SAHR 2007 - Health Systems Trust

Health and Related Indicators 15
Non-communicable and Chronic
Diseases of lifestyle
Although South Africa faces considerable challenges with
infectious diseases, it also faces a considerable non-communicable
disease burden. A recent World Bank publication
[Chronic non-communicable diseases] has noted that “poor
countries are catching up with wealthier nations in terms of
cancer, diabetes, obesity, and heart disease, and that by
2015, these chronic illnesses will be the leading cause of
death in developing countries”.
This issue has particular resonance for the private health
sector, where many non-communicable diseases are
included in the Prescribed Minimum Benefits (PMBs) stipulated
in terms of the Medical Schemes Act (Act 131 of 1998).
Prevalence data for these conditions can be extracted from
the REF study 2005 (extended to reflect the expected prevalence
in 2007) which drew on data from 4 large medical
scheme administrators who provide services to about 4.2
million insured people. Of these, 417 208 were receiving
treatment for a PMB condition. Selected data from this source
are presented graphically in Figure 20, also showing the selfreported
prevalence of these conditions from the SADHS
2003. Although the age group, time period and measurement
methods from the two sources are quite different, some
interesting broad correlations and deviations can be seen.
Health Status – Non-communicable and Chronic Diseases of lifestyle
Findings from the first nationally representative study of
mental disorders in SA [SASH 2002-4] confirm high 12-month
(16.5%) and lifetime (30.3%) prevalence of psychiatric disorders.
The study found that anxiety disorders, mood disorders
and substance abuse are common across all race groups
and across all the provinces, yet treatment rates for psychiatric
disorders were low with 72.4% of those with a serious
or moderate disorder receiving no treatment in the year
prior to the interview.
Coverage of cervical cancer screening appears to be
improving steadily. This indicator requires careful interpretation,
since the policy is that each woman 30 and older
should be tested once every 10 years. When considered
annually this indicator should thus be multiplied by 10 to
assess the real coverage in terms of the policy. The DHIS
value of 3.7 for 2006 (Table 31) therefore exceeds the target
of 20% given for 2006/07 at a national level, although
performance in some provinces still requires attention [DoH
Stratplan 2006-09].
Although there is known to be an association of invasive
cervical cancer with AIDS, incidence does not appear to be
increasing with the age-standardised incidence rate (ASIR)
per 100 000 population reported as 27.8, 29.0, 34.4 and
28.7 for 1996-1999 [Cancer incidence 1998].
Recommendations by the Risk Equalisation Technical Advisory Panel to
the Council for Medical Schemes. Methodology for the Determination of
the Risk Equalisation Fund Contribution Table 2007. April 2007.
Figure 20: Prevalence per 1 000 population of hypertension, hyperlipidaemia, asthma and diabetes mellitus (type 2)
for the total population (2003) and private sector (2007)
Hypertension
Male total population 2003 Female total population 2003
Per 1 000
450
400
350
300
250
200
150
100
50
0
15-24 25-34 35-44 45-54 55-64 65+
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Age group
Male private sector 2007
Female private sector 2007
271