Healthy Jozi: A Staged Approach to Better Workplace Food Choices and Chronic Disease Screening and Linkage to Care

Inner-city Johannesburg, in South Africa, mirrors the complex health challenges of middle-income countries. The appeal of city life has led to mass migration to urban areas where people face overcrowding, noise, pollution, crime, drugs, unemployment and other issues. Urban food options and offerings such as the availability of cheap, fast, processed food, along with modern, more sedentary lifestyles, is contributing to an unfolding obesity epidemic. South Africa's ongoing success with the HIV epidemic means the disease is now largely controlled by freely accessible drugs and care. To tackle HIV, South Africa developed and adopted new practices and approaches, not just treating HIV with drugs, but finding those who did not know they were sick, and linking them to health services. This is done in ways that enable patients to get the medicine and care needed but also to understand their condition, how they can help manage it to stay healthy, and what other services they are entitled to. We aim to use what we have learnt to find people with chronic diseases caused by lifestyle changes, especially undiagnosed and untreated high blood pressure and diabetes, which now account for most treatable deaths in South Africa. Many workplaces in the inner city are close to clinics and GPs, providing opportunities to link sick employees to healthcare quickly and easily. We will set up a health screening programme for city workplaces and design a friendly, innovative employee programme to screen for diseases like diabetes and high blood pressure and assist people to link to care at local health clinics. We will design an engaging, inner-city specific healthy food education programme to introduce people to other food choices including where to buy affordable healthy food nearby. The project will be designed by researchers from the University of Liverpool, the University of Witwatersrand in Johannesburg and local employees, managers, community groups, and charitable organisations involved in food activism, including diabetic groups and people involved in public health programmes and medical insurance: all groups with a stake in making screening successful. We aim to get a good understanding of the motivations related to health screening, health seeking and food consumption behaviours in order to be able to address it in an effective way to help people become and stay healthy. We will test the programme in workplaces to see what works and what needs improving, and cost our activities to ensure they are affordable. We will then make recommendations on our findings to policy makers, donors, governments and funders. If our project can find ways to better understand high blood pressure, diabetes and possibly obesity epidemics, using approaches that worked for HIV, we will have begun the process of tackling the challenge of complex lifestyle conditions which in future is likely to include other challenges like mental illness, chronic lung disease and sleep disorders.