Improving data to reduce the burden of disease--lessons from the Western Cape.

The Western Cape Provincial Government initiated the collaborative Burden of Disease (BOD) Reduction Project to reduce its burden of disease and promote equity in health. 1 This shift in thinking from facilities to a population-based approach to health demonstrates increased awareness about the crucial role of upstream factors on population health. It resonates with the recommendations of the World Health Organization (WHO) Commission on Social Determinants of Health, 2 which highlights three principles of action: improve the conditions of daily life (the circumstances in which people are born, grow, live, work, and age); tackle inequitable distribution of power, money and resources; and raise public awareness about the social determinants and evaluate their health impact. Mortality surveillance is an important foundation for monitoring health status and the impact of interventions to improve population health. While considerable progress has recently been made in the production of cause of death statistics by the South African vital registration system, there are concerns about quality, and the system has not been able to provide district and sub-district level information, which is crucial for monitoring inequities. The Western Cape BOD Reduction Project identified strengthening mortality surveillance at sub-provincial level as essential for building the district health system. The City of Cape Town has reported cause of death statistics for more than 100 years and has tried to improve the quality of the data collection and to provide public health-orientated reports. This system was extended to the Boland/Overberg health region in 2004. 3 As part of the BOD Reduction Project the local mortality surveillance system was extended to the rest of the province, to produce mortality data for all health districts using a common methodology for data collection and analysis. Such data are important in planning and monitoring by the health districts of the province. The Western Cape experience with mortality surveillance, notwithstanding concerns about the quality of death certification, 4 has assisted with the following: Identifying the major health priorities. Cape Town's four leading causes of premature mortality, HIV/AIDS, tuberculosis, homicides and road traffic injuries, account for nearly half of premature mortality. Identifying inequities. In line with the recommendations of the WHO Commission on Social Determinants of Health to monitor health inequities, the Cape Town data illustrate the importance of this. There are some sub-districts with substantially higher mortality; Khayelitsha in particular has mortality levels comparable with the high rates in other provinces (Fig. 1). 5 …