SOCIAL DETERMINANTS OF NONCOMMUNICABLE DISEASES AND OTHER PUBLIC HEALTH ISSUES IN SEYCHELLES: EVIDENCE AND IMPLICATIONS SOCIAL DETERMINANTS OF NONCOMMUNICABLE DISEASES AND OTHER PUBLIC HEALTH ISSUES IN SEYCHELLES: EVIDENCE AND IMPLICATIONS WORLD HEALTH ORGANIZATION Regional Office for Africa Brazzaville•2014 WHO/AFRO Library Cataloguing – in – Publication Social determinants of non-communicable diseases and other public health issues in Seychelles: evidence and implications 1 Chronic diseases 2 Social determinants of health 3 Socioeconomic factors 4 Public health 5 Risk factors 6 National Health Programs 7 Organizational Case Studies I. World Health Organization. Regional Office for Africa ISBN: 978-929023258-2 (NLM Classification: WA 525) © WHO Regional Office for Africa, 2014 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. 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Printed in the Republic of Congo Prepared by Dr William Muhwava Consultant in Social Determinants of Health ACKNOWLEDGEMENTS This report was prepared by Dr William Muhwava for the Ministry of Health, Seychelles with financial and technical assistance from the World Health Organisation, the Regional Official for Africa. Dr Muhwava worked with a technical team comprising experts from various government departments that provided technical guidance throughout the whole process of producing this report. The team consists of Dr. Cornelia Atsyor-WHO Liaison Officer in Seychelles; Dr. Shobha Hajarnis- Director General of Public Health in Ministry of Health; Mr. Joachim Didon- Principal Statistician in Ministry of Health; Ms Bharathi Viswanathan-Project Manager in the Unit for Prevention and Control of Cardiovascular Disease of the Ministry of Health, Mrs Gin Michel Project Manager in the Cancer and Mental Health Unit, Mrs Julita Williams-Programme Manager of Diabetic Unit Ms Veraine Louis-Marie- Nutritionist in the Nutrition Unit of Ministry of Health and Mr Jean Malbrook-Health Economist in the International Cooperation Unit. We would want to thank the technical team led by Dr Bovet that has undertaken the three waves of the Heart Surveys. Most of the information we use on non- communicable diseases come from those studies. We acknowledge using a significant amount of their analyses and papers in the report and duly referenced their works in the respective sections. Any attempt at reanalysing data from the HEART studies would have been unnecessary duplication as they have exhaustively done so. However, where necessary, these analyses have been complemented by further analysis and evidence from other sources. In the same context, we would like to thank Dr Kam Ki Tang, and Dr Dennis Petrie, both of the University of Queensland who provided technical assistance in using the realization of potential life years (RePLY), a new method to measure health inequalities caused by conditions amenable to policy intervention and use this to identify health differences between sexes and age groups. This collaboration will continue as we interrogate more the data from Seychelles and show the applicability of the method in the study of health inequalities. Mr Joachim Didon deserves special mention as he assisted in identifying all the datasets that have been used in this report. The support we got from the Minister of Health, and Dr Jude Gedeon, Public Health Commissioner was immense. Lastly, we would want to thank Professor Davison Munodawafa of WHO AFRO for technical assistance during the whole process. Cancer, diabetes, and heart diseases are no longer the diseases of the wealthy. Today, they hamper the people and the economies of the poorest populations even more than infectious diseases. This represents a public health emergency in slow motion. MR BAN KI-MOON United Nations Secretary-General 2009 Contents Page ACRONYMES ............................................................................................... ix EXECUTIVE SUMMARY .................................................................................. xi CHAPTER I: Introduction .......................................................................... 1 1.0 Background to the Study .................................................................. 1 1.1 Social Determinants of Health ........................................................... 5 1.2 Socio-Economic Profile ...................................................................... 6 1.3 Demographic Profile .......................................................................... 8 1.4 Health Care System ....................................................................... 11 CHAPTER II: Data Sources and Methods .................................................. 13 2.0 Introduction ................................................................................... 13 2.1 Data Sources ................................................................................. 13 2.1.1 Population and Housing Census 2010 ................................................ 13 2.1.2 Vital Registration System (VRS) ....................................................... 13 2.1.3 HEART Surveys .............................................................................. 14 2.1.4 Global School-based Student Health Survey (GSHS) ........................... 14 2.1.5 Global Youth Tobacco Survey in the Seychelles .................................. 15 2.2 Outcome Indicators ........................................................................ 16 2.2.1 Life Expectancy .............................................................................. 16 2.2.2 Causes of Deaths ........................................................................... 17 2.3 Stratification Indicators: Measures of Inequality ................................. 18 2.4 Risk Factors for Non-Communicable Diseases ................................................. 19 2.5 Measurement of Inequality .............................................................. 21 CHAPTER III: Mortality and Morbidity Patterns in the Seychelles .......... 26 3.0 Introduction ................................................................................... 26 3.1 Life Expectancy .............................................................................. 27 3.2 Cause of Death and Burden of Disease .............................................. 36 3.2.1 Cardiovascular Diseases .................................................................. 40 3.2.2 Cancers ......................................................................................... 43 3.2.3 Chronic Respiratory Diseases ........................................................... 45 3.2.4 Diabetes ........................................................................................ 47 3.2.5 Hypertension ................................................................................. 48 3.2.6 Communicable Diseases .................................................................. 49 3.2.7 Violent and Accidents Deaths ........................................................... 51 3.3 Risk Factors for Non-Communicable Diseases..................................... 51 3.4 All Risk Factors for Non-Communicable Diseases ................................ 51 3.5 Obesity ......................................................................................... 54 3.6 Tobacco Use .................................................................................. 62 3.7 Harmful Use of Alcohol and Drugs .................................................... 63 3.8 Physical Inactivity ........................................................................... 66 3.9 Food Consumption Patterns ............................................................. 69 CHAPTER IV: Structural Determinants of Health ..................................... 72 4.0 Introduction .................................................................................