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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

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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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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

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SuburbsZeroPositiveUnknownTotal Khayelitsha313 (15%)527 (21%)303 (8%)1143 (13%) Gugulethu97 (5%)169 (7%)143 (4%)409 (5%) Nyanga121 (6%)161 (7%)149 (4%)431 (5%) Kraaifontein73 (3%)124 (5)92 (2%)289 (3%) Philippi110 (5%)125 (5%)143 (4%)378 (4%)..... Total2135 (100%) 2460 (100%)3902 (100%)8497 (100%) Source: PIMMS (DoP analysis) Approx. 50% of alcohol-related violence occurs in 5 areas Violence is CONCENTRATED

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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

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Thank you