n South African Medical Journal - Health policies and practice : setting priorities for health in 21st-century South Africa : forum




South Africa (SA) commands financial health care resources comparable to Brazil, Mexico and Thailand. Despite spending similar amounts in the public sector (3.5% of gross domestic product (GDP) in terms of purchasing power parity, these and other countries have far better health outcomes than SA on almost all measures including life expectancy and maternal mortality (Table I). While the combined impact of HIV and tuberculosis (TB) on all-cause mortality has been immense, this only partially explains the plummeting life expectancy in SA from 63 years in 1990 to 45 years in 2007. Furthermore, SA is one of only 12 countries worldwide with a marked reversal of maternal and infant mortality, reflecting the complex epidemiological transition underway. An increasing percentage of the population now dies from chronic, non-communicable diseases such as vascular illness, diabetes and cancers and from violence and injury.


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