Socioeconomic status and chronic diseases in South Africa
| dc.contributor.advisor | Burger, Ronelle | en_ZA |
| dc.contributor.advisor | Von Fintel, Marisa | en_ZA |
| dc.contributor.author | Gangaidzo, Trust | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics. | en_ZA |
| dc.date.accessioned | 2022-11-15T08:26:32Z | |
| dc.date.accessioned | 2023-01-16T12:43:08Z | |
| dc.date.available | 2022-11-15T08:26:32Z | |
| dc.date.available | 2023-01-16T12:43:08Z | |
| dc.date.issued | 2022-12 | |
| dc.description | Thesis (PhD)--Stellenbosch University, 2022. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY: The global burden of non-communicable diseases (NCDs) is on the rise, and is expected to increase. The United Nations, through the 2030 Agenda for Sustainable Development Goals, acknowledged the public health importance of addressing NCDs, and set a goal to reduce premature mortality from NCDs by one-third by 2030. Key to achieving targets for prevention and control of NCDs is a holistic approach to understanding the underlying contextual causes. This thesis examines the role of inequality in socioeconomic status in the development of chronic diseases in South Africa, a highly unequal middle-income country battling communicable diseases and maternal and child mortality. To achieve this, the study had three objectives: (1) To examine how exposure to negative household events and neighbourhood characteristics relates to systolic blood pressure in South Africa; (2) To determine socioeconomic factors that explain depressive symptoms in South Africa; and (3) To ascertain the influence of the COVID-19 pandemic on income-related inequality in depressive symptoms in South Africa. The study is presented in three essays. In the first essay, I estimate the relationship between systolic blood pressure and exposure to stressful (negative) household events and neighbourhood characteristics. Using the correlated random effects model, I found that systolic blood pressure is significantly higher among respondents from households that had registered the death of a household member and those that reported a reduction in grant income and remittances. The direct effects of neighbourhoods were related to neighbourhood income level, whereby moving from a low-income neighbourhood to a middle-income neighbourhood was negatively associated with systolic blood pressure. With regard to the heterogenous effects of neighbourhoods, I found a negative and significant mean-level “job loss” effect. The implications of the study results are vast in a country like South Africa, which is already burdened with high mortality due to causes such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and tuberculosis (TB), injury and homicide, and NCDs such as cardiovascular diseases and diabetes. In the second essay, I examine the relationship between depressive symptoms and socioeconomic factors using the ordinary least squares model and the fixed effects model. Results from both models suggest significant socioeconomic gradients in depressive symptoms, whereby depressive symptoms are negatively associated with per capita household income, education, and social capital. However, I found a positive and significant association between depressive symptoms and unemployment only in men. The significant differences in the effects of variables by gender and by residence are a unique contribution to understanding the differences in health in South Africa, and may inform policies. Firstly, there are significant gender- and residence profiles in depression. Secondly, men who self-report good health may overestimate their health, most likely by excluding their state of mental health. Lastly, whilst the goal is to reduce the prevalence of mental disorders by targeting socioeconomic factors, differences by gender and residence underscore the need for mental health policies that promote equity. As reported in the third essay, I used a recentred influence function regression decomposition method developed by Heckley et al. (2016) to ascertain the influence of the COVID-19 pandemic on inequality in depressive symptoms related to income in South Africa. I found that the COVID-19 pandemic negatively and significantly influenced income-related inequality in good mental health in South Africa. This means that the COVID-19 pandemic disproportionately increased mental health problems amongst the affluent. I did not find an education profile in the joint distribution of income and mental health. Self-reported health-, age-, population group-, and gender profiles were present in the covariance between Income and good mental health. I used publicly available longitudinal data from the South African National Income Dynamics Survey in the study. Overall, the findings of this study suggest that socioeconomic factors contribute to the rising burden of chronic diseases in South Africa. Notwithstanding the study’s limitations, this thesis makes a significant contribution to understanding the typical mechanisms and pathways through which poverty and chronic conditions interact and reinforce each other in South Africa, and other low- to middle-income countries. This, in turn, provides useful inputs for policy and programmes to address the burden of chronic conditions in poor societies. Whilst pharmacological and medical technology advancements are important in extending life expectancy, socioeconomic interventions are equally important in curbing both rising morbidity and mortality from chronic diseases, and in addressing poverty and inequalities in low- to middle-income countries. Unlike physiological causes, socioeconomic determinants of health can be influenced through health- and government policy interventions, which could also be justifiable in terms of efficiency and equity. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Die wereldwye las van nie-oordraagbare siektes is aan die toeneem, en sal na verwagting vinniger toeneem. Die Verenigde Nasies het deur middel van die 2030 Agenda for Sustainable Development Goals vir volhoubare ontwikkelingsdoelwitte die belangrikheid van openbare gesondheid erken om sulke siektes aan te spreek, en die 'n doelwit gestel om voortydige mortaliteit van nie-oordraagbare siektes teen 2030 met een derde te verminder. Die sleutel tot die bereiking van teikens vir voorkoming en beheer van sulke siektes is 'n holistiese benadering om die onderliggende kontekstuele oorsake te verstaan. Hierdie tesis ondersoek die rol van ongelykheid in sosio-ekonomiese status in die ontwikkeling van chroniese siektes in Suid-Afrika, 'n hoogs ongelyke middelinkomsteland wat sukkel met oordraagbare siektes en moeder- en kindersterftes. Om dit te bereik, het die studie drie doelwitte gehad: (1) Om te ondersoek hoe blootstelling aan negatiewe huishoudelike gebeure en woonbuurt-eienskappe verband hou met sistoliese bloeddruk in Suid-Afrika; (2) Om sosio-ekonomiese faktore te bepaal wat depressiewe simptome in Suid-Afrika verklaar; en (3) om vas te stel wat die invloed van die COVID-19-pandemie op inkomsteverwante ongelykheid in depressiewe simptome in Suid-Afrika is. Die studie word in drie artikels aangebied. In die eerste artikel skat ek die verband tussen sistoliese bloeddruk en blootstelling aan stresvolle (negatiewe) huishoudelike gebeure en woonbuurt-eienskappe. Deur die gekorreleerde ewekansige effekte-model te gebruik, het ek gevind dat sistoliese bloeddruk aansienlik hoër is onder respondente van huishoudings wat die dood van 'n huishoudinglid geregistreer het en diegene wat 'n vermindering in toelae-inkomste en -oorbetalings gerapporteer het. Die direkte gevolge van woonbuurte was verwant aan buurtinkomstevlak, waardeur die verskuiwing van 'n lae-inkomstebuurt na 'n middelinkomstebuurt negatief geassosieer is met sistoliese bloeddruk. Met betrekking tot die heterogene uitwerking van woonbuurte, het ek 'n negatiewe en beduidende gemiddelde-vlak "werkverlies"-effek gevind. Die implikasies van die studieresultate is groot in 'n land soos Suid-Afrika, wat reeds belas is met hoë mortaliteit as gevolg van oorsake soos menslike immuniteitsgebrekvirus/verworwe immuniteitsgebreksindroom (MIV/VIGS) en tuberkulose (TB), beserings en moord, en nie-oordraagbare siektes soos kardiovaskulêre siektes en diabetes. In die tweede opstel ondersoek ek die verband tussen depressiewe simptome en sosio-ekonomiese faktore met behulp van die gewone kleinste-kwadrate-model en die vaste-effekte-model. Resultate van beide modelle dui op beduidende sosio-ekonomiese gradiente in depressiewe simptome, waardeur depressiewe simptome negatief geassosieer word met per capita huishoudelike inkomste, onderwys, en sosiale kapitaal. Ek het egter slegs by mans 'n positiewe en beduidende verband tussen depressiewe simptome en werkloosheid gevind. Die beduidende verskille in die uitwerking van veranderlikes volgens geslag en woonplek is 'n unieke bydrae om die verskille in gesondheid in Suid-Afrika te verstaan, en kan beleidsrigtings bepaal. Eerstens is daar beduidende geslags- en verblyfprofiele in depressie. Tweedens, mans wat self goeie gesondheid rapporteer, kan hul gesondheid oorskat, heel waarskynlik deur hul toestand van geestesgesondheid uit te sluit. Laastens, hoewel die doelwit is om die voorkoms van geestesversteurings te verminder deur sosio-ekonomiese faktore te teiken, beklemtoon verskille volgens geslag en woonplek die behoefte aan geestesgesondheidsbeleide wat gelykheid bevorder. Soos gerapporteer in die derde opstel, het ek 'n hersentreerde invloedsfunksie-regressie-ontbindingmetode gebruik wat deur Heckley et al. (2016) ontwikkel is om die invloed van die COVID-19-pandemie op ongelykheid in depressiewe simptome wat met inkomste in Suid-Afrika verband hou, vas te stel. Ek het gevind dat die COVID-19-pandemie inkomsteverwante ongelykheid in goeie geestesgesondheid in Suid-Afrika negatief en beduidend beinvloed het. Dit beteken dat die COVID-19-pandemie geestesgesondheidsprobleme onder die welvarendes buitensporig verhoog het. Ek het nie 'n profiel met betrekking to vlak van onderrig in die gesamentlike verspreiding van inkomste en geestesgesondheid gevind nie. Profiele van selfgerapporteerde gesondheid, ouderdom, bevolkingsgroep en geslags was in die kovariansie tussen inkomste en goeie geestesgesondheid teenwoordig. Ek het publieke longitudinale data van die Suid-Afrikaanse Nasionale Inkomstedinamika-opname in die studie gebruik. Oor die algemeen dui die bevindinge van hierdie studie daarop dat sosio-ekonomiese faktore bydra tot die toenemende las van chroniese siektes in Suid-Afrika. Nieteenstaande die studie se beperkings, lewer hierdie tesis 'n beduidende bydrae tot die begrip van die tipiese meganismes en wee waardeur armoede en chroniese toestande in wisselwerking tree en mekaar versterk in Suid-Afrika, en ook in ander lae- tot middel-inkomstelande. Dit verskaf, op sy beurt, nuttige insette vir beleid en programme om die las van chroniese toestande in arm samelewings aan te spreek. Terwyl farmakologiese en mediese tegnologiese vooruitgang belangrik is om lewensverwagting te verleng, is sosio-ekonomiese intervensies ewe belangrik om beide stygende morbiditeit en sterftes weens chroniese siektes te bekamp, en om armoede en ongelykhede in lae- tot middelinkomstelande aan te spreek. Anders as fisiologiese oorsake, kan sosio-ekonomiese determinante van gesondheid beïnvloed word deur gesondheids- en regeringsbeleidsingrypings, wat ook regverdigbaar kan wees in terme van doeltreffendheid en billikheid. | af_ZA |
| dc.description.version | Doctorate | |
| dc.format.extent | xv, 142 pages : illustrations, includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/125960 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject | Non-communicable diseases -- South Africa | en_ZA |
| dc.subject | Chronic Disease -- South Africa | en_ZA |
| dc.subject | Non-infectious diseases -- South Africa | en_ZA |
| dc.subject | UCTD | |
| dc.title | Socioeconomic status and chronic diseases in South Africa | en_ZA |
| dc.type | Thesis | en_ZA |
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