National Health Insurance
The Quadruple Burden of Diseases in South Africa

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In Policy Brief 3 a paper was quoted entitled “Conceptual Framework for Chronic Diseases of Lifestyle in South Africa.”. The author argues that “The quadruple burden of diseases in South Africa has serious consequences for the prevention and cost-effective management of chronic diseases and the unhealthy lifestyles and risk factors that precede them. The disease patterns in this region are characterised by a combination of poverty-related diseases together with the emerging chronic diseases [of lifestyle] associated with urbanisation, industrialisation and a westernised lifestyle. This double burden of diseases is exacerbated by high injury rates associated with the social instability of violence or high crime rates, and by the exploding epidemic of HIV/AIDS across the African continent. This multiple burden represents a demand on the health services of South Africa far beyond those experienced in developed countries and what the limited resources can accommodate.”

In the conclusion to the report on poverty and chronic diseases, the authors say: “The data presented in this report show a complex picture of mortality, morbidity, risk factor and unhealthy lifestyle patterns in South Africa – an amalgam of a stratified society undergoing the health transition at a rapid pace. The current mortality pattern of chronic diseases reflects a lifetime’s exposure to unhealthy lifestyles. The resulting risk factors were also poorly diagnosed and inadequately treated. South Africa has not escaped the protracted-polarised model of the epidemiological transition.”

“[T]he 1996 mortality pattern shows a strongly polarised pattern, with the rich having a more typical westernised pattern where chronic diseases dominate, though exceedingly high levels of trauma-related death were also found among men. In contrast, the mortality picture of the poor could be described as a typical example of the protracted-polarised pattern of mortality with a combination [of] disease types. The increased number of early adult female deaths is probably due to the emergence of the AIDS epidemic and can be seen in both the poor and wealthy areas.”

“Morbidity, measured by abnormal peak flow, and symptoms of “asthma” were not correlated with levels of wealth and poverty as reflected by the asset index, while chronic bronchitis was more common among the poor. Risk factors, such as hypertension and obesity, tended to increase in the wealthier groups. In contrast, the prevalence of unhealthy lifestyles, and exposures such as smoking (albeit light smoking) exposure to smoky fuels and alcohol dependence, tended to occur more frequently among the poor. This profile suggests that the poor are also likely to develop risk factors for chronic diseases as a result of their current unhealthy lifestyle. In addition, any alleviation of poverty leading to an increase in wealth may also contribute to additional increase in risk factors.”

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