Browsing by Author "Gangaidzo, Trust"

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    Socioeconomic status and chronic diseases in South Africa
    (Stellenbosch : Stellenbosch University, 2022-12) Gangaidzo, Trust; Burger, Ronelle; Von Fintel, Marisa; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
    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.