Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.
Journal: Journal of epidemiology and community health
Volume: 76
Issue: 5
Year of Publication:
Affiliated Institutions:
Research, Africa Institute for Health Policy, Nairobi, Kenya.
Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Department of Medicine, University of Washington, Seattle, WA, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Department of Medicine, University of Cape Town, Cape Town, South Africa.
MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa.
Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.
Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
Department of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia.
Department of Psychology, University of the Free State, Park WEst, Free State, South Africa.
Health Systems Research Unit, Health System Trust, Westville, South Africa.
Independent Consultant, Awka, Nigeria.
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa.
University of Environment and Sustainable Development, Somanya, Ghana.
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Grants, Innovation and Product Development Unit, South African Medical Research Council, Cape Town, South Africa.
Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
Division of Cardiology, University of Cape Town, Rondebosch, Western Cape, South Africa.
Department of Psychology, University of Ghana, Accra, Ghana.
Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa.
School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.
Hatter Institute Department of Medicine, University of Cape Town, Cape Town, South Africa.
Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa.
University of KwaZulu-Natal, Durban, South Africa.
Health Sciences Department, North-West University, Mmbatho, South Africa.
Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
University of Cape Town, Cape Town, South Africa.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA nagham@uw.edu.
Abstract summary
Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019.We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance.Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces.Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.
Authors & Co-authors:
Achoki
Sartorius
Watkins
Glenn
Kengne
Oni
Wiysonge
Walker
Adetokunboh
Babalola
Bolarinwa
Claassens
Cowden
Day
Ezekannagha
Ginindza
Iwu
Iwu
Karangwa
Katoto
Kugbey
Kuupiel
Mahasha
Mashamba-Thompson
Mensah
Ndwandwe
Nnaji
Ntsekhe
Nyirenda
Odhiambo
Oppong Asante
Parry
Pillay
Schutte
Seedat
Sliwa
Stein
Tanser
Useh
Zar
Zühlke
Mayosi
Hay
Murray
Naghavi
Study Outcome
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