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Explaining the role of the social determinants of health on health inequality in South Africa

BACKGROUND: Action on the social determinants of health (SDH) is relevant for reducing health inequalities. This is particularly the case for South Africa (SA) with its very high level of income inequality and inequalities in health and health outcomes. This paper provides evidence on the key SDH fo...

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Autores principales: Ataguba, John Ele-Ojo, Day, Candy, McIntyre, Di
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Co-Action Publishing 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575416/
https://www.ncbi.nlm.nih.gov/pubmed/26385543
http://dx.doi.org/10.3402/gha.v8.28865
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author Ataguba, John Ele-Ojo
Day, Candy
McIntyre, Di
author_facet Ataguba, John Ele-Ojo
Day, Candy
McIntyre, Di
author_sort Ataguba, John Ele-Ojo
collection PubMed
description BACKGROUND: Action on the social determinants of health (SDH) is relevant for reducing health inequalities. This is particularly the case for South Africa (SA) with its very high level of income inequality and inequalities in health and health outcomes. This paper provides evidence on the key SDH for reducing health inequalities in the country using a framework initially developed by the World Health Organization. OBJECTIVE: This paper assesses health inequalities in SA and explains the factors (i.e. SDH and other individual level factors) that account for large disparities in health. The relative contribution of different SDH to health inequality is also assessed. DESIGN: A cross-sectional design is used. Data come from the third wave of the nationally representative National Income Dynamics Study. A subsample of adults (18 years and older) is used. The main variable of interest is dichotomised good versus bad self-assessed health (SAH). Income-related health inequality is assessed using the standard concentration index (CI). A positive CI means that the rich report better health than the poor. A negative value signifies the opposite. The paper also decomposes the CI to assess its contributing factors. RESULTS: Good SAH is significantly concentrated among the rich rather than the poor (CI=0.008; p<0.01). Decomposition of this result shows that social protection and employment (contribution=0.012; p<0.01), knowledge and education (0.005; p<0.01), and housing and infrastructure (−0.003; p<0.01) contribute significantly to the disparities in good SAH in SA. After accounting for these other variables, the contribution of income and poverty is negligible. CONCLUSIONS: Addressing health inequalities inter alia requires an increased government commitment in terms of budgetary allocations to key sectors (i.e. employment, social protection, education, housing, and other appropriate infrastructure). Attention should also be paid to equity in benefits from government expenditure. In addition, the health sector needs to play its role in providing a broad range of health services to reduce the burden of disease.
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spelling pubmed-45754162015-10-20 Explaining the role of the social determinants of health on health inequality in South Africa Ataguba, John Ele-Ojo Day, Candy McIntyre, Di Glob Health Action Monitoring Health Determinants with an Equity Focus BACKGROUND: Action on the social determinants of health (SDH) is relevant for reducing health inequalities. This is particularly the case for South Africa (SA) with its very high level of income inequality and inequalities in health and health outcomes. This paper provides evidence on the key SDH for reducing health inequalities in the country using a framework initially developed by the World Health Organization. OBJECTIVE: This paper assesses health inequalities in SA and explains the factors (i.e. SDH and other individual level factors) that account for large disparities in health. The relative contribution of different SDH to health inequality is also assessed. DESIGN: A cross-sectional design is used. Data come from the third wave of the nationally representative National Income Dynamics Study. A subsample of adults (18 years and older) is used. The main variable of interest is dichotomised good versus bad self-assessed health (SAH). Income-related health inequality is assessed using the standard concentration index (CI). A positive CI means that the rich report better health than the poor. A negative value signifies the opposite. The paper also decomposes the CI to assess its contributing factors. RESULTS: Good SAH is significantly concentrated among the rich rather than the poor (CI=0.008; p<0.01). Decomposition of this result shows that social protection and employment (contribution=0.012; p<0.01), knowledge and education (0.005; p<0.01), and housing and infrastructure (−0.003; p<0.01) contribute significantly to the disparities in good SAH in SA. After accounting for these other variables, the contribution of income and poverty is negligible. CONCLUSIONS: Addressing health inequalities inter alia requires an increased government commitment in terms of budgetary allocations to key sectors (i.e. employment, social protection, education, housing, and other appropriate infrastructure). Attention should also be paid to equity in benefits from government expenditure. In addition, the health sector needs to play its role in providing a broad range of health services to reduce the burden of disease. Co-Action Publishing 2015-09-16 /pmc/articles/PMC4575416/ /pubmed/26385543 http://dx.doi.org/10.3402/gha.v8.28865 Text en © 2015 John Ele-Ojo Ataguba et al. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
spellingShingle Monitoring Health Determinants with an Equity Focus
Ataguba, John Ele-Ojo
Day, Candy
McIntyre, Di
Explaining the role of the social determinants of health on health inequality in South Africa
title Explaining the role of the social determinants of health on health inequality in South Africa
title_full Explaining the role of the social determinants of health on health inequality in South Africa
title_fullStr Explaining the role of the social determinants of health on health inequality in South Africa
title_full_unstemmed Explaining the role of the social determinants of health on health inequality in South Africa
title_short Explaining the role of the social determinants of health on health inequality in South Africa
title_sort explaining the role of the social determinants of health on health inequality in south africa
topic Monitoring Health Determinants with an Equity Focus
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575416/
https://www.ncbi.nlm.nih.gov/pubmed/26385543
http://dx.doi.org/10.3402/gha.v8.28865
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