Abstract:
BACKGROUND : Despite various policy interventions that have targeted reductions in socio-economic inequalities in
health and health care in post-Apartheid South Africa, evidence suggests that not much has really changed. In
particular, health inequalities, which are strongly linked to social determinants of health (SDH), persist. This study, thus,
examines how changes in the SDH have impacted health inequalities over the last decade, the second since the end
of Apartheid.
METHODS : Data come from information collected on social determinants of health (SDH) and on health status in the
2004, 2010 and 2014 questionnaires of the South African General Household Surveys (GHSs). The health indicators
considered include ill-health status and disability. Concentration indices and Oaxaca-Blinder decomposition of
change in a concentration index methods were employed to unravel changes in socio-economic health inequalities
and their key social drivers over the studied time period.
RESULTS : The results show that inequalities in ill-health are consistently explained by socio-economic inequalities
relating to employment status and provincial differences, which narrowed considerably over the studied periods.
Relatedly, disability inequalities are largely explained by shrinking socio-economic inequalities relating to racial
groups, educational attainment and provincial differences.
CONCLUSION : The extent of employment, location and education inequalities suggests the need for improved health
care management and further delivery of education and job opportunities; greater effort in this regard is likely to be
more beneficial in some way.
