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The remnants of the colonial and apartheid era are evident in the South African health system’s persistently higher levels of injury, mental health problems, disease and mortality amongst the poor and marginalized—mediated through a wide range of social determinants including environmental health factors such as hygiene, access to clean water, clean air and adequate sanitation, violent crime and trauma, occupational risk, alcohol abuse and tobacco dependence. Due to such structural factors, children of poor parents have lower levels of cognitive development, are more likely to be stunted and a greater share die young. The legacy also persists via severe inequalities in the resourcing of health providers across districts and provinces and also between the public and private sector. Additionally, there is evidence of inefficient resource allocation and inefficient use of resources in both sectors, which further diminishes the health sector’s ability to meet the needs of its population.

Keywords: health inequality, social determinants, TB, HIV, child health, maternal health, mental health

Reference: Burger, R & Ngwenya, M. 2021. The Economics of Health in South Africa.  In The Oxford Handbook of the South African Economy. Oqubay, A., Tregenna, F. & Valodia, I. (eds). Oxford: Oxford University Press, November 2021