Skip to main content
Log in

Population health in South Africa: Dynamics over the past two decades

  • Commentary
  • Published:
Journal of Public Health Policy Aims and scope Submit manuscript

Abstract

South Africa has experienced a rapid and complex health transition over the past two decades. Mortality has worsened in virtually all age groups, driven largely by HIV and AIDS. The morbidity profile comprises coexisting infectious and non-communicable diseases – including new infections such as HIV and AIDS, and emerging conditions such as vascular illness and diabetes – together with persisting child diarrhea and malnutrition, and high levels of interpersonal violence and accidents. Risk factors for cardiovascular disease are high even in rural parts of the country, with high levels of obesity rendering women at greater risk for metabolic disease. Reducing the negative impacts of the health transition will require targeted efforts within the health and social sectors, as well as broader development initiatives. Government should provide strong leadership, and priorities for action must be underpinned by a robust evidence base.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  • Garenne, M.L. (2007) Health transitions and regressions in Southern Africa [commentary]. Scandinavian Journal of Public Health 35 (Suppl 69): 66–67.

    Article  Google Scholar 

  • The World Bank. (2010) World Development Indicators. Washington DC: World Bank.

  • Day, C. and Gray, A. (2008) Health and Related Indicators. Durban, South Africa: Health Systems Trust.

    Google Scholar 

  • Tollman, S.M., Kahn, K., Garenne, M. and Gear, J.S.S. (1999) Reversal in mortality trends: Evidence from the Agincourt field site, South Africa, 1992–1995. AIDS 13: 1091–1097.

    Article  Google Scholar 

  • Kahn, K., Garenne, M., Collinson, M.A. and Tollman, S.M. (2007) Mortality trends in a new South Africa: Hard to make a fresh start. Scandinavian Journal of Public Health 35 (Suppl 69): 26–34.

    Article  Google Scholar 

  • WHO and UNICEF. (2010) Countdown to 2015 Decade Report (2000–2015): Taking Stock of Maternal, Newborn and Child Survival.

  • Anderson, B.A. and Phillips, H.E. (2006) Adult Mortality (Age 15–64) Based on Death Notification Data in South Africa: 1997–2004 Pretoria: Statistics South Africa. Report No. 03-09-05.

  • Abdool Karim, S.S., Churchyard, G.J., Abdool Karim, Q. and Lawn, S.D. (2009) HIV infection and tuberculosis in South Africa: An urgent need to escalate the public health response. Lancet 374 (9693): 921–933.

    Article  Google Scholar 

  • Day, C., Barron, P., Monticelli, F. and Sello, E.T. (2009) The District Health Barometer 2007/2008. Durban, South Africa: Durban Health Systems Trust.

    Google Scholar 

  • Houlihan, C.F., Mutevedzi, P.C., Lessells, R.J., Cooke, G.S., Tanser, F.C. and Newell, M. (2010) The tuberculosis challenge in a rural South African HIV programme. BMC Infectious Diseases 10: article 23, doi: 10.1186/1471-2334-10-23.

  • Tollman, S.M., Kahn, K., Sartorius, B., Collinson, M.A., Clark, S.J. and Garenne, M.L. (2008) Implications of mortality transition for primary health care in rural South Africa: A population-based surveillance study. Lancet 372 (9642): 893–901.

    Article  Google Scholar 

  • Mayosi, B.M., Flisher, A.J., Lalloo, U.G., Sitas, F., Tollman, S.M. and Bradshaw, D. (2009) The burden of non-communicable diseases in South Africa. Lancet 374 (9693): 934–947.

    Article  Google Scholar 

  • Seedat, M., Van Niekerk, A., Jewkes, R., Suffla, S. and Ratele, K. (2009) Violence and injuries in South Africa: Prioritising an agenda for prevention. Lancet 374 (9693): 1011–1022.

    Article  Google Scholar 

  • Thorogood, M., Connor, M.D., Tollman, S.M., Lewando-Hundt, G., Fowkes, G. and Marsh, J. (2007) A cross-sectional study of vascular risk factors in a rural South African population: Data from the Southern African Stroke Prevention Initiative (SASPI). BMC Public Health 7: article 326, doi: 10.1186/1471-2458-7-326.

  • Alberts, M. et al (2005) Prevalence of cardiovascular diseases and associated risk factors in a rural black population of South Africa. European Journal of Cardiovascular Prevention and Rehabilitation 12: 347–354.

    Article  Google Scholar 

  • Kimani-Murage, E.W. et al (2010) The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African children. BMC Public Health 10: article 158, doi: 10.1186/1471-2458-10-158.

  • Thorogood, M., Connor, M.D., Lewando-Hundt, G. and Tollman, S.M. (2007) Understanding and managing hypertension in an African sub-district: A multidisciplinary approach. Scandinavian Journal of Public Health 35 (Suppl 69): 52–59.

    Article  Google Scholar 

  • Clark, S.J., Collinson, M.A., Kahn, K., Drullinger, K. and Tollman, S.M. (2007) Returning home to die: Circular labour migration and mortality in South Africa. Scandinavian Journal of Public Health 35 (Suppl 69): 35–44.

    Article  Google Scholar 

  • Gomez-Olive, F.X., Thorogood, M., Clark, B.D., Kahn, K. and Tollman, S.M. (2010) Assessing health and well-being among older people in rural South Africa. Global Health Action 3 (Suppl 2): 23–35, doi: 10.3402/gha.v3i0.2126.

    Google Scholar 

  • Schatz, E.J. and Ogunmefun, C. (2007) Caring and contributing: The role of older women in rural South African multi-generational households in the HIV/AIDS era. World Development 35: 1390–1403.

    Article  Google Scholar 

  • South African Social Security Agency. (2010) You and Your Grants 2010/11, http://www.sassa.gov.za/Portals/1/Documents/23047402-2ddc-471a-8670-0366d758aeb9.pdf, accessed 17 January 2011.

  • Twine, R., Collinson, M.A., Polzer, T.J. and Kahn, K. (2007) Evaluating access to a child-oriented poverty alleviation intervention in rural South Africa. Scandinavian Journal of Public Health 35 (Suppl 69): 118–127.

    Article  Google Scholar 

  • Goudge, J., Gilson, L., Russell, S., Gumede, T. and Mills, A. (2009) The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor. Tropical Medicine & International Health 14 (4): 458–467.

    Article  Google Scholar 

  • Collinson, M.A., Lurie, M., Kahn, K., Tollman, S.M., Wolff, B. and Johnson, A. (2006) Health consequences of migration: Evidence from South Africa's rural northeast (Agincourt). In: M. Tienda, S.E. Findley, S.M. Tollman and E. Preston-Whyte (eds.) Africa on the Move: African Migration and Urbanisation in Comparative Perspective. Johannesburg, South Africa: Wits University Press, pp. 308–328.

    Google Scholar 

  • Frenk, J., Bobadilla, J.L., Sepulveda, J. and Cervantes, M.L. (1989) Health transition in middle-income countries: New challenges for health care. Health Policy Planning 4 (1): 29–39.

    Article  Google Scholar 

  • Garenne, M. (1996) Mortality in sub-Saharan Africa: Trends and prospects. In: W. Lutz (ed.) The Future Population of the World: What Can We Assume Today? Laxenburg, Austria: Earthscan Publications and IASSA, pp. 149–169.

    Google Scholar 

  • Leon, D.A. et al (1997) Huge variation in Russian mortality rates 1984–94: Artefact, alcohol or what? Lancet 350: 383–388.

    Article  Google Scholar 

  • Hargreaves, J.R., Collinson, M.A., Kahn, K., Clark, S.J. and Tollman, S.M. (2004) Childhood mortality among former Mozambican refugees and their hosts in rural South Africa. International Journal of Epidemiology 33 (6): 1271–1278.

    Article  Google Scholar 

  • Omran, A.R. (1971) The epidemiologic transition: A theory of the epidemiology of population change. Milbank Memorial Fund Quarterly 49 (4): 509–538.

    Article  Google Scholar 

Download references

Acknowledgements

Stephen Tollman provided valuable insights and critical comments.

Author information

Authors and Affiliations

Authors

Additional information

The author summarizes available information on population health in South Africa over two decades, and argues for strong government leadership and broader development initiatives that are evidence-based.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kahn, K. Population health in South Africa: Dynamics over the past two decades. J Public Health Pol 32 (Suppl 1), S30–S36 (2011). https://doi.org/10.1057/jphp.2011.27

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/jphp.2011.27

Keywords

Navigation