Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys.

John E Ataguba,James Akazili,Di Mcintyre

doi:10.1186/1475-9276-10-48

Abstract

BackgroundInequalities 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. 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.MethodsSeveral rounds (2002, 2004, 2006, and 2008) of the South African General Household Surveys (GHS) data were used, with standardized and normalized self-reported illness and disability concentration indices to assess the distribution of illness and disability across socio-economic groups. Composite indices of socio-economic status were created using a set of common assets and household characteristics.ResultsThis 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. These results have also been confirmed internationally.ConclusionThe 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.

Highlights

Inequalities in health, especially with reference to the burden of ill-health on the poor, have received considerable attention among health scientists and economists [1]
The cumulative shares show that for flu, the top 40% of the population bear over 43% (46%) of the burden compared to the bottom 40% of the population who bear about 37% (35%)
This study demonstrates that the burden of the major categories of ill-health and disability is greater among lower socio-economic groups in South Africa

Summary

Introduction

Inequalities in health, especially with reference to the burden of ill-health on the poor, have received considerable attention among health scientists and economists [1]. A recent study in South Africa shows that the distribution of health service utilisation and of the benefits (measured in monetary terms) from using services is skewed in favour of the rich for most public facilities, especially hospitals, and across all private sector services [13] These findings need to be compared to the distribution of ill-health across socio-economic groups. Trend analyses are yet to be conducted In this regard, this paper investigates health inequality in South Africa from a bivariate perspective (health in relationship to socioeconomic status) [19] and seeks to understand how the burden of illness and disability is distributed across socio-economic groups and whether this has changed since the early 2000s. This paper 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

Results

Discussion

Conclusion