Journal article
Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study
- Abstract:
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Background 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.
Methods 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.
Results 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.
Conclusions 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 5.3MB, Terms of use)
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- Publisher copy:
- 10.1136/jech-2021-217480
Authors
- Publisher:
- BMJ Publishing Group
- Journal:
- Journal of Epidemiology and Community Health More from this journal
- Volume:
- 76
- Issue:
- 5
- Pages:
- 471-481
- Place of publication:
- England
- Publication date:
- 2022-01-19
- Acceptance date:
- 2021-12-14
- DOI:
- EISSN:
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1470-2738
- ISSN:
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0143-005X
- Pmid:
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35046100
- Language:
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English
- Keywords:
- Pubs id:
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1236576
- Local pid:
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pubs:1236576
- Deposit date:
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2023-08-23
- ARK identifier:
Terms of use
- Copyright holder:
- Achoki et al
- Copyright date:
- 2022
- Rights statement:
- © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.
- Licence:
- CC Attribution (CC BY)
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