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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 3 : Problem Statement

3.2 Burden of Disease


43. The South African population is relatively young although trends in the past few years have shown an increase in life expectancy with the steadily increasing numbers of the older age groups. Despite life expectancy showing an increasing trend in the past few years, the average life expectancy is still low at 63.1 years for females and 59.1 years for males23.


44. The country is facing an increasing burden of diseases that negatively affects the health of the population and has negatively impacted on the poorest groups of the population. Epidemiologically, South Africa is confronted with a quadruple burden of disease because of HIV and AIDS and Tuberculosis; high maternal neonatal and child morbidity and mortality; rising disease burden of non-communicable disease; and high levels of violence and trauma. According to census figures from StatsSA, TB is the biggest contributor to years of life lost followed by pneumonia and influenza; intestinal infectious diseases; other forms of heart diseases; cerebrovascular disease; diabetes mellitus; HIV /AIDS; hypertensive disease; chronic lower respiratory tract disease; and lastly other viral diseases24.


45. The combined impact of these epidemics has influenced the doubling of the death rate between 1997 and 2006 in our country. HIV, AIDS and TB have contributed the most in this increased death rate. In 2012, an estimated 6.4 million people living with HIV resided in South Africa. The estimated number of new HIV infections in South Africa was 1.08% in 2012. According to the UNAIDS estimates, the national HIV prevalence among the general adult population aged 15 - 49 years old has remained stable at around 17.3% since 2005 and the estimated number of people living with HIV and AIDS is 6.4 million in 201225. Women have borne the brunt of burden of HIV and AIDS epidemic disproportionately in society.


46. Women remain at higher risk of HIV and are 1.6 times more likely than males to be HIV positive26. In 1990, less than 1% of pregnant women accessing public health services were found to be infected with HIV. By 2004, this figure had increased to 20% and currently the overall national HIV prevalence estimates among 15 - 49 year pregnant women have increased significantly from the 1990 figure and remain hovering at 29.5% in 2011 and 201227. The total number of women between the ages of 15-49 years living with HIV has also increased from an estimated 16.7% in 2002 to 18.5% in 201428, translating to approximately one-fifth of South African women in their reproductive ages being HIV positive.


47. With respect to maternal, new-born and child health, the burden of disease is 2-3 times greater than the average of comparable countries and about 1% of the global burden29. Although the Under-5 (U5MR) and Infant (IMR) mortality rates have decreased to 56 and 40 per 1000 live births respectively, neonatal mortality rates have remained stable at 14 deaths per 1000 live births30.


48. In addition to the aforementioned causes of high burden of diseases, Non-Communicable Diseases (NCDs) are also a key contributor to the mortality and morbidity. NCD’s are not contagious and result from conditions such as high blood pressure, diabetes mellitus, cardiovascular diseases, obesity, cancer, respiratory diseases such as asthma, and mental health problems. They are lifestyle diseases driven by four key risk factors that have been identified as the main causative factors and include: tobacco use, alcohol abuse including use of narcoleptic agents, poor diet and eating habits and lack of physical activity. The lack of focused health promotion and prevention programmes and interventions, poor health seeking behaviour and the late detection of diseases are some of the major factors contributing to the high burden of NCDs. Low levels of physical activity affect 45.2% of women and 29.9% of males aggravating the prevalence of NCD’s.


49. Despite some efforts to improve mental health services over the past years, mental ill-health continues to pose a huge burden on individuals, society and the economy straddling both communicable and non-communicable disease burden.


50. Violence and injury also contribute significantly to the burden of disease. South Africa has an injury rate of 158 per 100 000. The most recent South African Burden of Disease data indicates that road traffic accidents and interpersonal violence are the leading causes of Years of Life Lost (YLL).


51. There are 17 million workers in South Africa, 13 million of which are in the formal economy and four million in the informal economy. Even though they are the backbone of the economy, their health or occupational health has been inadequate with a lack of human resources and a poor system of delivery of health services in both the public and private sectors. The burden of occupational disease and injury has left many workers, families and affected communities in dire straits and has often shifted the health and social consequences of workplace injuries and diseases to the public health and government social security systems. The system of dealing with occupational health in both public and private healthcare is at best fragmented, uncoordinated and at worst even non-existent for certain sections of workers in some parts of the country.