Improving wellness: Overview of the Burden of Disease Western Cape Wellness Summit Tracey Naledi...
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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
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
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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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Biological Behavioural SocietalStructural 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
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4
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Development can also be a negative consequences
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What does our burden in WC look like? Child Deaths
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What does our burden in WC look like? HIV and TB
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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? NCDs e.g. diabetes,
hypertension, cancer
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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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15 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
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
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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 ~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
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NON COMMUNICABLE DISEASES
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We are more overweight We smoke more We are less active Adults
Adolescents Physical Activity Patterns in SA Youth AND The trend is
getting worse
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Presented with permission from David Sanders Unhealthy food
imports growing exponentially
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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 M&E Monitoring outcomes Proactive rather than
reactive response Provincial Transversal Management System Great
opportunities to harness ideas and resources of all sectors