Transforming the workplace environment to prevent non-communicable chronic diseases: participatory action research in a South African power plant

Multisectoral interventions for urban health in Africa: a mixed-methods systematic review

Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world's fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989-2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet.Paper ContextMain findings: Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental.Added knowledge: We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings.Global health impact for policy and action: This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.

Fostering cardiovascular health at work - case study from Senegal

BACKGROUND

Of the 15 million annual premature deaths from non-communicable diseases (NCDs), 85% occur in low- and middle-income countries (LMICs). Affecting individuals in the prime of their lives, NCDs impose severe economic damage to economies and businesses, owing to the high mortality and morbidity within the workforce. The Novartis Foundation urban health initiative, Better Hearts Better Cities, was designed to improve cardiovascular health in Dakar, Senegal through a combination of interventions including a workplace health program. In this study, we describe the labor policy environment in Senegal and the outcomes of a Novartis Foundation-supported multisector workplace health coalition bringing together volunteering private companies.

METHODS

A mixed method design was applied between April 2018 and February 2020 to evaluate the workplace health program as a case study. Qualitative methods included a desk review of documents relevant to the Senegalese employment context and work environment and in-depth interviews with eight key informants including human resource representatives and physicians working in the participating companies. Quantitative methods involved an analysis of workplace health program indicators, including data on diagnosis, treatment and control of hypertension in employees, provided by the coalition companies, and a cost estimate of NCD-related ill-health as compared to the investment needed for hypertension screening and awareness raising events.

RESULTS

Senegal has a legal and regulatory system that ensures employee protection, supports social security benefits, and promotes health and hygiene in companies. The Dakar Workplace Health Coalition comprised 18 companies, with a range of staff between 300 and 4'220, covering 36'268 employees in total. Interviews suggested that the main enablers for workplace program success were strong leadership support within the company and a central coordination mechanism for the program. The main barrier to monitor progress and outcomes was the reluctance of companies to share data. Four companies provided aggregated anonymized cohort data, documenting a total of 21'392 hypertension screenings and an increasing trend in blood pressure control (from 34% in Q4 2018 to 39% in Q2 2019) in employees who received antihypertensive treatment.

CONCLUSION

Evidence on workplace health and wellness programs in Africa is scarce. This study highlights how private sector companies can play a significant role in improving cardiovascular population health in LMICs.

Identifying co-occurrence and clustering of chronic diseases using latent class analysis: cross-sectional findings from SAGE South Africa Wave 2

OBJECTIVES

To classify South African adults with chronic health conditions for multimorbidity (MM) risk, and to determine sociodemographic, anthropometric and behavioural factors associated with identified patterns of MM, using data from the WHO's Study on global AGEing and adult health South Africa Wave 2.

DESIGN

Nationally representative (for ≥50-year-old adults) cross-sectional study.

SETTING

Adults in South Africa between 2014 and 2015.

PARTICIPANTS

1967 individuals (men: 623 and women: 1344) aged ≥45 years for whom data on all seven health conditions and socioeconomic, demographic, behavioural, and anthropological information were available.

MEASURES

MM latent classes.

RESULTS

The prevalence of MM (coexistence of two or more non-communicable diseases (NCDs)) was 21%. The latent class analysis identified three groups namely: minimal MM risk (83%), concordant (hypertension and diabetes) MM (11%) and discordant (angina, asthma, chronic lung disease, arthritis and depression) MM (6%). Using the minimal MM risk group as the reference, female (relative risk ratio (RRR)=4.57; 95% CI (1.64 to 12.75); p =0.004) and older (RRR=1.08; 95% CI (1.04 to 1.12); p<0.001) participants were more likely to belong to the concordant MM group, while tobacco users (RRR=8.41; 95% CI (1.93 to 36.69); p=0.005) and older (RRR=1.09; 95% CI (1.03 to 1.15); p=0.002) participants had a high likelihood of belonging to the discordant MM group.

CONCLUSION

NCDs with similar pathophysiological risk profiles tend to cluster together in older people. Risk factors for MM in South African adults include sex, age and tobacco use.

Changes in risk factors for non-communicable diseases associated with the 'Healthy choices at work' programme, South Africa

BACKGROUND

Globally 71% of deaths are attributed to non-communicable diseases (NCD). The workplace is an opportune setting for health promotion programs and interventions that aim to prevent NCDs. However, much of the current evidence is from high-income countries.

OBJECTIVE

The aim of this study was to evaluate changes in NCD risk factors, associated with the Healthy Choices at Work programme (HCWP), at a commercial power plant in South Africa.

METHODS

This was a before-and-after study in a randomly selected sample of 156 employees at baseline and 137 employees at 2-years. The HCWP focused on food services, physical activity, health and wellness services and managerial support. Participants completed questionnaires on tobacco smoking, harmful alcohol use, fruit and vegetable intake, physical activity, psychosocial stress and history of NCDs. Clinical measures included blood pressure, total cholesterol, random blood glucose, body mass index, waist circumference and waist-to-hip ratio. The 10-year cardiovascular risk was calculated using a validated algorithm. Sample size calculations evaluated the power of the sample to detect meaningful changes in risk factors.

RESULTS

Paired data was obtained for 137 employees, the mean age was 42.7 years (SD 9.7) and 64% were male. The prevalence of sufficient fruit and vegetable intake increased from 27% to 64% (p < 0.001), those meeting physical activity guidelines increased from 44% to 65% (p < 0.001). Harmful alcohol use decreased from 21% to 5% (p = 0.001). There were clinical and statistically significant improvements in systolic and diastolic blood pressure (mean difference -10.2 mmHg (95%CI: -7.3 to -13.2); and -3.9 mmHg (95%CI: -1.8 to -5.8); p < 0.001) and total cholesterol (mean difference -0.45 mmol/l (-0.3 to -0.6)). There were no significant improvements in BMI. Psychosocial stress from relationships with colleagues, personal finances, and personal health improved significantly. The cardiovascular risk score decreased by 4.5% (> 0.05).

CONCLUSION

The HCWP was associated with clinically significant reductions in behavioural, metabolic and psychosocial risk factors for NCDs.

Cost and consequence analysis of the Healthy Choices at Work programme to prevent non-communicable diseases in a commercial power plant, South Africa

BACKGROUND

The workplace is an ideal setting for the implementation of a health promotion programmes to prevent non-communicable diseases (NCD). There are limited resources assigned to workplace health promotion programmes in low-and middle-income countries (LMIC).

AIM

This study aimed to conduct a cost and consequence analysis of the Healthy Choices at Work programme.

SETTING

This study was conducted at a commercial power plant in South Africa.

METHODS

Incremental costs were obtained for the activities of the Healthy Choices at Work programme over a two-year period. A total of 156 employees were evaluated in the intervention, although the effect was experienced by all employees. An annual health risk factor assessment at baseline and follow up evaluated the consequences of the programme.

RESULTS

The total incremental costs over the two-year period accumulated to $4015 for 1743 employees. The cost per employee on an annual basis was $1.15 and was associated with a -10.2mmHg decrease in systolic blood pressure, -3.87mmHg in diastolic blood pressure, -0.45mmol/l in total cholesterol and significant improvement in harmful alcohol use, fruit and vegetable intake and physical inactivity (p 0.001). There was no correlation between sickness absenteeism and risk factors for NCDs.

CONCLUSION

The cost to implement the multicomponent HCW programme was low with significant beneficial consequences in transforming the workplace environment and reducing risks factors for NCDs. Findings of this study will be useful for small, medium and large organisations, the national department of health, and similar settings in LMICs.

Associations Between the Breakroom Built Environment, Worker Health Habits, and Worker Health Outcomes: A Pilot Study Among Public Transit Rail Operators

OBJECTIVE

To investigate the association between the breakroom built environment and worker health outcomes.

METHODS

We conducted this study in a mass transit organization (rail). We collected a user-reported breakroom quality score (worker survey), a worksite health promotion score (validated audit tool), and self-reported worker health outcomes (survey).

RESULTS

Among the 12 breakrooms audited and 127 rail operators surveyed, the average worksite health promotion score was 9.1 (out of 15) and the average user-reported breakroom quality was 3.1 (out of 7). After multivariable regression, breakrooms with higher worksite health promotion scores and user-reported breakroom quality were associated with lower odds of depression and fewer medical disability days.

CONCLUSIONS

This cross-sectional study demonstrates an association between the quality of the breakroom built environment and worker health, specifically depression and medical disability days.