Your
April/May 2016 – Issue 9
Matters
English
The community paper to whom your wellness matters. facebook.com/yourwellnessza
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Discovery honours nurses and celebrates nursing excellence in South Africa
Continued on page 2
Do more to address BIRTH defects - PAGE 8
Discovery thanks nurses for their service to society and highlights local awards a symbol forits breastfeeding protection, promotion and support. and global programme that aim to nurture excellence and leadership in the nursing profession
The Golden Bow #DOC Helps with household burns
One in nine TB patients co-infected with diabetes
IN THIS
ISSUE
PARTNERS:
WesternCape on Wellness
BURN Awareness week
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Discovery honours nurses and celebrates nursing excellence in South Africa
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n 12 May is International Nurses Day, celebrated around the world to highlight the impactful role of and the crucial service nurses provide in the healthcare system. On the anniversary of Florence Nightingale’s birth, the world recognises each person who has dedicated him or herself to, and has built a career in, providing crucial nursing care.
“At Discovery, we place great value on the role nurses play in ensuring the best health outcomes for patients,” says Dr Roshini Moodley Naidoo, Head of Quality of Care at Discovery Health. She said, “Today, we want to extend a warm thank you to all nurses and care workers for their unwavering commitment to an excellent healthcare system designed around addressing the needs of patients and families.” In support of nurses’ critical role and to elevate the profession, Discovery Health, in 2014, launched the Discovery Excellence Awards for Nurses (DEAN). The purpose of these awards is to reward and enhance nursing excellence in hospitals, and to create opportunities for further education and training in nursing services.
“Through these initiatives, Discovery Health aims to strengthen the country’s healthcare system, improve the quality of care, and promote excellence in service delivery in hospitals,” said Moodley Naidoo.
Nurses nominated for these awards in the private sector are identified from Discovery Health Medical Scheme members’ feedback on their hospital experiences. Nurses are recognised bi-annually, and winners in these rounds are considered for the annual award. Discovery Health has also partnered with the National Department of Health in 2015 to add the Cecilia Makiwane Award category (named after the first registered professional Black nurse in South Africa) for nursing excellence in the public sector to the DEAN. All shortlisted candidates in the different categories go through rigorous interviews with an independent panel of judges from local academic institutions and the South African Nursing Council. Winners are announced and honoured at a prestigious annual event. Discovery - Massachusetts General Hospital (MGH) Global Health Services Partnership In effort to develop nurses’ leadership skills, and clinical knowledge, Discovery Health also announced its Massachusetts General Hospital (MGH) Global Health Services Partnership. This partnership takes the form of a two-week Nurse Leadership Exchange and Development Programme. The Nurse Leadership Exchange and Development Programme between Discovery Health and MGH gives DEAN winners selected from the private, public and NGO sectors the opportunity to attend a unique leadership programme at MGH in Boston, USA. The programme includes leadership development, clinical observations, simulations to apply clinical knowledge and skills, visits to community hospitals and lectures on quality and patient safety. MGH Global Health responds to global health disasters and humanitarian aid requests. Their aim is to increase nursing
training, and the number of nurses to address critical shortages. Through the Global Health Services Partnerships, they help boost nursing education and public sector systems. The first attendees in the global learning partnership at MGH Global Health In February 2016, four winners in the 2015 DEAN had an opportunity to attend the development programme in Boston. On their return, attendees called the experience an inspirational highlight in their careers. Holliness Dladla: From Ethekwini Hospital and Heart Centre won for her natural and influential connections with patients. Commenting on her MGH learning experience, she said,
“It changed my life”. She is now doing a bridging course to further her career. She said Massachusetts General Hospital is remarkable, and she learnt a lot from clinical observations. The facilitators were engaging and showed that leadership skills form a huge part of quality patient care. Holiness said she would share what she has learnt with her colleagues to uplift the nursing standard. Mavis Mwale: From Springs Parkland Clinic won for her deep respect for the influence that she has in her interactions with her patients, and for being a role model to young colleagues through patient-centred care. Mavis said she found the training programme rewarding in that it brought out her strengths, and helped her identify areas of her leadership skills. She said she would put all the information into use to promote quality nursing in our institutions. Simone Bothma: From Wilmed Park Private Hospital won for her insight into the sub-
CREDITS Your Wellness Matters is the first free wellness community newspaper created to assist people in understanding all aspects of wellness.
Managing editors Jehad Kasu Dali Chiwara
The Matrix No. 8 Bridgeways Road Bridgeways Precinct Century City Cape Town 7441
Shared services division Mymoena Sedick Celest Alexander
ywm@44tenmedia.co.za +27 (0)21 830 5490/ +27 (0)21 388 5522 www.44tenmedia.co.za
Staff writers Tasneem Smith Nicole Watson
Designer Reggie Jooste
Advertising ywmads@44tenmedia.co.za
Proofreading and Afrikaans translations Lois-Mari Swanepoel
Printing Paarl Coldset
Xhosa translations Nobuntu Stengile
Published by 44Ten MEDIA Publishing
Contributors
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• • • • •
Western Cape Government: Health Heart and Stroke Foundation of South Africa CANSA
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Your Wellness Matters – Issue 9 – April/May 2016
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continue from page 2 stance of nursing, and for making a difference through her positive, thoughtful approach to care. Simone called the MGH learning experience a “highlight of my life”. She felt recognised and appreciated as a nurse. She now feels even more inspired to excel in her work, and said the clinical observation at MGH was astonishing. Thobeka Williams: From Gateway Private Hospital won for her understanding of care and how furthering her knowledge influences her level of care for each patient. She described her MGH learning opportunity as “unique and inspirational”. She highlighted the safe hospital environment, and efficient teamwork in the hospital setting regardless of the ward. She was also inspired by the self-empowerment through education. Hazel is planning further studies following her visit to MGH and said the quality of nursing is 110% because patients' safety is a priority.
“We are glad to see the awards and global exchange programme are succeeding in their aim to improve the level and impact of co-ordinated care and uplift nurses to take pride in their career and role in society. Nurses can, not only today but every day, feel proud of their work and valuable role in society,” she said.
“Our nurses work tirelessly to provide essential care to patients and families. Recognising their work is a means of encouraging others to be inspired by these exceptional leaders so that our healthcare system can be further strengthened” Moodley Naidoo said.
WASHING HANDS
A HEALTHY HABIT You Should Teach Your Kids
DID YOU KNOW? By frequently washing your hands the right way, you'll wash away germs such as bacteria and viruses that you have picked up from other people, through contaminated water and food, from surfaces like keyboards, or from animals.
CELEBRATING WORLD HAND HYGIENE DAY
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Lilly Diabetes Conversation Map Tools to Support Patients Living with Diabetes Fasting During Ramadan Lilly educators help raise awareness among healthcare providers and patients on how to fast safely and avoid potential diabetic complications during Ramadan Every day during Ramadan, the ninth month of the Islamic Lunar Calendar, Muslims around the world spend the daylight hours in a complete fast. Muslims observe the holy month of Ramadan by abstaining from all food, drink and oral medications from dawn to dusk, observing fasting, praying and giving to charity which is at the heart of the observance of Islam. It is a time of strict observance where Muslims re-evaluate their lives in light of Islamic guidance. Given its significance in Islamic faith, not being able to participate in Ramadan due to a health condition can be a devastating blow. Although the Qur’an specifically exempts people with a medical condition from the duty of fasting, many people living with diabetes still choose to fast. According totheEPIDIAR Study Group (Study of Diabetes and its Characteristics During the Fasting Month of Ramadan), it is estimated that 40-50 million people with diabetes, worldwide, will fast during Ramadan, which starts this year on 6 June (subject to the sighting of the new moon).
“Fasting presents significant challenges for people living with diabetes in managing blood sugar levels, which is why patients with diabetes should consult with a healthcare specialist at least one month prior the holy month of Ramadan to find out if they can fast safely,” says Dr Aneesa Sheik, Medical Director of Lilly South Africa.
The lack of food and water during the day, along with a heavy evening meal, can create serious health issues for people living with diabetes. They face major disruptions to their diet and daily routines, which may lead to serious complications among which are low or high blood sugar levels. Studies have shown that there is an increased risk of severe low blood sugar levels for individuals with type 1 or type 2 diabetes, especially for those who change the dosages of their oral medications or insulin. A blood sugar level that is too low and left untreated can cause confusion, clumsiness, or fainting, and in the case of severe low blood sugar, can lead to seizures, coma, and even death. A high blood sugar level can damage blood vessels, and over a long period of time can result in serious complications, including irreversible organ damage. In general, fasting is very challenging for people living with diabetes, particularly patients with type 1 diabetes, who are dependent on insulin. Muslims with diabetes who wish to fast must plan diligently for a safe and healthy Ramadan. Providing healthcare professionals with the right tools and resources, including time and personnel to educate patients and encourage them to discuss a treatment plan for fasting during Ramadanhas been a key focus area for Lilly. The “Lilly Diabetes Conversation Map” tool, specific to “Managing Diabetes during Ramadan” was launched in 2013 and used across the country and beyond. The Lilly Diabetes Conversation Map toolwas created by Healthy Interactions, in collaboration with the International Diabetes Federation (IDF).
It has been used in more than forty countries and translated into more than thirty languages. According to Lilly’s Dr. Sheik,
the Lilly Diabetes Conversation Map tool represents an innovative approach to educate patients through conversations facilitated by IDF certified health experts. The map is created specifically for people with diabetes who choose to fast during Ramadan. It helps doctors and nurses guide their patients on how to manage diabetes during the month of Ramadan, understand myths and facts about diabetes, the major complications to watch out for during fasting and the important habits to maintain while fasting. Healthcare professionals who would like to use the Lilly Diabetes Conversation Map tools for patient group consultations can contact Lilly on 011 510 9300 for more information.
People living with diabetes who would like to attend a Conversation Map session with a healthcare practitioner to ensure better management of their diabetes duringRamadan can contact Lilly on 011 510 9300 with your suburbs details. You’ll be forwarded details of the educational sessions closest to you.
Lilly AMECA members consulted with Lilly on this educational tool to help Muslims with diabetes during Ramadan. Lilly partners with Healthy Interactions and the International Diabetes Federation on the "Managing Diabetes During Ramadan" Conversation Map® to help improve diabetes management skills for both individuals with diabetes and the people who care for them whether they choose to fast or not.
The management and staff at Your Wellness Matters wishes its readers observing the Holy month of Ramadaan,
a Ramadan Kareem.
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Your Wellness Matters – Issue 9 – May 2016
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Link between Stress, Inȵammation, Heart Attack & Death
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"…It's become clear that stress is not only a result of adversity but may itself also be an important cause of disease. The risks of heart disease linked to stress (are) on par with that for smoking, high blood pressure, high cholesterol and diabetes, yet relatively little is done to address this risk compared to other risk factors,"
New research shows that increased activity in the stress center of the brain leads to inȵammation in arteries and a higher risk of heart attack, stroke and death.
The study, by the American College of Cardiology, showed subjects with greater activity in the brain’s stress center (the aP\JGDOD KDG PRUH LQȵDPPDWLRQ LQ WKH arteries and stood a greater risk of cardiovascular problems. It also showed that stress stimulated bone marrow to release FHOOV WKDW PD\ WULJJHU LQȵDPPDWLRQ LQ WKH body.
activities that nourish your body, ȏ Pursue mind and soul. ȏ 3XW \RXUVHOI ȴUVW 7KLV ZLOO HQDEOH \RX WR serve others better. down. Seek balance. Be present. Pray ȏ Slow or meditate every day. ȏ Follow a healthy diet. Dark, green, leafy
Tawakol said. Pharmacist, complementary medicines expert and life coach, Giulia Criscuolo, says prolonged stress may also lead to anxiety and depression. She said research showed a 39% increase in antidepressant use in SA over the past four years. Criscuolo says studies show that at least 90% of those on anti-depressants experience at least one side eect such as anxiety, constipation, suicidal thoughts, insomnia, weight gain and sexual dysfunction such as low libido.
"Our study illuminates, for the ȴrst time, a relationship between activation of neural tissues…and subsequent heart disease events," said the study’s co-author, Dr Ahmed Tawakol from Massachusetts General Hospital.
Criscuolo suggests the following to help counter stress, anxiety and depression: up to 30 minutes each day being ȏ Spend quiet. something physical for 30 minutes ȏ Do every day. time in nature. Walk on the beach, ȏ Spend swim in the sea or hike up a mountain.
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vegetables improve mood; fermented IRRGV LPSURYH JXW KHDOWK DQG IDWW\ ȴVK DUH rich in omega 3 fats which help manage anxiety. Avoid sugar and stimulants. Increase intake of vitamins and minerals such as BetterYou’s Magnesium Oil and B12 Boost oral sprays. Connect with others. Seek credible natural remedies such as Felix, a food supplement which utilises a FOLQLFDOO\ UHVHDUFKHG H[WUDFW RI VDURQ called Satiereal, shown to help lower cardiovascular disease and treat mild to PRGHUDWH GHSUHVVLRQ 6DURQ KDV EHHQ used for thousands of years as a traditional medicine, mood enhancer, stress reliever and aphrodisiac.
Coyne Healthcare
Felix is available in South Africa nationally at leading health stores, pharmacies and DisChem
For product info: www.coynehealthcare.co.za or call Felicia on 021-421-9144
Your DID YOU KNOW?
Matters
Every cigarette you smoke reduces your expected life span by 11 minutes. A single cigarette contains over 4,800 chemicals, 69 of which are known to cause cancer. About 69% of smokers want to quit completely. Over 30% of cancer could be prevented by avoiding tobacco and alcohol, having a healthy diet and physical activity. Smoking makes your hair turn gray faster, a study found. Smoking makes the risk of a heart attack 200% to 400% greater than that of nonsmokers.
FACTS ABOUT SMOKING
BURN AWARENESS WEEK BE CAREFUL WITH
HOT WATER & FIRE.
LET #DOC HELP with household BURNS. KITCHEN BURNS In the kitchen specifically HOT water takes to contribute significantly towards burns The other thing we tend to see is FLAME burns and these usually comes from GAS stoves. Another common one we see is kids putting their hands on HOT plates.
HELPFUL TIPS FROM DOCTOR RIAAD MOOSA The things you don’t really want to do is apply anything onto the burn apart from WATER e.g. BUTTER, TOOTH PASTE or any other ointments Get immediately to the tap and let the COLD WATER it serves dual purpose - It washes away all the DEBRIS coming from the BURN itself and very importantly cools the skin down. You need to expose the wound for about 15-20 minutes
- You need to then cover the wound with bandage to protect it from any other INFECTIONS and prevent dirt/bacteria to enter the would itself. - A useful thing one can use around in the kitchen is CLEAN WRAP Wrap a few layers around the wound itself then you can expose that to something cool/cold. - Then go to a DOCTOR to get the correct treatment.
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Do more to address birth defects
O
f these, about 80 percent are caused by genetic factors such as chromosomal abnormalities or single gene defects. The remaining 20 percent are caused by environmental agents or “teratogens”, including alcohol, drugs, maternal infections and chemicals. This figure is higher than most other countries because South Africa has such a high
Can be prevented Helen Malherbe and colleagues writing in the SA Health Review 2016 argue that up to 70 percent of congenital disorders can be prevented or alleviated if health workers are more aware of how they can intervene. Iron and folic acid supplements during pregnancy can reduce neural tube defects, while mothers can be educated about the dangers of alcohol and smoking during pregnancy. Potential parents can be screened for inherited disorders, while pregnant women’s infections (particularly syphilis) and chronic ailments such as diabetes can be managed to reduce impact on the foetus.
Protect your baby
About seven percent of all South African babies are born with congenital disorders – or birth defects that are present in babies before they are born. The foetuses of at-risk mothers, particularly older women, can be screened via amniocentesis for conditions such as Down syndrome.
But the biggest intervention that help children with birth defects is surgical – 40 percent of cases could be cured by surgeries to correct cleft palates and lips, club feet and heart defects.
Before 2011, there were significant reductions in child mortality thanks largely to the scale-up of prevention of mother-to-child HIV transmission programmes, antiretroviral therapy, and the addition of the rotavirus and pneumococcal conjugate vaccines to childhood vaccines. But in provinces where infectious diseases are more under control, the impact of birth defects is starting to emerge. In the Western Cape, for example, 10 percent of children’s deaths are due to birth defects.
Before 2011, there were significant reductions in child mortality thanks largely to the scale-up of prevention of mother-to-child HIV transmission programmes
One in nine TB patients co-infected with diabetes About one in nine South African tuberculosis (TB) patients are also living with type 2 diabetes, according to Stellenbosch University medical biologist Dr Katharina Ronache. Ronacher warns rising rates of coinfection could have consequences for treatment outcomes
A
About 2.3 million South Africans may be living with diabetes and many of these people may not even know it, according to the International Diabetes Federation. According to the federation’s 2015 atlas, nearly half Africa’s diabetes patients are found in just four countries – South Africa, Democratic Republic of Congo, Nigeria and Ethiopia. The federation estimates that two-thirds of diabetes patients in Africa are undiagnosed In South Africa the lack of early diagnosis of diabetes is exacerbated by poor screening services, and most people are diagnosed only once they develop complications from the disease, which affects how the body uses blood sugar or glucose and triples a person’s risk of developing active TB disease.
The condition may also affect TB treatment outcomes, Ronacher warns. “Not
only are people with diabetes more likely to get TB, they are also less likely to respond to treatment which can lead to relapse or even death,” Ronacher tells Health-e News. One reason for poorer treatment outcomes in co-infected patients is that people with diabetes have lower levels of TB medication in their blood. According to Ronacher, researchers are currently unsure about what causes this and if it is due to the interaction between the two diseases, or because people with diabetes
generally have a higher body mass index and medication is not being dosed adjusted to account for this. Ronacher has recently been awarded a R25-million grant by the American National Institutes of Health to explore how TB/diabetes co-infection may change transmission patterns within homes. Ronacher and her team of researchers will also be exploring whether poorly managed diabetics have an increased risk of developing active TB as compared to diabetics who are better able to manage their medication and blood sugar levels.
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Sugar tax could save South Africa billions
Students cautioned about Ritalin abuse As tertiary institutions reopen across the country, the South African National Council on Alcoholism and Drug Dependence (SANCA) has issued a strong warning to students to steer clear of performanceenhancing drugs.
s
outh Africa’s recently announced tax on sugarsweetened beverages could save South Africa billions if implemented over the next 20 years, according to recent University of Witwatersrand research. In February, Finance Minister Pravin Gordhan proposed introducing a tax on sugar-sweetened beverages, or what in some countries has been dubbed a “soda tax” although the tax could also apply to juice and sweetened teas. Recent mathematical modelling by University of Witwatersrand researchers suggests that a 20 percent “soda tax” could save the country R10 billion over the next 20 years in costs related to treating rising cases of type 2 diabetes largely caused by poor diet and rising obesity rates.
Already the third underlying cause of natural death, diabetes is expected to cost South Africa as much as R2 billion per year by the year 2030 in costs such as hospitalisations and medication, according to a 2010 study.
SUGARY
Conducted by Wits’ Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA) unit, additional modelling presented yesterday also found that a tax on sugarsweetened beverages could also prevent obesity in about 280,00 young adults. In a 2012 Coca-Cola survey, South Africa was among the top ten consumers per capita of the beverage giant’s products. Mexico ranked highest consumer of Coca-Cola products. To curb soda consumption, Mexico instituted a sugary beverages tax in 2014. Within a year, Mexico had seen a 12 percent reduction in the purchase of sugar-sweetened beverages. Hamish Van Wyk is education facilitator at Johannesburg’s Centre for Diabetes and Endocrinology. According to Van Wyk, South Africa must begin to do more to prevent rather than simply treat diabetes.
“We can’t do more treating, we need to do prevention,” he said.
DRINKS
I
t began when Relebohile failed her first module at varsity. When she failed her second unit, friends offered Relebohile something they thought could help.“My friends offered me this ‘amazing tablet’ called Ritalin,” said Relebohile. “It helps you to stay awake for hours and improves your concentration levels.” “With Ritalin, you can stay away from your lectures then when exam time comes you drink it, study hard and pass,” says Relebohile, who adds she and friends allegedly got the tablets from a Rustenburg pharmacist. But the Free State student’s reliance on the pills to study soon increased. “I started with one or two tablets in the beginning then the dosage increase to every time I was writing my exams,” she said. Ritalin is commonly used to treat attention deficit hyperactivity disorder (ADHD) as part of a wider treatment programme that also includes psychosocial and educational support, according to SANCA National Coordinator Louina le Roux. She adds that a mix of academic and social pressures can make abusing Ritalin look appealing to students. social life, fit in with peers, and experience all that student life has to offer,” she told OurHealth. “Sleep is then viewed as a very unwelcome guest.” “Stimulants such as Ritalin may seem (like) a good way to buy a few extra hours a day to say, cram for an exam, or to stay up later to drink more, or to feel better after a night of drinking,” Le Roux added. “Stimulants such as Ritalin may seem (like) a good way to buy a few extra hours a day to say, cram for an exam, or to stay up later to drink more…”/quote]SANCA says Ritalin abuse may be high among not only varsity students but also pupils at upmarket private schools. According to Le Roux, SANCA has even heard of older
pupils getting younger students to fake ADHD symptoms to get scripts for the medication. Stimulants like Ritalin have side effects, including anxiety, agitation, sleeplessness and headaches, Le Roux added. 1/2 People who are addicted could, like Relebohile, face challenges in quitting and withdrawal symptoms. After her pharmacist contact cut off her Ritalin supply, Relebohile struggled to cope and eventually told her doctor about what had happened. “I went to see a GP for my condition and was admitted to rehab, so as I am telling my story I am a recovering addict,” she said. “(Your addiction) can spiral out of control so quickly that you can’t function without it. I wish I had never had it to start off.” Le Roux urged students to stay away from the drug and instead try to talk out problems and pressures. “Using Ritalin for any other purpose than treating a disorder diagnosed and prescribed by a medical practitioner can without a doubt lead to addiction,” she said. “It is therefore strongly recommended that learners or students take cognisance of the above and rather approach a counsellor or any other available resource – including SANCA – for assistance when faced with certain challenges. “When you are failing grades, the peers that incite you to join in the social activities that prevent you from reaching your dreams will not be there to support you,” she added. “Addiction prevention is better than cure.”
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PLAIN PACKAGING OF TOBACCO PRODUCTS
T
The Cancer Association of South Africa (CANSA) supports the call from the Secretariat of the World Health Organization (WHO) Framework Convention on Tobacco Control that requires tobacco products to have plain packaging and graphic warning signs. Plain packaging is an important reduction measure,making tobacco products less attractive, restricting the use of tobacco packaging to be used as a form of advertising and limiting misleading packaging and labelling. The
Elize Joubert, CANSA’s CEO says,
“We’re pleased that the South African Government has already worked on a Draft Bill to this effect. Tobacco still remains one of the biggest killers in the world, albeit in the form of cancer or other tobacco-related diseases. So as part of World No Tobacco Day on 31 May, we welcome the stand that the country is taking against tobacco use plain packaging.” country iswith enforcing a new law which will
Sign up for our CANSA eKick Butt programme on www.ekickbutt.co.za.
GET READY FOR PLAIN PACKAGING
Get ready for plain packaging
force Joubert tobacco products to have plain And the use of graphic (pictorial) package concludes, “We really want people warnings willshow the serious harmful packaging and graphic warning to make educated choices whensigns. it comes effects of tobacco use. to smoking, and also about smoking in the Plain packaging is an important demand presence of other people. As a nonPlain packaging restricts the use of logos, reduction measure: smoker, you have the risk of being colours, brand images and promotional exposed to second-hand smoke, which is thetoattractiveness of tobacco information. Other countries that have • It reduces also harmful your health. We really want implemented plain packaging are UK, to encourage people to quite the habit and products, Northern Ireland and France who all reap the benefits of a healthier lifestyle to • Restricts the cancer use ofrisk. tobacco packaging to passed laws to implement plain packaging reduce their as from May 2016. Tobacco consumption be used as a form of advertising and in Australia decreased by 13% during the www.cansa.org.za/will-my-body-recover packaging and labelling. three years since plain packaging was • Limits misleading -after-i-quit-smoking introduced. And the use of graphic (pictorial) package warnings will depict the serious implications of tobacco use.
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TIME TO QUIT Quitting tobacco can have a positive effect on your health and lifestyle: Reducing the cancer risk Lower heart rate and blood pressure Breathing better Being able to walk without shortness of breath Living a longer and healthier life Having more physical energy Being a good role model for children and youth
Toll-free 0800 22 66 22 www.cansa.org.za
HIGH BLOOD WORLD HYPERTENSION DAY
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PRESSURE COMBAT HIGH BLOOD PRESSURE
educe
ALL THINGS THAT CAUSES HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD YOUR BLOOD PRESSURE HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD TO RISE HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD
DID YOU KNOW what causes high blood pressure?
HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD HIGH BLOOD
Eating too much salt Not eating enough fruit and vegetables Not active enough Alcohol
NO MORE D O O F K N JU
EAT HEAL THY
E S I C R E C EX MORE