SA doctors to tackle lifestyle diseases epidemic

South African GPs and other healthcare professionals (HCPs) are being offered free training to help patients quit smoking and excessive drinking, improve their diets and exercise more as part of a new nationwide programme to stem the tide of chronic lifestyle diseases such as diabetes, hypertension and heart disease.

South Africans are among the worst in the world when it comes to the increasing incidence of cardiovascular disease and diabetes. And, say the experts, this is largely due to our increasingly unhealthy lifestyles that combine poor diets and a lack of physical activity with smoking and drinking.

Statistics from Stats SA and the WHO Global Status Report show that among BRICS (Brazil, Russia, India, China and SA), South African women have the highest incidence of CVD and diabetes, and only Russian men are ahead of South African men for the same conditions. CVD is attributable to eight risk factors: smoking, drinking, low fruit and vegetable intake, physical inactivity, excess bodyweight, high cholesterol, high blood pressure and diabetes. The joint effect of these factors increases your chance of developing CVD by 65%.

But changes in lifestyle can prevent you from developing these diseases and can help you avoid the worst complications if you already have such a condition.


In a new programme called iChange4Health, doctors and other medical professionals from across the country will receive training on how to effectively motivate and support patients to make healthier choices around their lifestyles.

The tools and training for this programme were researched and developed by the Chronic Disease Initiative for Africa (CDIA). Pharma Dynamics South Africa’s largest supplier of cardiovascular medication will launch iChange4 health to doctors across South Africa later this year.

Mariska Fouché, public affairs manager for Pharma Dynamics, says there is a definite public desire for more information that is practical, easy to implement and cost effective.

"iChange4Health will start by giving GPs and other HCPs the tools to assist patients who want to get on the road to better health. Pharma Dynamics decided to launch iChange4Health after the success of its healthy-eating initiative last year, a free recipe book called Cooking from the Heart, which offered heart-friendly alternatives to favourite local dishes.
“The massive popularity of Cooking from the Heart showed us that many people want to live healthier lives and reduce their risk of developing chronic diseases of lifestyle but are unsure of how to start. Others are unaware of how unhealthily they are living.

"The iChange4Health resource package assists doctors and other health care providers to establish a non-threatening, supportive environment for the patient to discuss behavioural issues. It also provides them with the skills to exchange information, actively listen to the patient’s perspective on change and stimulate intrinsic motivation. In this way, patients become active participants in their own care rather than just passive recipients of their doctor’s advice."

Sedentary lifestyles

She says that chronic diseases of lifestyle are skyrocketing in South Africa because of increasingly sedentary lifestyles, poor diet and other lifestyle factors.

"For example the Food and Agriculture Organisation’s research shows that our daily intake of fats has increased by more than 10g since the 1990s to over 80g today. According to published sales statistics, the average South African drank 254 soft drink products in 2010, up from 139 in 1992 – that’s 115 more per year or 10 more per month.

"The 2003 South African Demographic and Health Survey shows that nearly 50% of men aged 25 to 34 and 60% of women in the same category were described as physically inactive. In this group of people who should be in their physical prime, a National Income Dynamics Study revealed that a third of men and more than two-thirds of women had a BMI of over 25, making them severely overweight. One in five men and one in four women suffer hypertension at this relatively young age.”

The long-term objectives of iChange4Health include a reduction in the burden on the increasingly overstretched public health system, believes Dr Katherine Everett-Murphy of the CDIA.

"It has become very important that the prevention of lifestyle diseases gets greater attention, otherwise our already overburdened health system will simply not be able to cope. Already, lifestyle related diseases like high blood pressure are the main reason why most people attend primary healthcare services. The iChange4Health package aims to increase the capacity of local health workers to effectively motivate and assist patients to make healthier lifestyle choices. Local research shows that most patients want more information about lifestyle from their HCPs and trust what they say."

Behavioural change

The pilot phase of iChange4Health will focus on teaching community-based and private HCPs how to tackle questions of quitting smoking, diet and exercise with their patients. Further phases are planned to target drinking.

"Many HCPs feel that they do not have the time to discuss lifestyle risk behaviours with their patients. The strategies and tools in the package do not require any significant additional investment of time and resources and can easily be integrated into usual clinical care. The approach is based on the ‘Five A’s’ best practice method for brief behavioural change counselling, which consists of five simple steps - Ask; Advise; Assess; Assist and Arrange - that can be done in a few minutes. International research shows that even just a few minutes discussion time in the consultation on smoking, diet, drinking or physical activity can help motivate patients change to their habits.

"The iChange4Health package includes tools for patients to support them improve each of the main risk behaviours. These tools showcase other people who have broken their unhealthy habits and offer tips and advice for those looking to do the same."

The iChange4Health trainers who will train HCPs are currently receiving specialised instruction from experts in the field of BBCC, including Prof Bob Mash (HOD – Division of Family Medicine and Primary Care at Stellenbosch University); family medicine specialist Dr Zelra Malan and Dr Everett-Murphy. The trainees have been recruited from Departments of Family Medicine around the country and once familiar with the methods and approaches in the iChange4Health resource package, will go on to train other HCPs later in the year.

  - (Pharma Dynamics press release)
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