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
– 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
Structural
Societal
Behavioural
Biological
Examples:
Examples:
Examples
Examples:
• Inequalities
• Poor• parenting
Demographic factors
• Concentration of poverty
• Norms that support violence
• Marital
• Psychological
conflict
and
• High residential mobility
• Availability of means
personality
who engage
disorders
in violence
• High unemployment• Friends
• Weak police/criminal justice
• History of violent behaviour
• Social isolation
• Experienced abuse
• Local illicit drug trade
Source: TEACH VIP www.who.int/violence_injury_prevention/publications/violence/en/index.html
4
Development can also be a negative
consequences
What does our burden in WC look like?
Western Cape Province Males Deaths 2009, N=25,729
Western Cape Province Females Deaths 2009, N=21,064
2,500
2,000
2,000
Deaths
1,000
1,500
1,000
500
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Non-communicable
Injuries
Non-communicable
Injuries
Child Deaths
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0
0
1-4
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
5-9
10-14
1-4
0
500
0
Deaths
1,500
What does our burden in WC look like?
Western Cape Province Males Deaths 2009, N=25,729
Western Cape Province Females Deaths 2009, N=21,064
2,500
2,000
2,000
Deaths
1,000
1,500
1,000
500
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Non-communicable
Injuries
Non-communicable
Injuries
HIV and TB
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0
0
1-4
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
5-9
10-14
1-4
0
500
0
Deaths
1,500
What does our burden in WC look like?
Western Cape Province Males Deaths 2009, N=25,729
Western Cape Province Females Deaths 2009, N=21,064
2,500
2,000
2,000
Deaths
1,000
1,500
1,000
500
Injuries
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Non-communicable
Injuries
Non-communicable
Injuries
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0
0
1-4
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
5-9
10-14
1-4
0
500
0
Deaths
1,500
What does our burden in WC look like?
Western Cape Province Males Deaths 2009, N=25,729
Western Cape Province Females Deaths 2009, N=21,064
2,500
2,000
2,000
Deaths
1,000
1,500
1,000
500
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Comm/Mat/Peri/Nutri
HIV/AIDS and TB
Non-communicable
Injuries
Non-communicable
Injuries
NCD’s
e.g. diabetes, hypertension, cancer
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0
0
1-4
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
5-9
10-14
1-4
0
500
0
Deaths
1,500
What does our burden in WC look like?
Cause of death profile, Western Cape
25%
Injuries
20%
Infectious and parasitic
Respiratory infections
15%
Stroke
Cardiovascular disease
Diabetes mellitus
10%
Malignant neoplasms
Respiratory disease
5%
Other diseases
Ill-defined
0%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: Western Cape BOD reduction project using StatsSA data
Child Mortality is decreasing
Source: Western Cape BOD reduction project using StatsSA data
Infections and perinatal causes are our major
problems
Meningitis TB
2%
2%
Septicaemia
3%
Injuries
8%
Other
8%
Preterm
15%
Malnutrition
4%
HIV
8%
Perinatal
35%
Birth asphyxia
6%
Sepsis 4%
Pneumonia
14%
Other perinatal 2%
Congenital
8%
Diarrhoea
16%
Source: Western Cape BOD project
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
Source: Saving children
Pre-school
Pre-School
15
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
Motivations for rape
80
Girl<15 yrs
70
Girlfriend
60
Non-partner
Gang rape
50
40
30
20
Context of families
and social
environment
important to consider
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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
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)
DECREASE DEMAND FOR
ALCOHOL
EXAMPLES
•Brief Interventions
•Counter-messaging
•Education
•Recreation
•Skills development
•ECD
•Mental Health
•Social Cohesion
•Urban upgrading
M&E FOR OUTCOMES AND
TARGETING OF INTERVENTIONS
EXAMPLE
•Detailed trauma
surveillance
REDUCE SUPPLY
OF ALCOHOL
EXAMPLES
•Targeted implementation
of Liquor Act
•Community Mobilisation
around liquor act and
licensing
CREATE SAFER
DRINKING ENVIRONMENTS
EXAMPLES
•Social mobilisation for
Safer drinking environments
•Traffic calming
•Infrastructural improvements
•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-districts
Of TB diagnoses, 76% are in the same 14 subdistricts
NON COMMUNICABLE DISEASES
We are more overweight
We smoke more
We are less active
Adolescents
70
National (M)
40
National (F)
W Cape (M)
30
W Cape (F)
20
Percentage
Prevalence (%)
50
Adults
Men
Women
WC Men
WC Women
60
50
40
30
20
10
10
0
0
Inactiv ity
Smoking
Ov erw eight
Ov erweight
Tobacco
Inactiv ity
Behaviour
AND
The trend is
getting worse…
Physical Activity Patterns in SA Youth
Unhealthy food imports growing exponentially
Presented with permission from David Sanders
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