Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups, using 2002-04 World Health Survey data from 41 low- and middle-income countries. Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality.
Equity in Health
This study aimed to review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within low-income and lower-middle-income countries (LLMICs). The authors searched 13 electronic databases, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. They used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of higher socioeconomic status. Groups at higher socioeconomic status were found to be less physically active and to consume more fats, salt, and processed food than individuals of low socioeconomic status. Despite significant heterogeneity in exposure and outcome measures, the evidence shows that behavioural risk factors are affected by socioeconomic position within LLMICs.
Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. The study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008.
Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. This study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa.
In this interview, Patrick Bond discusses the failings of South Africa’s drive towards meeting the Millennium Development Goals (MDGs) and the extent to which the country’s government continues to operate against the interests of its poor majority. According to Bond, South African urban poverty increased from 1993–2008 and rural poverty declined only because more poor people moved to the cities and the welfare grant system was extended. The South African economy is structured so as to generate poverty-expanding 'growth' of GDP (gross domestic product) so, as accumulation of capital occurs in much of South Africa, the rich grow richer and the poor grow poorer. That structuring happens in ways concordant with the speculative, financial-driven and profit-exporting character of capitalism, interrupted only briefly by the great crash of 2008. Most of Pretoria's economic policies amplify this trend because of their neoliberal (pro-business) character, he argues. South Africa cannot be confident of making progress on any MDGs, given the coming austerity associated with a failing global and national 'Keynesian' (deficit-based) macroeconomic strategy that was largely based on white-elephant infrastructure investments. Such spending – especially for now-empty World Cup soccer stadiums costing R22 billion – plus declining state revenues (as profits and taxes fell) moved the national budget from a surplus of around 1% of GDP to more than 7%. What is therefore likely, within five years, is a similar turn by the Treasury to the kind of austerity now being felt in many other countries which ratcheted up their deficits to deal with the crisis. As shown in the recent civil servants' strike, the state is willing to put services mainly utilised by the poor majority – public schools, clinics and hospitals – at risk to maintain some semblance of fiscal discipline, which does not bode well for future state expenditure on MDG-related needs.
South Africa fares worse on health than the residents of any other BRICS country, according to the country’s Health Minister Aaron Motsoaledi. In a speech delivered on 29 July 2012, the Minister presented standard health indicators for life expectancy, with the average South African expected to live until 54, far behind the Chinese at 74, Brazilians at 73, Russians at 68 and Indians at 65. He quoted South Africa’s maternal mortality rates at 410 per 100,000 births, almost double India’s rate of 230, which lags behind Brazil (58), Russia (39) and China (38).
The world's biggest AIDS treatment plan gets a boost this week as five pilot hospitals in South Africa's richest province roll out life-saving anti-retroviral medication. Officials say the April 01 launch in Gauteng, which includes Johannesburg, shows the government fulfilling a pledge to make ARVs available in South Africa - the country most battered by HIV/AIDS with some 5.3 million of its 45 million people infected.
South Africa's health minister has dashed any remaining hopes that her government will provide antiretroviral treatment for the estimated five million people who are infected with HIV. Dr Manto Tshabalala-Msimang has told parliament again, and repeated in several group meetings, that her government cannot afford the drugs regardless of how low the price goes. She repeated the government's view that the infrastructure necessary to deliver the treatment is not uniformly available, and she expressed the government's continuing fears of "toxicity" and the development of resistance. The government is also afraid that patients taking the treatment will not fully comply with the regimen.
A disputed new report on mortality rates in South Africa, released on Tuesday, said Aids was the biggest killer in the country, and predicted that it would account for the death of between 5 and 7 million people by 2010.
A rebellion against government policy on the treatment of HIV/AIDS is taking place in South Africa, with four provinical governments openly defying national policy and announcing the provision of nevirapine to all pregnant women in the public sector.