WoW! (WesternCape on Wellness) Healthy Lifestyle Initiative
Physical inactivity, unhealthy eating and an unhealthy weight are considered major risk factors for a number of harmful health outcomes including obesity, diabetes, hypertension, cardio vascular diseases and other non-communicable diseases (NCDs). The risk profile of ordinary South Africans indicates that nearly 7 out of every 10 women and 1 in 3 men are overweight or obese; 1 in 3 women and 1 in 5 men have hypertension. Between 11-13% may be diabetic or have impaired glucose tolerance (Peer et al., 2014; SANHANES 2013). Over 80% of the South African population relies on the state services for health care (SANCDA, 2015).
In South Africa, NCDs accounted for 51% of all deaths in 2013 of which 20% was due to cardiovascular disease and cancers alone. In the Western Cape, NCDs accounts for 60% of deaths for males and females from 2009 to 2013, with cardiovascular disease the leading cause of death in 2013 (Morden et al, 2016).
Results from 2014 Healthy Active Kids South Africa report showed that overweight and obesity in children continue to increase due to unhealthy eating and a lack of physical activity. The current generation of children may experience a shorter life expectancy than their parents (HAKSA Report Card, 2014).
The Western Cape Government Health (WCGDoH) is committed to address these harmful health outcomes through the implementation of novel healthy lifestyles initiatives aimed at promoting increased physical activity, healthy eating and healthy weight management in order to prevent and reduce the burden of NCDs in the Western Cape. The first of such initiatives was Walk4Health tested in 2013 that entailed a 6-week interdepartmental pedometer challenge involving all departments within Western Cape Government (WCG). A total of 140 people participated from the 13 WCG Departments, 50 were tracked for monitoring purposes and 30 completed pre/post-intervention assessments and gave consent for their data to be used. The results indicate that:
- 70% lost on average 2.8kg and lowered their BMI
- 90% reduced chest circumference, average 4.5cm
- 80% reduced waist circumference, average 4,9cm
- 97% increased fitness (distance covered in 12 min), average 278m increase
- 60% lowered cholesterol
- 50% lowered blood pressure
Building on the above outcomes and the lessons learned, the WesternCape on Wellness (WoW!) healthy lifestyles initiative was developed and tested in 2015/16 (WoW! Phase-1).
The WoW! initiative
WoW! represents a novel transversal and cross-sectoral partnering approach to promote, activate, expand and maintain a healthy lifestyles movement across multiple settings, including: Worksite, Primary Healthcare Facility, School, Community and Public Space settings. The initiative aims to co-develop, test, evaluate and systematise (institutionalise) a healthy lifestyle initiative that is multi-sectoral (“all of government” and “all of society”), multi-modal (various methods), geographic specific and that follows a person-centred life course approach (ultimately from pre-pregnancy to senior citizens). The initiative addresses both individual health behavioural and social determinants of wellness to co-create enabling environments in order to prevent, reduce and better manage the burden of NCDs (including obesity) as the first focus. As an expanding wellness-promoting platform for Self-Management and to address the key components of wellness (physical, mental, social, spiritual, intellectual, financial and environmental), future foci of the initiative include, for example, reduction of harmful personal behaviours (including alcohol, drugs and smoking), safe and healthy pregnancies, child rearing, stress and relationship management, budgeting and green living.
Strategic alignment of the WoW! initiative
The initiative is being developed in alignment with international, national and provincial policies and strategies:
- WHO Global Strategy on Diet, Physical Activity and Health.
- Centres for Disease Control and Prevention: Strategies to Prevent Obesity and Other Chronic Diseases.
- Global Advocacy for Physical Activity Group.
- STOP Obesity Alliance.
- United Nations Sustainable Development Goals: Ensure healthy lives and promote well-being for all at all ages.
- Strategy for the Prevention and Control of Obesity in South Africa.
- Strategic plan for the prevention and control of non-communicable diseases 2013-17.
- Health Promotion Policy and Strategy.
- 2012 SANHANES Report.
- 2014 HAKSA Report Card.
- South African Food Based Dietary Guidelines and Food Guide (2012 edition).
- Provincial Strategic Plan: 2015-2019.
- Healthcare 2030: The Road to Wellness.
- Western Cape Youth Development Strategy – 2013
- Nourish to Flourish: Strategic Framework for Household Food and Nutrition Security (draft)
Objectives of the WoW! initiative
The short-term outcomes are to achieve and maintain:
- People development concerning healthy lifestyles through an inclusive communication platform that will provide:
- Knowledge and skills among the general public and patients at risk of or diagnosed with NCDs for better Self-Management of healthy lifestyles (including NCD prevention, reduction and better control; increased physical activity; healthy eating and healthy weight management).
- Inter-personal communication: settings-based and bi-directional communication for co-learning, co-development and co-action.
- Interactive functionality: individual and group goal setting and self-management with appropriate person-centred and timeous feedback.
- Electronic and printed wellness-promoting resources: accessible information, including for people without cell phones and/or internet access.
- Knowledge Management: mobi-website, Cell App, web-based Health Passport (wellness screening), cell-based messaging, Self-Management guides and links.
- Increased health-related physical activity or fitness through awareness promotion and activations by:
- Enjoying a range of fun (and free) physical activities on a regular basis, for example: walking, running, cycling, home and office-based workouts, pilates, yoga, stretching, outdoor gym workout, indigenous games, dancing, gardening, etc.
- Changing health behaviour at work and home/leisure, for example: taking stairs and walk up escalators, park further away from work/shops, walk to work/shops, use public transport and parks, sitting less and conducting standing meetings.
- Joining (free) public activity events such as walking, running, hiking, community sport events, swimming and cycling.
- Starting an activity group such as a walking/exercise groups or home/office-based workouts.
- Individual and team activities such as regular group meetings for motivation.
- Increased healthy eating and healthy weight management through promoting food awareness, food safety and food gardens for:
- Gradual changes to eat healthier for a healthier weight, for example: reduce salt intake, use lemon juice instead; drink more water, add natural flavours such as apple or mint; reduce sugar-sweetened food and beverages; practice portion control; eat more fresh plant-based food (such as fruit, vegetables, legumes and nuts) and less meat and processed food.
- Behavioural modifications at work and home/leisure such as reducing fast foods; buying healthy food and snacks; use healthy cooking methods; implement Healthy Catering, Tuck Shops and vending machines.
- Healthy recipes sharing and cooking demonstrations to encourage healthy cooking and eating.
- Establishment of a community, home or school food garden to promote economical healthy eating and address hunger.
- Individual and team activities such as regular group meetings for motivation.
The long-term outcome of the WoW! initiative is to prevent, reduce and better manage NCDs by addressing their key risk factors (individual health behaviour and broader social/structural determinants).
Design and impact evaluation of the WoW! initiative
The initiative follows a settings based approach: Worksite, Primary Healthcare Facility, School, Community and Public Spaces that includes WoW! Wednesdays (offering free and fun physical activities for public participation), WoW! Seniors (offering free and fun wellness-promoting events to invited Senior Citizens) and WoW! Open Streets (offering a range of free and fun physical activities and basic wellness screening in specific communities).
WoW! Champions (Peer Leaders) are recruited, trained and resourced to establish and maintain a WoW! Club in their respective settings. Initial training, elective training and monthly mentoring are conducted by a UCT-led Training, Implementation, Research and Evaluation Consortium (TIREC) in partnership with the WCGDoH. All evidence-based training materials are developed through this partnership.
WoW! Champions are expected to work in pairs and establish a WoW! Club consisting of approximately 20-30 team members for voluntary participation at the respective sites. WoW! Champions are expected to arrange and coordinate activities for their participants to promote people development, increased physical activity, healthy eating and healthy weight management.
WoW! participants (Champions and their Club members) are required to complete a confidential health and fitness assessment and a brief questionnaire about Physical Activity, Healthy Eating and Healthy Habits (in terms of smoking and alcohol use). The assessment measures include height, weight, waist circumference, BMI and a fitness test. Informed consent is obtained from all individuals for participation in a nested research study to evaluate the impact, outcome, sustainability and scalability of the WoW! initiative. The findings guide the strengthening of the accessibility scalability and sustainability of WoW! across the Western Cape.
WoW! Phase-1 (testing) of the initiative was completed during 2015/16 in partnership with WoW! Champions and Clubs across multiple settings. The encouraging results from 315 volunteer participants indicate:
- Significant reduction in blood pressure (both systolic and diastolic).
- High blood pressure was halved in 3 months.
- Significant improvement in healthy eating.
- Significant increase in physical activity.
- Significant reduction in time spend sitting.
- Significant increase in overall quality of life.
- Significant increase in general health status.
- Significant reduction in waist circumference.
The WoW! Phase-1 report with detailed findings is available on request. Underpinned by the results (changes in health risk behaviours, proximal health outcomes, evaluative data and observational data), WoW! Phase-2 is focusing on strengthening the systematisation, scalability and sustainability of WoW! across the Western Cape during 2017 and beyond.
Strategic partnerships of the WoW! initiative
The WoW! healthy lifestyle initiative is being designed, implemented and evaluated through transversal, inter-governmental and cross-sectoral partnerships. The existing partners include:
Transversal and Inter-Governmental partnering
- Western Cape Government: Health, Education, Community Safety, Agriculture, Cultural Affairs and Sport, Department of The Premier.
- National Government: Eskom/Eskom Western Cape, Transport/Metrorail Western Cape, PRASA CRES.
- Academia: SSISA/University of Cape Town, University of the Western Cape, Stellenbosch University,
- Private, NGO, NPO and CBO: Your Wellness Matters/44ten Media, The Heart & Stroke Foundation South Africa, BASA (Biokinetics Association South Africa), Pharma Dynamics, Ubuntu Touch Project, Appenberg Digital Publishing, Mamelani Projects, Chrysalis Academy, Fuller Music, Jazzart Dance Theatre, Cape Town Partnership, SASP (South African Society of Physiotherapy), Teenactiv, Medscheme, Green Monday SA/Humane Society International, Rennie Property, Open Streets Cape Town, Bonteheuwel Walking Ladies
- Discovery Vitality, Virgin Active, RMB, FNB, Capitec Bank, Dis-Chem Pharmacies, Premier Foods, Shoprite Checkers, Table Bay Hotel/SUN International
Keeping an inclusive approach, new partners with commitment and expertise in the field are welcome and encourage to joining the growing partnership. The impact of the WoW! partnership was evaluated by the Western Cape Economic Development Partnership in October 2015 and received a very positive report on its partnering approach, progress and achievements (WCEDP, 2015).