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

1. Improving wellness:Overview of the Burden of DiseaseWestern Cape Wellness Summit Tracey Naledi Director: Health Impact Assessment Western Cape Government Health 8 November 2011

2. 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

3. 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

5. Development can also be a negative consequences

6. What does our burden in WC look like? Child Deaths

7. What does our burden in WC look like? HIV and TB

8. What does our burden in WC look like? Injuries

9. What does our burden in WC look like? NCD’s e.g. diabetes, hypertension, cancer

10. What does our burden in WC look like? Source: Western Cape BOD reduction project using StatsSA data

11. Child Mortality is decreasing Source: Western Cape BOD reduction project using StatsSA data

12. Infections and perinatal causes are our major problems Source: Western Cape BOD project

13. 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.

14. Life course approach: South Africa Source: Saving children

15. Pre-school Pre-School

16. 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

17. 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

18. 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

19. Injuries, WC 2009 18.1% Source: Western Cape BOD project

20. Alcohol is an important risk factor Source: Western Cape Provincial Injury Mortality Surveilance System January – December 2008

21. Violence is CONCENTRATED Approx. 50% of alcohol-related violence occurs in 5 areas Source: PIMMS (DoP analysis)

22. 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

23. HIV/AIDS AND TB

24. New cases of HIV Source: ASSA 2011

25. 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

26. NON COMMUNICABLE DISEASES

27. 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

28. Unhealthy food imports growing exponentially Presented with permission from David Sanders

29. Unhealthy choices in tuck shops

30. 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

31. 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

32. Thank you