‘I am active and healthy, so I don’t need to make lifestyle changes!’ A short report of clinical markers of ‘risk’ for NCDs versus health and physical activity perceptions in a low-resourced setting

Non-communicable diseases (NCDs) are the leading cause of death globally. Almost three quarters of NCD-related deaths occur in low and middle-income countries (LMICs). Moreover, approximately 60% of NCD deaths occur before the age of 70 years, with 82% of these ‘premature’ deaths occurring in LMICs. Risk factor modification including smoking, alcohol use, nutrition and physical activity is an important strategy in both the prevention and management of NCDs. However, specifically in low-resourced settings, people may face a multitude of socioeconomic challenges, including lack of food security, safety, income and health. As a consequence, healthcare may have to compete against these other socioeconomic markers for the attention required. Previous research suggests that people who face prolonged socioeconomic hardship may have reduced capacity to delay gratification and subsequently engage in diverse risk behaviours which lead to more direct and tangible rewards (e.g. smoking). Although the association between socioeconomic hardship, risk behaviour and disease burden is not endemic to LMICs, specifically in the context of the exponentially increasing burden of NCDs across LMICs, it is important to understand how to facilitate behaviour change in the context of healthy lifestyle, in which gratification is often delayed and not directly noticeable, to prevent and manage NCD risk factors. The objective of this cross-sectional and pragmatic study was to determine clinical markers of NCD risk in a low-resourced and socioeconomic challenging neighbourhood, and to determine the association between key commonly measured health parameters with selfreported levels of physical activity and perceived health. This study was embedded within the annual Bishop Lavis Health Festival, a free event held on a week day, which included among other things a 5 km community walk and information stands. Bishop Lavis (Cape Town, South Africa) is a densely populated, urban township – home to approximately 54,000 people living mostly in formal dwellings, and partly informal dwellings. Only 66% of the usually economically active population of this community is employed. Half of these (47%) earn between $0 and $544 (purchase power parity) per household (average approximately 4.4 dependents per household) per month. Crime rates in the area are excessive. All participants of the health festival (Friday 19 October 2018) were requested to complete a fully anonymous ‘health passport’, specifically designed for the purpose of this study, on return from the community walk. This study has been approved by the health research ethics committee, Stellenbosch University (M17/09/031) as an amendment to a larger study on the feasibility of patientcentred rehabilitation in low-resourced settings. The health passport included gender, age, smoking, alcohol, drug use, work status, medical insurance and the self-reported presence of NCD (i.e. cancer, cardiovascular disease, respiratory disease or diabetes). Body weight and height were obtained from a medical grade scale with an integrated height measure. The derived body mass index (BMI; kg/m) was categorised according to World Health Organization guidelines. A single systolic blood pressure (SBP; mmHg), diastolic blood pressure (DBP) and heart rate (bpm) reading was obtained in a seated position using an automated