University of the Witwatersrand: Ground-breaking report card gives crucial health data to manage illnesses of middle-age
This prompted the Wits Developmental Pathways for Health Research Unit (DPHRU), based at Chris Hani Baragwanath Academic Hospital, to develop a Healthy Ageing Adult South Africa (HAASA) report card, which is the first of its kind to guide the information available on middle-aged adults.
Health information on middle-aged adults is a crucial component of ensuring that the health system serves this population appropriately. The DPHRU’s ground-breaking HAASA report card provides a systematic review of evidence published between 2013 and 2020 on 45-65-year-olds’ diet, physical activity, tobacco and alcohol use, obesity, hypertension, diabetes, and dyslipidaemia [abnormally elevated cholesterol or fats (lipids) in the blood].
Each of these indicators was assigned two grades: The first was whether there was indeed prevalence data available, and the second was whether policies had been proposed and implemented for the respective indicators.
Because more data is available for alcohol consumption, obesity, hypertension and diabetes, these indicators received an “A” on the report grade. On the other hand, tobacco use, and diet received an “A” for policy implementation.
“While one’s disease risk increases as one gets older, it does not mean that this is inevitable. This is where science and hard data are so useful: if we know what is going on, we can find ways to mitigate or prevent them from happening,” says DPHRU researcher Gudani Mukoma, who co-authored the paper, titled The Healthy Ageing Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women.
Mukoma notes the stark difference between middle-aged adults in SA and those in the USA. “The prevalence of non-communicable diseases [NCDs], as well as levels of alcohol and tobacco use in South Africa, is much higher. This kind of information is useful to inform how we can manage this – especially in a low- and middle-income country [like SA].”
Due to their protracted and chronic nature, NCDs place considerable burdens on families and healthcare systems. The South African government has acknowledged the increasing non-communicable diseases burden and has initiated various strategies to target the significant lifestyle and physical risk factors associated with NCDs, including cancer, diabetes, hypertension, and cardiovascular disease.
Government initiatives include the implementation of the Strategic Plan for the Prevention and Control of NCDs 2013-2017 to achieve certain targets by 2020, and the adoption of the South African Declaration on the Prevention and Control of NCDs.
However, there is inconsistency in providing critical information for the different indicators. “We need more data, especially at the national level. While we do have regional-level data, we need to show what is nationally applicable,” says Mukoma.
The HAASA reveals the disconnect between the prevalence and policy grades for all indicators, with some indicators – physical inactivity, alcohol consumption, obesity, hypertension, and diabetes – having higher grades for the availability of prevalence data, while others (tobacco, diet, and dyslipidaemia) have higher grades for policy and implementation.
Mukoma adds that there should be standardised methods in collecting and analysing prevalence data. Furthermore, those where information is readily available should be prioritised by policy makers.
Chronic disease burden set to increase
“With increasing urbanisation, life expectancy and population size, we will see increased non-communicable diseases in sub-Saharan Africa,” says Mukoma. Indeed, there are models estimating that the sub-Saharan population will expand from 13% of the global population in 2017 to 35% in 2100. But the Sustainable Development Goal (SDG) target 3.4 of reducing premature mortality from NCDs by a third by 2030 (relative to 2015), is a guiding light and offers impetus for providing appropriate policies and frameworks.
“Ensuring that harmonised methodologies are used to collect prevalence data for this age group to pool data and more clearly understand national and regional trends should be a priority towards achieving an ‘A’ prevalence grading for physical activity, tobacco, diet, and dyslipidaemia,” says Mukoma.
The countdown to achieving SDG 3.4 by 2030 has begun. “But what we know is that no country will achieve this by addressing a single disease, and that a combination of ‘multimorbidity’ prevention strategies and strengthening the health system are necessary.”
While Denmark and New Zealand are on track to meet their SDG targets by 2030, it is a lot more complex in sub-Saharan Africa. Thus, it is important to fully understand the socio-economic factors that contribute to the prevalence of NCDs and to promote policies that are acutely sensitive to that.
Mukoma notes that future HAASA report cards will include whether current targets set out by the Strategic Plan for the Prevention and Control of NCDs 2013-2017 have been met.