oa South African Health Review - Determinants of health and their trends : Primary Health Care : in context
Despite uncertainty about the exact levels of mortality, it is clear that the health of the South African population has worsened in the last decade. South Africa can be considered to have a quadruple burden of disease, including diseases and conditions related to poverty and under-development, chronic diseases, injuries and HIV and AIDS. The spread of HIV has been extremely rapid with an extensive impact, particularly among young adults and children. Differentials in health status have been observed between population groups, wealth groups, urban-rural and education levels. Globally, there has been a renewed interest in the determinants of health, including social determinants. A review of South African trends shows that economic and social policies have resulted in economic growth and some improvements in access to basic services such as water, sanitation and electricity. Increased provision of social grants, extreme wealth inequalities and high unemployment likely play an important role in poor health outcomes. Cultural and macro-social trends are difficult to capture, but of obvious concern to health are the culture of violence and the lower social status afforded to women. The theoretical understanding of health and its determinants is not completely formed. Nonetheless, the World Health Organization Commission on Social Determinants of Health argues that there is enough evidence for governments to take action following three principles: improving the daily living conditions of people; reducing health inequalities; and strengthening the ability to monitor population health. A revitalised Alma Ata provides an aspirational charter to build primary curative and preventive care accompanied by intersectoral action linking health and action.
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