Government has noted the findings of the research into issues of
mortality in South Africa. The research was requested by Cabinet to
help clarify trends and programmatic challenges in respect of
various causes of death.
It is highly appreciated by Cabinet that various institutions co-operated to produce this report, and the Team has been urged to continue with such joint work to disaggregate the data and identify any steps that may need to be taken in the policy sphere.
Main Findings
It should be noted that the research was based on a survey of registered deaths and that the statistics are derived from death certificates recorded by medical practitioners or other such appropriate authorities.
As Statistics South Africa has indicated, the research points to the following basic facts, aspects of a triple burden of disease and death: infectious diseases; unnatural causes; and for older people non-communicable diseases of lifestyle:
* The five leading underlying causes of death among South Africans are unnatural causes, ill-defined causes, TB, HIV and influenza/ pneumonia.
* While infectious diseases have grown in prominence as causes of death, unnatural causes such as injuries, motor accidents, suicide and drowning still constitute the highest underlying causes of death among young males.
* There has been a shift in mortality patterns over the period under review, with HIV per se, TB and pneumonia emerging as major underlying causes of death. This emerging pattern is most pronounced among the age cohort of 15 to 49 years of age.
* Females are more likely to be certified as having died from HIV, influenza and pneumonia, while there is a high prevalence of unspecified unnatural causes and TB among males.
Assessment of Elements of the Data
The fact that these statistics are derived from death certificates brings two critical issues.
Firstly, clinical appearance rather than actual tests may influence a practitioner's decision on the recording of death.
Yet, on the other hand, there are many factors, which may result in the under-reporting of HIV related deaths. These include the fact that while the diagnosed illness may be TB or pneumonia/influenza, fatality may be the result of a compromised immune system as a result of HIV. Further, practitioners' consideration of insurance and other implications, especially among breadwinners, may result in avoidance of the HIV notification.
As such, deaths due to HIV would, on balance, be larger than indicated in these statistics.
Critical Challenges
One of the major challenges arising from this research is the need to gather more information on the so-called unspecified unnatural causes. This will require collaboration between the Task Team and agencies such as the Police who also record data such as these. Further, consideration will need to be given to revising the 1992 Births and Deaths Registration Act to ensure greater accuracy in recording information on causes of death.
One of the challenges we face is improving the accuracy of data, including data on the influence of HIV on other infectious diseases such as TB. We believe that we need to continue the public dialogue around the merits and demerits of making HIV notifiable. This arises in relation to the management of the epidemic as well as the accuracy of data. Yet this would have to be addressed in tandem with such critical factors as societal attitudes and stigma, as well as implications for bereaved families in the case of breadwinners passing away.
While the recorded incidence of death due to HIV and related diseases is higher among females, it should be emphasised that a combination of many factors including probability of having undergone a test, trends in recording causes on the part of medical practitioners, gender power relations in our society and physiology may account for this. As such it would be patently wrong to stigmatise a section of the population. In any case, the main transmission mechanism for HIV involves both sexes.
Major Campaigns
It should be emphasised that, whatever the precise figures or differences in approximations among various research agencies, there are changes in patterns of mortality, with the triumvirate of TB, HIV and pneumonia/influenza playing a significant role.
This confirms the need among all South Africans to intensify the implementation of the country's AIDS strategy, combining awareness and change in lifestyles, systematic treatment of opportunistic infections, research into a vaccine and use of both antiretrovirals and alternative medication to reduce the impact of HIV as such. Government commits itself to this multifaceted strategy, as articulated in Cabinet statements issued on 17 April and 9 October this year. It is in that context that expenditure by Government on the Enhanced Response to HIV/AIDS, launched last year, will be stepped up by R3, 3 billion over the next three years.
It is also clear that an adequate national response to the challenge of TB is critical to the ability of our Health Service to cope with our complex burden of disease.
The findings also confirm the need to intensify campaigns around the problems of violence, alcohol abuse, road accidents and unhealthy lifestyles in our society.
This research constitutes a critical step in the efforts to shed light on the health condition and safety within our society. It is an important piece of work-in-progress.
On the basis of these findings further research work will be done, and relevant concrete proposals will be presented to Cabinet regarding the implications of these and other data for public policy, programmes and campaigns.
Government will continue to invest in the overall strengthening of our health system as the bedrock of a successful national response to these challenges - Health Department.
It is highly appreciated by Cabinet that various institutions co-operated to produce this report, and the Team has been urged to continue with such joint work to disaggregate the data and identify any steps that may need to be taken in the policy sphere.
Main Findings
It should be noted that the research was based on a survey of registered deaths and that the statistics are derived from death certificates recorded by medical practitioners or other such appropriate authorities.
As Statistics South Africa has indicated, the research points to the following basic facts, aspects of a triple burden of disease and death: infectious diseases; unnatural causes; and for older people non-communicable diseases of lifestyle:
* The five leading underlying causes of death among South Africans are unnatural causes, ill-defined causes, TB, HIV and influenza/ pneumonia.
* While infectious diseases have grown in prominence as causes of death, unnatural causes such as injuries, motor accidents, suicide and drowning still constitute the highest underlying causes of death among young males.
* There has been a shift in mortality patterns over the period under review, with HIV per se, TB and pneumonia emerging as major underlying causes of death. This emerging pattern is most pronounced among the age cohort of 15 to 49 years of age.
* Females are more likely to be certified as having died from HIV, influenza and pneumonia, while there is a high prevalence of unspecified unnatural causes and TB among males.
Assessment of Elements of the Data
The fact that these statistics are derived from death certificates brings two critical issues.
Firstly, clinical appearance rather than actual tests may influence a practitioner's decision on the recording of death.
Yet, on the other hand, there are many factors, which may result in the under-reporting of HIV related deaths. These include the fact that while the diagnosed illness may be TB or pneumonia/influenza, fatality may be the result of a compromised immune system as a result of HIV. Further, practitioners' consideration of insurance and other implications, especially among breadwinners, may result in avoidance of the HIV notification.
As such, deaths due to HIV would, on balance, be larger than indicated in these statistics.
Critical Challenges
One of the major challenges arising from this research is the need to gather more information on the so-called unspecified unnatural causes. This will require collaboration between the Task Team and agencies such as the Police who also record data such as these. Further, consideration will need to be given to revising the 1992 Births and Deaths Registration Act to ensure greater accuracy in recording information on causes of death.
One of the challenges we face is improving the accuracy of data, including data on the influence of HIV on other infectious diseases such as TB. We believe that we need to continue the public dialogue around the merits and demerits of making HIV notifiable. This arises in relation to the management of the epidemic as well as the accuracy of data. Yet this would have to be addressed in tandem with such critical factors as societal attitudes and stigma, as well as implications for bereaved families in the case of breadwinners passing away.
While the recorded incidence of death due to HIV and related diseases is higher among females, it should be emphasised that a combination of many factors including probability of having undergone a test, trends in recording causes on the part of medical practitioners, gender power relations in our society and physiology may account for this. As such it would be patently wrong to stigmatise a section of the population. In any case, the main transmission mechanism for HIV involves both sexes.
Major Campaigns
It should be emphasised that, whatever the precise figures or differences in approximations among various research agencies, there are changes in patterns of mortality, with the triumvirate of TB, HIV and pneumonia/influenza playing a significant role.
This confirms the need among all South Africans to intensify the implementation of the country's AIDS strategy, combining awareness and change in lifestyles, systematic treatment of opportunistic infections, research into a vaccine and use of both antiretrovirals and alternative medication to reduce the impact of HIV as such. Government commits itself to this multifaceted strategy, as articulated in Cabinet statements issued on 17 April and 9 October this year. It is in that context that expenditure by Government on the Enhanced Response to HIV/AIDS, launched last year, will be stepped up by R3, 3 billion over the next three years.
It is also clear that an adequate national response to the challenge of TB is critical to the ability of our Health Service to cope with our complex burden of disease.
The findings also confirm the need to intensify campaigns around the problems of violence, alcohol abuse, road accidents and unhealthy lifestyles in our society.
This research constitutes a critical step in the efforts to shed light on the health condition and safety within our society. It is an important piece of work-in-progress.
On the basis of these findings further research work will be done, and relevant concrete proposals will be presented to Cabinet regarding the implications of these and other data for public policy, programmes and campaigns.
Government will continue to invest in the overall strengthening of our health system as the bedrock of a successful national response to these challenges - Health Department.
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