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

Improving wellness:Overview of the Burden of Disease

Western Cape Wellness Summit

Tracey NalediDirector: Health Impact AssessmentWestern Cape Government Health

8 November 2011

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

BiologicalBehaviouralSocietalStructural

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

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

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

What puts us at risk of ill health, e.g. violence

4

Development can also be a negative consequences

What does our burden in WC look like?

0

500

1,000

1,500

2,000

2,500

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+

Wes tern Cape Prov ince Females Deaths 2009, N=21,064

Comm/Mat/Peri /Nutri HIV/AIDS and TB

Non-communicable Injuries

0

500

1,000

1,500

2,000

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+

Wes tern Cape Prov ince Males Deaths 2009, N=25,729



Child Deaths


0

500

1,000

1,500

2,000

2,500

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+




0

500

1,000

1,500

2,000

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+




HIV and TB


0

500

1,000

1,500

2,000

2,500

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+




0

500

1,000

1,500

2,000

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+




Injuries


0

500

1,000

1,500

2,000

2,500

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+




0

500

1,000

1,500

2,000

Dea

ths

0

1-4

5-9

10-

14

15-

19

20-

24

25-

29

30-

34

35-

39

40-

44

45-4

9

50-

54

55-5

9

60-

64

65-

69

70-7

4

75-

79

80-

84

85+




NCD’se.g. diabetes, hypertension, cancer

0%

5%

10%

15%

20%

25%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Cause of death profile, Western Cape

Injuries

Infectious and parasitic

Respiratory infections

Stroke

Cardiovascular disease

Diabetes mellitus

Malignant neoplasms

Respiratory disease

Other diseases

Ill-defined


Source: Western Cape BOD reduction project using StatsSA data

Child Mortality is decreasing

Source: Western Cape BOD reduction project using StatsSA data

Diarrhoea16%

Pneumonia14%

HIV8%

Malnutrition4%

Septicaemia3%

Meningitis2%

TB2%

Injuries8%

Other8%

Preterm15%

Birth asphyxia6%

Sepsis 4%Other perinatal 2%

Congenital8%

Perinatal35%

Infections and perinatal causes are our major problems

Source: Western Cape BOD project

Social determinants for child healthInfant 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

Source: Saving children

15

Pre-schoolPre-School

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

Women (victims)

Men (perpetration)

% %

Any physical IPV 33.1 50.5

>1 episode of physical violence 30.8 43.4

Physical IPV in last 12 months 13.2 5.8

Any rape ever 25.2 37.4

Sexual IPV ever 18.8 18.2

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 Africa

010

2030

40

50

60

70

80

Motivations for rape

Girl<15 yrs

Girlfriend

Non-partner

Gang rape

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

18.1%

Source: Western Cape BOD project

Alcohol is an important risk factor

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

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%)

Source: PIMMS (DoP analysis)

Approx. 50% of alcohol-related violence occurs in 5 areas

Violence is CONCENTRATED

DECREASE DEMAND FOR ALCOHOL

REDUCE SUPPLY OF ALCOHOL

CREATE SAFER DRINKING ENVIRONMENTS

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

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

M&E FOR OUTCOMES AND TARGETING OF INTERVENTIONS

EXAMPLE•Detailed trauma surveillance

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

HIV/AIDS AND TB

New cases of HIV

Source: ASSA 2011

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

NON COMMUNICABLE DISEASES

We are more overweightWe smoke more

We are less active

Inactivity Overweight Tobacco0

10

20

30

40

50

60

70 MenWomenWC MenWC Women

Behaviour

Perc

enta

ge

Smoking Overweight Inactivity0

10

20

30

40

50National (M)National (F)W Cape (M)W Cape (F)

Prev

alen

ce (%

)

AdultsAdolescents

Physical Activity Patterns in SA Youth

AND The trend is

getting worse…

Presented with permission from David Sanders

Unhealthy food imports growing exponentially

Unhealthy choices in tuck shops

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

• 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

Thank you

Documents

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