This afternoon I had the privilege of attending a talk regarding the social determinants of health in South Africa by John Ataguba of the Health Economics division here. When I refer to social determinants of health, I actually refer to the larger field of epidemiology – the study of the distribution of health states and their determinants across time and populations. It then follows that factors at the social level – group – are social determinants.
In his talk, John highlighted the commonly referred to quadruple burden of disease in South Africa – infectious disease, non-communicable diseases (NCDs), injury and now the forth one eludes me. In any case, he pointed out that NCDs are not diseases of the rich only, as is commonly though, but that the poor bear a higher burden.
To show this he used data that he collated into a measure known as the concentration index. I barely understand this, but apparently it measures how progressive something is. In taxation, progressive means that the rich people pay a higher proportion of their income in tax relative to the poor. In terms of disease burden, does it mean that a larger proportion of the rich suffer from a certain disease compared to the poor? I remember him showing that the concentration index for TB was negative – meaning it was highly regressive – the poor being disproportionately burdened compared to the rich. Just understanding this measure would have been wonderful.
I loved being in the fully packed seminar room – where people were standing at the end of the room – and listening to him speak as I ate my rice cakes with penut butter, walnuts and apple, professor Dave Coetzee was snacking on a salad in a recycled container. Here we were a bunch of people whose lifestyles are likely to reflect those of a select few who can afford to well in South Africa discussing the health of the whole country. Since I cannot really understand the measure he used to analyze a national household income census in South Africa, I find it difficult to comment on the findings.
In any case, I found a number of things striking. Firstly, he pointed out how the inequality in health care provision in South Africa is somewhat addressed by the private medical aids. From what I understood, people who are on medical aid have protection against using too much of their money on health care. When you take these people out of the equation though, what is left is a society very divided in terms of access to health – one group can afford to pay for it and the other cannot. The public health system, which is free, is supposed to fill the gap.
The other was the huge disparity in educational attainment between rural and urban areas. One country with two different groups of people, and just over half of whom have even a high school leaving certificate. Since the association between educational attainment and improved health is well documented the world over, I wonder what this means for health disparities in South Africa.
And that is all for now. I really enjoyed his talk, in fact I hope to be able to present like he did one day.