Premier of the Western Cape
Officials from the World Health Organisation
HOD of the Western Cape Health Department and HOD of the Secretariat for Safety and Security
International visitors to South Africa
Distinguished guests
Ladies and gentleman
It is a privilege for me to be here opening this important meeting. Since I assumed office as Minister of Health in 2009 I have emphasised that we are experiencing a quadruple burden of disease in South Africa and that it is our responsibility to reduce mortality and morbidity from these main conditions. One of these four categories is injury and violence. The others are HIV and AIDS and Tuberculosis; Maternal and Child Health and Non-communicable Diseases. In fact it is not me who said that we have this quadruple burden but the prestigious journal the Lancet that made this point in their review of health and health services in South Africa. This important research was based on sound scientific evidence and was conducted by South African researchers and leaves us with little doubt around where we need to be focusing our priorities.
Each of these four areas not only causes high mortality and morbidity but puts massive strain on our limited health resources. Of course not each of these areas contributes to our disease burden equally but what troubles me most about all of these categories is that so many cases of illness and death could have been prevented. Our life expectancy from birth in South Africa is so much lower than it should be, currently around 54 for men and 59 for women and our hospitals and other health services are clogged up with people who could have been prevented from needing health services.
It is therefore extremely pleasing to me that this meeting on violence and injury is not about improving surgical techniques for gun shot or stab wound victims, but it is a concentration of people looking at prevention. You may know that many people, especially from first world countries, come to South Africa to learn about how to deal with stab wounds and gun shots because South Africa is a living laboratory when it comes to such things. The trainees I'm told go home very satisfied that they have gained expertise and experience that they can take home with them as the training they get from our surgeons is excellent.
Please do not get me wrong I am not condemning this learning and I truly respect the experts in South Africa who are able to so effectively deal with wounds from violent acts, and yes our visitors also help to take some of the strain off our health practitioners, but rather I wish to congratulate you here for coming to meet around prevention of violence rather than dealing with the health impacts. I also hope that like our experts in surgery our experts in prevention from South Africa will also be able to give some good lessons in prevention to our overseas visitors and demonstrate some good prevention practices that we have already begun.
In terms of the last burden of disease study done in South Africa Violence and injuries are the second leading cause of death and lost Disability Adjusted Life Years - after HIV. The overall injury death rate of 157.8 per 100 000 population is nearly twice the global average. The high injury death rates are driven primarily by violence. Nearly half of injury deaths are from interpersonal violence, four and a half times the global proportion. In South Africa we see in the region of 3.5 million people annually in our health services for injuries. The burden of injury has a significant economic effect, with estimates that the total medical cost for violent injuries is R4.7 billion.
I believe that our mortality from violence is beginning to decline and this is something to be pleased about but not yet to celebrate. It seems that interventions such as the Firearms Control Act which makes firearms far less accessible than previously and more vigilant policing are reasons for this, but much more needs to be done. I am sure that this meeting will also come up with other strategies to prevent injury, not just for the Western Cape, but for the country as a whole.
In analysing our responses to health problems we have realised that unless we get to the underlying causes or social determinants of health we will win fights but loose battles and the war. (My apologies for the war analogy in a violence prevention meeting!) This is perhaps nowhere better reflected than in the area of injury prevention. It is often said that health has very little to do with injury prevention. Yes health must deal with the consequences of injuries in the clinics and hospitals and yes health is responsible for increasing life expectancy, but no there isn`t anything that health can do in terms of prevention. I disagree with this.
Government has realised that the work of departments cannot happen in isolation and has taken steps for government departments to work together. In my Negotiated Service Delivery Agreement with the President I have garnered the commitment of a number of different departments to work collaboratively in reaching our goal of a long and healthy life for all and this applies to injury as well.
The Department of Health, through a decision of the Directors-General Forum, has formed a task team to look at injury and safety prevention collectively and to determine what each department should be responsible for. Departments that attend include Transport; Social Development; Trade and Industry; Human Settlements; Basic Education; Correctional services; SA Police Services and Justice and Constitutional Development. Other departments will also come on board soon. From a conventional health perspective we know that many deaths and disabilities could be prevented if our emergency medical services operated optimally. I am not just speaking about our ambulance services alone, and certainly not just about drivers of ambulances, but also about our health service response more generally to treat people as quickly and effectively as possible at the appropriate level of our health services. We are working hard to improve this. But there are other things the Department of Health can and should be doing.
On commission from the Health Department the Medical Research Council together with the University of South Africa have recently presented us with a thorough review of best practices in injury prevention both nationally and internationally and this is being used to assist the different departments to develop an intersectoral strategy for the country. I don't want to pre-empt this process by making public announcements but for example, and not surprisingly, alcohol has been identified as a major risk factor for both intentional and unintentional injury.
It is public knowledge that government is so concerned about this issue that we have formed an Inter Ministerial Committee on this and action will be seen soon from various sectors to redress this issue. People from South Africa will know that I feel passionately about this issue and how for example we allow a product that has such major health harms to be widely advertised, even to children, is beyond me. We will take action on alcohol advertising very soon. Let me though not tell you what must be done, rather you deliberate and inform me. I am listening because I have a responsibility to improve the health of our population and specifically in terms of my commitments to the President and to the people of this country to increase Life Expectancy. This means, amongst other things, preventing violence and injuries.
I and the National Department of Health look forward to hearing the recommendations that come from this meeting and we will act wherever we can to reduce our disease burden from injury and violence. I wish to thank the Western Cape for taking initiative around this issue and for hosting this meeting. I must emphasise though that the problem is wider than the Western Cape and we need to address this issue countrywide. We intend to do this.
I thank you.
