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Prevention, education, wellness solutions: The chronic diseases of lifestyle demand more than treatment

Shocking Statistics

A report Issued by THE Heart and Stroke Foundation SA during September 2007, entitled ‘Heart Disease in South Africa’, based on research carried out on heart disease in South Africa, revealed shocking statistics requiring urgent intervention.

Commissioned by The Heart and Stroke Foundation SA (HSFSA) and released by the Medical Research Council (MRC), this report was authored by Prof Krisela Steyn from UCT Department of Medicine.

The report revealed the following:

  • Despite the high rates of AIDS deaths in South Africa actuaries project that chronic disease, including heart disease is also going to increase by 2010. Between 1997 – 2004 in South Africa, 195 people a day died due to some form of heart and blood vessel disease (cardiovascular disease). About 33 people a day die due to heart attacks.
  • High blood pressure, high cholesterol and diabetes add considerably to the burden of disease in South Africa. Heart disease is the second biggest killer of South Africans after Aids (est. 890 people / day die from Aids). Every single day 30 South Africans die from heart attacks and 60 from strokes alone. 70% of these occur in people younger than 55 years of age. Heart disease is not the male only problem it was thought to be years ago. One out of four (25%) SA women younger than 60 is affected. Heart disease is the cause of death in 20% of all deaths in women.
  • More than half the deaths due to chronic disease, including heart disease, occur before the age of 65 years. These are premature deaths that affect the workforce in the country and have a major impact on the economy of the country. Premature deaths due to heart and blood vessel diseases in people of working age (35 – 64 years) are expected to increase by 41% between 2007 – 2030. The negative economic impact of this will be enormous.
  • The highest rates of heart and blood vessel disease in South Africa are found in the Indian community, followed by the coloured community with the white and black community having the lowest and most similar rates.
  • Although the white and black population has similar rates of disease the pattern differs dramatically. The white population predominantly has a pattern of deaths due to heart attacks, while the black population predominantly has a pattern of deaths due to stroke, heart muscle disease and heart disease due to high blood pressure.

Experts estimate the total direct and indirect costs of death and disability from heart disease and stroke to exceed R8 billion a year.

According to Professor Anthony Mbewu, President of the Medical Research Council and Visiting Professor of Cardiology and Internal Medicine at the University of Cape Town, heart attacks and stroke are particularly tragic as they often strike down the victim in their productive years of life, removing the breadwinner from families. Even when nonfatal they often result in severe disability and consequent impoverishment for entire families. Up to 80% of heart disease and stroke could be prevented by setting up healthy habits for life with a good diet, exercise, stress management and avoiding smoking.

Heart disease, depression and diabetes mellitus often occur together, one leading to the other in a vicious circle of hopelessness and despair. The major causes of heart disease and diabetes mellitus are high levels of long term stress, lack of exercise, smoking and poor eating habits. We have to do something to change our thoughts to create a different reality!

A way to a different reality

Employees are a company’s most important assets. Therefore, it simply doesn’t make economic sense to pay attention only to the treatment of the chronic diseases of lifestyle, which at best reaches but the tip of the iceberg, hopefully keeping the lid on the symptoms. Treatment will never cure the disease, or get close to the real cause or origin of illness.

All South African companies find that heart disease, high blood pressure, high cholesterol, diabetes, Aids, TB, and depression and cancer, lead to tremendous loss of work hours and cost to company from accidents, presenteeism and absenteeism.

The emphasis in the workplace is on the treatment of the CDL’s as it is easier to implement, monitor and evaluate. This perspective is not economically viable in the long run. It is much better and a more lasting solution, to pay attention to prevention and lifestyle management. Prevention and lifestyle modification are about changing behaviour. This is more difficult and takes longer. It involves the acquiring of knowledge, training, changing attitudes and beliefs among employees.

The most practical solution to obtain this, is through peer educator training, where volunteers among the employees are trained in basic physiology, anatomy, nutrition, fitness, stress management, body-mind connection, the importance of thought awareness, control and change, food as medicine, food gardens and natural remedies. The volunteers take the information back to their peers, and within a short time span, results are noticed.

A recommended summary of the procedure for peer educator training

  1. Find the volunteers by sending out a notice for volunteers. Also ensure nominations from employees in each department, section or shift. Get at least 3 nominations, to select two to be trained, as some resign, move work area, or leave the company. Where there are occupational health services, I strongly recommend that the occupational health nurse work closely with the trainer and is trained to become a trainer her- or himself
  2. Through a selection and voting process, volunteers are therefore selected by their peers, not by management!
  3. The training facilitator, HR manager, occupational health department and of course, senior management should support and be involved in the process.
  4. Interviews should then be arranged with each peer educator, with specific questions to assess suitability, commitment, understanding of involvement as volunteers not getting additional pay, etc.
  5. Peer educator training can be implemented as part of SHEQ programs (e.g. putting the ‘H’ back in SHE)
  6. Obtain well qualified trainers that have an interactive, interesting teaching style, who can really connect with their students from all cultures and make them think and reason for themselves, allowing them to simultaneously develop as human beings, and work from the basis of ‘we teach best what we most have to learn’.
  7. Obtain necessary manuals, mostly through the training facilitator
  8. Obtain visual aids, e.g. posters, books, CD’s also through the training facilitator
  9. Set up training sessions


Peer educators from Minopex during training session

Feedback from recent peer educator training courses

Following is the feedback report from the peer educators from six mines. As you will see, the spin offs from the basic training in health, wellness and an integrative whole being approach to the chronic diseases of lifestyle, are unexpected, surprising and very encouraging. It is also a clear indication of the success of peer educator training as workplace wellness intervention, and the only intervention to consistently demonstrate long term, lasting and sustainable, health behaviour change. Developing life skills and leadership qualities, experiencing personal growth, learning to manage emotions, increase self esteem and self confidence, lowering blood pressure, all added to the increase in knowledge on health and wellness, after only 3 training sessions, shows that peer educator training has to be one of the best return on investment wellness programs available today.

  • Since I’ve become a peer educator, I have become more aware of health issues. I personally have learned to cope with stress a lot better and to manage anger as well. I no longer use blood pressure medication, for my blood pressure is much more stable and under control. The breathing exercises, meditation and awareness of upsetting emotions help me to control my anger better. I have more inner calmness.
  • The safety manager said that we are always concerned with protecting ourselves from physical harm, but never realise the personal harm we do by wrong lifestyles and that wellness is just as important. He encouraged me. That felt good, as well as the fact that he saw the worth in what I, as peer educator was doing.
  • I’ve started to adapt my grocery list to make healthier food choices, and I’m actually saving money!
  • When our group eat together at work, I eat healthier and also then show others: cold drinks, pap with greasy gravy, and chips should be replaced by water, fruit, vegetables, peanuts and yogurt. And, it’s not more expensive! Even the woman who sells the food has been bringing healthier food to sell during lunch break!
  • I knew I had it in me, but this training has helped me develop to take a positive leadership role, gain knowledge, learn more about health & wellness, and to help others do the same. I want to spread this knowledge to my community.
  • All the peer educators had a chance to do a short presentation, and even Martha, who only joined the day before the actual 2nd training session, had her say as the last presenter of 15 peer educators! Here is a transcript of her presentation:
    ‘Hi my name is Martha. Actually, I just want to say thank you to myself for joining as a peer educator, because you know what? According to my own point of view, I thought the word ‘peer educator’ was more about communication between your peers about AIDS, and I often became bored with these topics. Thank you all very much for the knowledge I’ve gained today, and about health. The only thing that I knew about health was to eat healthy food, HIV diseases and to exercise -that is the main thing I knew about health, but today I learnt a lot! How to make decisions and life choices is also health. I was so amazed. Happiness is also health. Wellness and lifestyles are also health. To lead by example, more especially we peer educators: you must always practice what you preach. You can’t tell somebody don’t smoke when immediately after the break you smoke, then they would say these people are just lying to us! To understand other people’s culture and religion, I was also not aware it was part of people’s health. To sleep enough, I thought maybe you should just sleep four hours as long as you have rest, I was unaware that this was part of health. I thank myself and all my fellow partners, to see myself being here today and become a peer educator, it means I gained a lot and can teach more and more. I study for my family and fellow workers, also my community. Thank you!’
  • Ever since I became a Peer Educator and attending a wellness course my life hasn’t changed much yet, because my personal problems are still around me. But I’m glad that there are easier and more empowering ways to deal with them. I am learning and I do share with my friends, my colleagues and everyone who are nearest to me about health and wellness. I do teach them how to look out for their own health and their wellness as a whole in this beautiful world
  • I learn to live free with others. I learn to have one partner and become faithful to her
  • I have already changed in my life because I learnt more and get to be a person with many health and wellness habits. I can teach the best of my newly acquired knowledge. Before, I was too shy to talk to others, now I can do it easily. I can talk to my peers. I am more self-confidant. I know the better food that must be eaten for better health and teach others.
  • Since I started being a Peer Educator my life has changed a lot because I know how to deal with stress and I can also manage my budget. Before, when I was sad or people upset me, I used to cry and feel lonely, but now I feel much better. I feel stronger inside. I know that I can accept things and I can do some breathing exercise and meditate. I know the right food for me and my family. No more stress! I save a lot of money because the healthy food is cheaper than the fancy food
  • Eating the right food is important to help the tissue & cells of the immune system and build up bodies. It makes the immune system keep active to fight with the infectious diseases like Aids and TB in the body. I can teach this to others. It feels good to help people
  • Since I’ve become a peer educator I’ve learnt to be responsible about my health when buying groceries. At work also now I’m in the spotlight because when you are a peer educator people look at you and then you become a leader, even if you don’t notice. Even management takes a look at you to be a leader. So now I can speak to people and people will listen. Before, I was scared to talk to management. Now I’m not! So all I can say is then I have grown personally
  • My life has changed so much after being a peer educator:
    • Because I know the importance of knowing my health status
    • How to manage my stress and anger
    • I even know the importance of eating healthy food, how to choose healthy food
    • I’ve started to talk at community gatherings to also make them more aware. Some listen, some don’t. I know not to become upset. I’ve learnt that I can’t change people, I can only plant the seeds. Each one changes when ready
  • I was very happy to be one chosen to be a Peer Educator. I now know God must have a purpose for my life, because before I was so scared to stand in front of people, but now it is easy, to stand and share some important views about healthy things to my colleagues and also community and my family, it is changing me a lot. I feel free inside
  • As I am taking these programs of wellness, it gives me a lot of knowledge; life changing behavior; know how to deal with problems easily and reducing bad habits like too much smoking, alcohol and sex caused by stress. From 6 beers a day I now only take 6 a month, 30 cigarettes a day and now stopped. My brain can think, my body feels good. I found other ways to deal with stress: walking, exercise, breathing and meditation.

Peer educators on the red carpet, on the way to receive their certificates during their inauguration ceremony


Peer educators and senior management from Minopex during graduation ceremony after completing their training course

There is a better way

These responses show that there truly is a better way for South Africans to find real and lasting wellness solutions to lessen the burden of disease on the one hand, but also to enable people to become empowered and knowledgeable to take responsibility for their own health and wellness, as well as their thoughts, values and beliefs, to become who they truly are. Each and every one of us can have an impact on thousands of others. Disseminating positive thoughts and health enhancing messages is the ultimate use of network marketing!

DR ARIEN VAN DER MERWE MBChB (Pret.) FRIPH (London) FRCAM (Dublin) MISMA (UK) is a medical doctor specialising in workplace wellness, natural medicine and stress management. Arien is a Fellow of the Royal Institute of Public health, Fellow of the Royal College of Alternative Medicine and Member of the International Stress Management Association. She is the author of many books on health and wellness and currently focuses her work on peer educator training in the workplace and communities to address the chronic diseases of lifestyle, or health challenges as she prefers to call them. She also presents three short courses in peer educator training, wellness and stress management at the University of Pretoria, through the Department of Social Work. Her dream remains to be involved in a truly integrative wellness sanctuary and retreat centre. More info on her website: Contact her on e-mail:

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