Burden of Disease Research Unit Understanding the Burden of Disease and Health Inequalities in South Africa

Transcription

1 Burden of Disease Research Unit Understanding the Burden of Disease and Health Inequalities in South Africa Dr Debbie Bradshaw

2 Outline Socio-economic conditions in South Africa Burden of disease Inequalities in health and social determinants What does it mean for health services, training and research?

3 Demography + 5 million population + 1 million births per year Youthful population with growing numbers of older persons 6% urbanised Socio economic Upper middle income country Gini coefficient :.68 High unemployment : 25% Varied living conditions

4 Source: StatsSA Living Standards 27/8

5 National Burden of Disease Study 2 Unintentional injuries 7% Intentional injuries 7% Total DALYs= Neuropsychiatric 8% Cardiovascular and diabetes 7% HIV & AIDS 31% Respiratory disease 5% Neoplasms 3% Other noncommunicable 1% Perinatal.matern al and nutritional 1% Infectious and parasitic (excluding HIV/AIDS) 9% Respiratory infections 3% Source: Revised South African National Burden of Disease Estimates for 2 Norman et al, 26

6 , Male deaths , South Africa 3, 25, 2, 15, 1, 5, , Female deaths , South Africa 3, , , , , Source: Own analysis of StatsSA data 5,

7 Adult mortality ( 45 q 15 - risk of dying between age 15 and 6) Source: Unpublished analysis by Bradshaw, Dorrington and Laubsher

8 Life expectancy - Provincial range Source: ASSA28

9 9 Under-5 Mortality Rate (per 1, live-births) ASSA28 UNPD IMHE 5 UNAIDS 4 IGME 3 VR 2 MDG 4 target

10 Under-5, Infant and Neonatal Mortality Rates (per 1, live-births) Source: Unpublished analysis by Bradshaw, Dorrington and Laubsher

11 Deaths per 1 live births U5MR Black African Coloured Asian White Source: ASSA28

12 Source: Groenewald et al, 211 Mortality Rates by Metro, 28

13 Percentage with hypertension Percentage with hypertension who are aware, use medication and are controlled Percentage with with hypertension Percentage with hypertension who are aware, use medication and are controlled Hypertension, awareness and treatment, males 15+ yrs Poorest Second Middle Fourth Richest Hypertension Use of hypertension medication Awareness of hypertension Control of hypertension Hypertension, awareness and treatment, females 15+ yrs Poorest Second Middle Fourth Richest Hypertension Use of hypertension medication Awareness of hypertension Control of hypertension Source: Schneider et al, 29

14 Violence and injuries Interpersonal violence rates may have decreased slightly, but remain substantially higher than international average Support intersectoral actions: Reduce inequalities and social deprivation Target alcohol risk to reduce access to alcohol, modifying the drinking context, counter drunk-driving and regulate alcohol promotion and advertising Improve criminal justice and social welfare systems Change cultural norms and strengthen communities through reducing alcohol availability, improving child care facilities; investing in early childhood education; and increasing positive adult involvement in the monitoring and supervision of children and adolescents; gun control Brief interventions for high risk drinkers Source: Matzopoulos et al, 28 ; Seedat et al, 29

15 Source: Rohde et al, 28 * South Africa

16 National Development Plan Vision for 23 But what will it take to make it reality?

17 Extensive and changing burden of disease What does it mean for health services, training and research? 1. Health service needs to provide for a wide spectrum of conditions 2. Innovative primary health care approaches to reach the community are needed for chronic conditions in particular for the high AIDS and TB burden, the emerging cardiovascular and diabetes burden and mental health problems 3. Strengthening public health, building the evidence base and improving surveillance data are needed to promote health and prevent disease 4. Addressing social determinants and inequalities needs to be high on the agenda