Assessing Changes in Social Determinants of Health Inequalities in South Africa : a Decomposition Analysis

Overview

Journal Int J Equity Health

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2018 Dec 13

PMID 30537976

Citations 22

Authors

Kehinde O Omotoso

Steven F Koch

Affiliations

Soon will be listed here.

Abstract

Background: Despite various policy interventions that have targeted reductions in socio-economic inequalities in health and health care in post-Apartheid South Africa, evidence suggests that not much has really changed. In particular, health inequalities, which are strongly linked to social determinants of health (SDH), persist. This study, thus, examines how changes in the SDH have impacted health inequalities over the last decade, the second since the end of Apartheid.

Methods: Data come from information collected on social determinants of health (SDH) and on health status in the 2004, 2010 and 2014 questionnaires of the South African General Household Surveys (GHSs). The health indicators considered include ill-health status and disability. Concentration indices and Oaxaca-Blinder decomposition of change in a concentration index methods were employed to unravel changes in socio-economic health inequalities and their key social drivers over the studied time period.

Results: The results show that inequalities in ill-health are consistently explained by socio-economic inequalities relating to employment status and provincial differences, which narrowed considerably over the studied periods. Relatedly, disability inequalities are largely explained by shrinking socio-economic inequalities relating to racial groups, educational attainment and provincial differences.

Conclusion: The extent of employment, location and education inequalities suggests the need for improved health care management and further delivery of education and job opportunities; greater effort in this regard is likely to be more beneficial in some way.

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References

Filmer D, Pritchett L . Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography. 2001; 38(1):115-32. DOI: 10.1353/dem.2001.0003. View

Braveman P, Tarimo E . Social inequalities in health within countries: not only an issue for affluent nations. Soc Sci Med. 2002; 54(11):1621-35. DOI: 10.1016/s0277-9536(01)00331-8. View

Zere E, McIntyre D . Inequities in under-five child malnutrition in South Africa. Int J Equity Health. 2003; 2(1):7. PMC: 201028. DOI: 10.1186/1475-9276-2-7. View

van Doorslaer E, Koolman X . Explaining the differences in income-related health inequalities across European countries. Health Econ. 2004; 13(7):609-28. DOI: 10.1002/hec.918. View

Wagstaff A . The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2004; 14(4):429-32. DOI: 10.1002/hec.953. View

Marmot M . Social determinants of health inequalities. Lancet. 2005; 365(9464):1099-104. DOI: 10.1016/S0140-6736(05)71146-6. View

Burgard S, Treiman D . Trends and racial differences in infant mortality in South Africa. Soc Sci Med. 2005; 62(5):1126-37. DOI: 10.1016/j.socscimed.2005.07.025. View

Charasse-Pouele C, Fournier M . Health disparities between racial groups in South Africa: a decomposition analysis. Soc Sci Med. 2006; 62(11):2897-914. DOI: 10.1016/j.socscimed.2005.11.020. View

Vyas S, Kumaranayake L . Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006; 21(6):459-68. DOI: 10.1093/heapol/czl029. View

10.

Kilbourne A, Switzer G, Hyman K, Crowley-Matoka M, Fine M . Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health. 2006; 96(12):2113-21. PMC: 1698151. DOI: 10.2105/AJPH.2005.077628. View

11.

Whitehead M . A typology of actions to tackle social inequalities in health. J Epidemiol Community Health. 2007; 61(6):473-8. PMC: 2465710. DOI: 10.1136/jech.2005.037242. View

12.

Marmot M . Achieving health equity: from root causes to fair outcomes. Lancet. 2007; 370(9593):1153-63. DOI: 10.1016/S0140-6736(07)61385-3. View

13.

Gilson L, McIntyre D . Post-apartheid challenges: household access and use of health care in South Africa. Int J Health Serv. 2007; 37(4):673-91. DOI: 10.2190/HS.37.4.f. View

14.

Erreygers G . Correcting the concentration index. J Health Econ. 2008; 28(2):504-15. DOI: 10.1016/j.jhealeco.2008.02.003. View

15.

Mackenbach J, Stirbu I, Roskam A, Schaap M, Menvielle G, Leinsalu M . Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008; 358(23):2468-81. DOI: 10.1056/NEJMsa0707519. View

16.

Marmot M, Friel S, Bell R, Houweling T, Taylor S . Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008; 372(9650):1661-9. DOI: 10.1016/S0140-6736(08)61690-6. View

17.

Govender V, Penn-Kekana L . Gender biases and discrimination: a review of health care interpersonal interactions. Glob Public Health. 2009; 3 Suppl 1:90-103. DOI: 10.1080/17441690801892208. View

18.

Wagstaff A, Paci P, Doorslaer E . On the measurement of inequalities in health. Soc Sci Med. 1991; 33(5):545-57. DOI: 10.1016/0277-9536(91)90212-u. View

19.

Kleinert S, Horton R . South Africa's health: departing for a better future?. Lancet. 2009; 374(9692):759-60. DOI: 10.1016/S0140-6736(09)61306-4. View

20.

Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D . The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009; 374(9692):817-34. DOI: 10.1016/S0140-6736(09)60951-X. View