Chapters in Books (Stellenbosch Institute for Advanced Studies (STIAS))

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Celebrity health promotion messaging : novel opportunities to engage youth in the developmental origins of health and disease
(African Sun Media, 2020) Macnab, Andrew J.; Mukisa, Ronald
This chapter is a personal view seen from disparate viewpoints of age and culture. Two proponents of health promotion, one a Ugandan youth with firsthand experience of the burden of illness among African children and the other a Canadian academic with a lifetime spent treating sick children, speak to the place and potential of celebrity in the promotion of health among youth. Since 2011, school-based health promotion programmes conceived at the Stellenbosch Institute for Advanced Study (STIAS) have been introduced into many communities in Uganda. These initiatives are seen as an example of innovative health promotion with the potential to give the next generation health knowledge and skills that will translate into an important measure of ‘health independence’ for them in their future lives. A regular component of these programmes enables schools to introduce new topics through teacher-guided in-class discussions about health; in this way, pupils were introduced to elements of the developmental origins of health and disease (DOHaD) agenda, and then asked to discuss which ‘messages’ they saw as most relevant to them, and which ‘messengers’ could deliver these messages with the greatest impact. Amongst the messengers, celebrities were identified as particularly influential; young people said they would listen to what a celebrity said about health, lifestyle and behaviour. Expanding on these discussions, pupils quoted health and lifestyle messaging that they already knew from listening to celebrity-recorded music videos. Here we describe examples, from a Ugandan perspective, of this form of celebrityendorsed health messaging contained in music videos; these are the songs young people told us they listened to and knew the promotional messages they contain. National music celebrities, whom these young people identify with, have recorded a variety of videos with content advocating specific health behaviours, endorsing physical, emotional or spiritual health and calling for individual and collective action to address challenges such as maternal deaths related to childbirth and infant mortality. Some artists even raise awareness of difficult but very important social issues such as gender inequity, sexual harassment and domestic violence through their music. Music videos resonate with youth, and celebrity recordings appeal as they combine young people’s love of music with their fascination of the aura of celebrity. We review the production concepts, content and messaging that make these celebrity music videos particularly powerful, and also suggest future directions where the engagement of celebrity messengers could offer a conduit for innovative delivery of DOHaD-related messages, and an effective way to impart knowledge and impact health behaviours among youth.
Ensuring healthier trajectories that start in early life to assist non-communicable disease prevention in Africa : a life-course approach
(African Sun Media, 2020) Norris, Shane A.
Non-communicable diseases are increasing globally, particularly in low- and middle-income countries. For countries on the African continent, this is of particular concern as the combination of a persisting burden of infectious disease coupled with a burgeoning of non-communicable diseases could cripple already strained health care systems. The current paradigm subscribes heavily on detection, treatment and management of patients with non-communicable diseases. This perspective is important, but a more balanced approach that strengthens prevention efforts is also needed.
How environmental exposures early in life might influence phenotypes of non-cummunicable diseases in Africa
(African Sun Media, 2020) Mandy, Mirembe; Lule, Swaib A.; Nyirenda, Moffat J.
Chronic non-communicable diseases, such as diabetes, cancer, cardiovascular and chronic respiratory diseases are leading causes of death and disability in the world – accounting for over 60 per cent of the nearly 60 million deaths in 2008.4 Importantly, 80 per cent of non-communicable disease deaths occur in low- and middle-income countries.5 Although Africa still has a high burden of infectious diseases, the non-communicable disease epidemic is rising rapidly; it is projected that, by 2030, non-communicable diseases will account for 46 per cent of all deaths in the region.6 For example, although diabetes was considered a rare disease in Africa until about a century ago, it now affects up to a third of the population in some countries; the prevalence of diabetes and hypertension will have increased by nearly 80 per cent, and deaths from ischemic heart disease doubled between 2008 and 2030. This chapter discusses how environmental exposures early in life might influence phenotypes of non-communicable diseases in Africa.
The implications of developmentel origins of health and disease for Africa : what can be learnt from available data?
(African Sun Media, 2020) Byass, Peter
There is a broad spectrum of knowledge globally that shows that specific exposures in early life – during pregnancy and early childhood – might affect what happens at various later stages of life. The scientific field behind this has become known as the developmental origins of health and disease (DOHaD). The underlying mechanisms may be complex, and understanding and analysing the epidemiology of the causes and effects are complicated. Long-term individual data, often across generations, are the best way into understanding the precise nature of such effects. Therefore, much of the research that has been done in this area has happened where detailed, individual data on health and welfare are a routine part of social structures – for example, in Scandinavian countries. Nevertheless, it is reasonable to suppose similar exposures and effects might apply within African populations – the difference being that relevant details are much less likely to be documented. Since there is no quick fix for implementing data collection that spans generations, the only indirect clues as to how DOHaD may be affecting Africans is to consider how available data sources might be used in derivative analyses. In this chapter, an example is presented of taking a relationship established elsewhere between breastfeeding and obesity, applied to publicdomain estimates on breastfeeding and childhood obesity in Africa, and analysed to estimate the magnitude of the likely consequences of non-breastfeeding on childhood obesity in Africa. This approach is much less rigorous than the ideal situation where specific individuals’ breastfeeding histories could be related to their later individual obesity, but it offers some clues as to the likely magnitude of this particular issue in Africa, and offers a proof-of-principle for this general approach.
International Society for Developmental Origins of Health and Disease's work at the Stellenbosch Institute for Advanced Study
(African Sun Media, 2020) Daar, Abdallah; Pauw, Christoff; Macnab, Andrew J.
This chapter describes the core group at the Stellenbosch Institute for Advanced Study (STIAS) who have contributed to the long-term theme project, ‘Health in Transition’. It also describes what this book is about, why it is crucial, and the different strands and topics that are covered.
Intersectoral approaches to health and non-communicable disease prevention in Africa
(African Sun Media, 2020) Oni, Tolu
This chapter grounds efforts to achieve optimal population health in Africa, within the context of global and regional aspirations for health as part of the sustainable development agenda. The author highlights the important role that the rapidly growing urban centres in Africa are playing in the ongoing epidemiological transition, with an emerging non-communicable disease epidemic alongside a high burden of infectious disease. Far from seeing this only as a challenge, the author of this chapter explores the opportunity to harness this changing environment for health creation, propose a re-thinking of accountability for health towards a more inclusive definition of health services, and the role that adolescents can and should play both as important targets for non-communicable disease prevention and as agents of change, advocating for an all of government, all of society’s approach to health.
Mapping of developmental origins of health and disease to 'Sustainable Development Goals' and implications for public health in Africa
(African Sun Media, 2020) Kajee, Nabeela; Daar, Abdallah; Macnab, Andrew J.; Sobngwi, Eugene
A call for new approaches and knowledge systems has emerged, to map the way forward for the ‘Sustainable Development Goals’ in Africa.6 Public health on the continent, calls for an approach to effect changes to reach the goals proposed by the World Health Organization.7 It is against this backdrop that the developmental origins of health and disease (DOHaD) are proposed as a framework of implementation for specific Sustainable Development Goals.8 The DOHaD concept identifies the origins of health and disease, and also elucidates early mechanisms for achieving these goals. Numerous Sustainable Development Goals are specifically applicable to the DOHaD concept, and DOHaD and Sustainable Development Goals have immense synergistic potential. The chapter identifies gaps in which DOHaD may offer direct, informed solutions to the hurdles encountered in Sustainable Development Goals achievement strategies, and these have direct public health implications for the continent.
School-based initiatives to reduce malaria morbidity and promote academic achievement in children
(African Sun Media, 2020) Macnab, Andrew J.
In sub-Saharan Africa, the challenge of addressing illnesses related to the developmental origins of health and disease (DOHaD) is compounded by other determinants of health, most notably the impact of poverty and infectious disease. Research has identified social factors to be the root cause of inequities in health that involve both non-communicable and infectious diseases, hence the calls for remedial action to involve social and treatment strategies. There is a recognised need for school programmes to educate the next generation about DOHaD, so that young people gain a measure of ‘health independence’ through learned knowledge, acquired skills and positive behaviours with the potential to improve the future health of their offspring. However, this goal is at risk when other adverse social determinants of health exist, and especially where infectious diseases are endemic, and morbidity from infection among school children is high. In sub-Saharan Africa, for example, malaria is the principal reason a child will be absent from school. How long a child is absent is a well-accepted measure of the severity of morbidity from malaria. Such absences can be of long duration, and associated residual cognitive compromise can compound the negative impact of malaria on a child’s ability to learn. For this reason, school-based strategies to advance knowledge about DOHaD in sub-Saharan Africa will benefit where school-based programmes addressing malaria are offered in parallel. A variety of educational approaches able to advance knowledge and provide practical skills related to DOHaD lend themselves to parallel programmes. For example, programmes can follow policies to advance the United Nations (UN)’ ‘Sustainable Development Goals’, adopt global strategies to promote the education of girls and implement the World Health Organization (WHO)’s ‘Health-Promoting School’ model. Malaria morbidity exemplifies how health inequity can negatively impact a child’s ability to benefit from education. However, simple and effective school-based approaches exist that can positively impact morbidity, provide access to diagnostic and treatment services, reduce absence due to illness and increase the capacity of large numbers of children to learn. This chapter reviews global efforts to reduce the impact of malaria on children's health, improve their ability to attend school, enhance their potential for academic achievement and minimise their risk of cognitive impairment. It also describes a successful and inexpensive community participatory intervention model based on WHO-endorsed diagnostic and treatment principles, that also follows the 2017 Lancet Commission’s current recommendations on the future of health in sub- Saharan Africa to use ‘non-traditional outlets’, ‘people-centred approaches’ and ‘improved tools’ to address health challenges. This model is suitable for use in schools worldwide where malaria is endemic and can be offered in parallel with school-based strategies to engage youth in the context of the DOHaD agenda.
The World Health Organization's 'Health-promoting School' model: a potential avenue for developmental origins of health and disease education in Africa
(African Sun Media, 2020) Macnab, Andrew J.
Traditional health care strategies to manage illness are based on the tenets of prevention and cure. Health promotion is an urgent matter from both a health and economic standpoint, as most non-communicable diseases cannot be cured, and the future costs of management are prohibitive. Hence, a new focus on prevention involving youth has been widely called for, including by the Cape Town Manifesto.2 This chapter reviews the challenge and opportunities of engaging youth in health promotion related to the developmental origins of health and disease (DOHaD) agenda. It explores the potential for using the World Health Organization (WHO)’s ‘Health-Promoting School’ model as part of health initiatives in Africa to promote the adoption of a DOHaD related health agenda. At a societal level, effective disease prevention must often rely on the application of new science and technological innovation, plus legislation to dictate change. However, at an individual level, alterations in health behaviours are required to contain the epidemic of DOHaD-related non-communicable diseases, which can only be achieved through learning and increased awareness driving attitudinal change. The challenge facing DOHaD related health promotion is how we, as a society, can disseminate valid information widely and frame compelling arguments to engage and motivate individuals to improve their health and change their behaviours. The nature of DOHaD also predicates that the most fertile place to invest in prevention and health improvement strategies is the next generation. The WHO estimates are that school-based health promotion has the potential to reach one billion children worldwide. Health-Promoting School programmes are a proven means of providing children with the knowledge and practical ways to improve their health and have been shown to positively impact a range of specific health issues and health behaviours. Importantly in the context of Africa, the integrated educational approach used in Health-Promoting School has proved to be applicable and beneficial even in low- and middle-income settings. Significantly in the context of prevention, children who participate in good Health-Promoting School programmes have been shown to develop improved resilience, self-esteem and self-efficacy; traits recognised to engender a greater desire and increased ability to exercise control over their lives, and characteristics all likely relevant to advancing the DOHaD agenda.

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