TEACH VIP www.who.int/violence_injury_prevention/publications/violence/en/index.html

what does our burden in wc look like3
What does our burden in WC look like?

NCD’s

e.g. diabetes, hypertension, cancer

what does our burden in wc look like4
What does our burden in WC look like?

Source: Western Cape BOD reduction project using StatsSA data

child mortality is decreasing
Child Mortality is decreasing

Source: Western Cape BOD reduction project using StatsSA data

social determinants for child health
Social determinants for child health

Infant mortality rate per 1000 live births, South Africa

Source: L. Lake Children’s rights to health presentation to WC Premier’s 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.

life course approach south africa
Life course approach: South Africa

Source: Saving children

slide15

Pre-school

Pre-School

women s health
Women’s 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
community based randomly selected sample of adult men and women in gauteng province south africa
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

community based randomly selected sample of adult men and women in gauteng province south africa1
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

injuries wc 2009
Injuries, WC 2009

18.1%

Source: Western Cape BOD project

alcohol is an important risk factor
Alcohol is an important risk factor

Source: Western Cape Provincial Injury Mortality Surveilance System January – December 2008

violence is concentrated
Violence is CONCENTRATED

Approx. 50% of

alcohol-related

violence occurs

in 5 areas

Source: PIMMS (DoP analysis)

slide22

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

M&E FOR OUTCOMES AND

TARGETING OF INTERVENTIONS

EXAMPLES

  • Social mobilisation for

Safer drinking environments

  • Traffic calming
  • Infrastructural improvements
  • Urban upgrading

EXAMPLE

  • Detailed trauma

surveillance

new cases of hiv
New cases of HIV

Source: ASSA 2011

siamese twins hiv and tb in areas of deprivation
Siamese twins: HIV and TB in areas of deprivation

~300,000 HIV infected individuals

~50,000 diagnosed TB cases per annum

Of HIV-infected people, 86% are in 14 sub-districts

Of TB diagnoses, 76% are in the same 14 sub-districts

slide27

Adolescents

Adults

We are more overweight

We smoke more

We are less active

AND

The trend is getting worse…

Physical Activity Patterns in SA Youth

unhealthy food imports growing exponentially
Unhealthy food imports growing exponentially

Presented with permission from David Sanders

the right choice is not the easy choice
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: 24–6. &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

these complexities present opportunities
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 M&E
    • Monitoring outcomes
    • Proactive rather than reactive response
  • Provincial Transversal Management System
    • Great opportunities to harness ideas and resources of all sectors