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

南非约翰内斯堡市中心反映了中等收入国家面临的复杂卫生挑战。城市生活的吸引力导致大量人口迁移到城市地区，在那里人们面临着拥挤、噪音、污染、犯罪、毒品、失业和其他问题。城市的食物选择和供应，如廉价、快速、加工食品的可得性，以及现代、更久坐的生活方式，正在导致肥胖症的流行。南非在防治艾滋病毒方面取得的持续成功意味着，这种疾病现在在很大程度上得到了免费获得的药物和护理的控制。为了应对艾滋病毒，南非制定并采用了新的做法和方法，不仅用药物治疗艾滋病毒，而且找到那些不知道自己生病的人，并将他们与卫生服务联系起来。这样做的方式是使患者能够获得所需的药物和护理，但也要了解他们的病情，他们如何帮助管理以保持健康，以及他们有权获得哪些其他服务。我们的目标是利用我们所学到的知识，寻找因生活方式改变而患有慢性病的人，特别是未确诊和未经治疗的高血压和糖尿病，这些疾病目前占南非可治疗死亡的大多数。市中心的许多工作场所都靠近诊所和全科医生，为生病的员工提供了快速方便地获得医疗服务的机会。我们将为城市工作场所设立一个健康检查方案，并设计一个友好的、创新的员工方案，以检查糖尿病和高血压等疾病，并协助人们在当地卫生诊所接受治疗。我们将设计一个吸引人的、针对市中心的健康食品教育方案，向人们介绍其他食品选择，包括在附近哪里可以买到负担得起的健康食品。该项目将由利物浦大学、约翰内斯堡威特沃特斯兰德大学的研究人员和参与食品活动的当地雇员、管理人员、社区团体和慈善组织设计，包括糖尿病团体和参与公共卫生项目和医疗保险的人：所有团体都与筛查成功有关。我们的目标是很好地了解与健康检查、寻求健康和食物消费行为相关的动机，以便能够有效地解决这个问题，帮助人们变得和保持健康。我们将在工作场所测试该计划，看看哪些有效，哪些需要改进，并为我们的活动花费成本，以确保它们是负担得起的。然后，我们将根据我们的调查结果向决策者、捐助者、政府和资助者提出建议。如果我们的项目能够找到更好地了解高血压、糖尿病和可能的肥胖流行病的方法，使用对艾滋病毒有效的方法，我们将开始应对复杂生活方式条件的挑战，这在未来可能包括其他挑战，如精神疾病、慢性肺病和睡眠障碍。

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.