oa South African Health Review - Health status and determinants : chapter 4



South Africa is undergoing a demographic transition with declining fertility. However, compared with other middle income countries, the health status is poor. This is due to a triple burden of disease from a combination of poverty-related diseases, emerging chronic diseases and injuries. The HIV/AIDS epidemic has exacerbated this in recent years resulting in increased child and young adult mortality and reduced life expectancy. It is estimated that in the next 10 years 6 million South Africans will die from AIDS. However, even at this late stage of the epidemic, there is scope for reducing the impact. There is an urgent need for people to change their behaviour, the management of STD's needs to be strengthened and the transmission of HIV from mother to child needs to be prevented. Anti-retroviral drugs need to be made affordable in the public sector and it is essential to develop appropriate guidelines for the treatment of opportunistic infections. Much could be done to reduce the overall burden of disease through health promoting and disease preventing strategies. These need to target the youth and focus on promoting safe sexual practices, preventing smoking, alcohol abuse and violence. Secondary prevention strategies are also important and the limited control of hypertension suggests that there is much room for improvements in primary care. Extensive inequalities in health status by population group, urban/rural area and province have been observed. Social interventions are necessary to overcome the extensive levels of poverty and unemployment in South Africa. While some of the disparities in health reflect the underlying economic inequalities, the health sector needs to find ways to redress these inequalities. The national epidemiological database has clearly improved over the last few years. Government needs to continue its efforts in this regard. In particular, mortality statistics need to be compiled more rapidly and the disease notification system needs attention. It is timely for South Africa to undertake a national burden of disease study to assess the coherence of the different data sources and provide consistent estimates of the health of the nation and subgroups.


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