Browsing by Author "Ross, Hana"

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    Lifestyle and Income-related Inequality in Health in South Africa
    (2017) Mukong, Alfred Kechia; van Walbeek, Corné; Ross, Hana
    BACKGROUND: Many low- and middle-income countries are experiencing an epidemiological transition from communicable to non-communicable diseases. This has negative consequences for their human capital development, and imposes a growing economic burden on their societies. While the prevalence of such diseases varies with socioeconomic status, the inequalities can be exacerbated by adopted lifestyles of individuals. Evidence suggests that lifestyle factors may explain the income-related inequality in self-reported health. Self-reported health is a subjective evaluation of people's general health status rather than an objective measure of lifestyle-related ill-health. METHOD: The objective of this paper is to expand the literature by examining the contribution of smoking and alcohol consumption to health inequalities, incorporating more objective measures of health, that are directly associated with these lifestyle practices. We used the National Income Dynamic Study panel data for South Africa. The corrected concentration index is used to measure inequalities in health outcomes. We use a decomposition technique to identify the contribution of smoking and alcohol use to inequalities in health. RESULTS: We find significant smoking-related and income-related inequalities in both self-reported and lifestyle-related ill-health. The results suggest that smoking and alcohol use contribute positively to income-related inequality in health. Smoking participation accounts for up to 7.35% of all measured inequality in health and 3.11% of the inequality in self-reported health. The estimates are generally higher for all measured inequality in health (up to 14.67%) when smoking duration is considered. Alcohol consumption accounts for 27.83% of all measured inequality in health and 3.63% of the inequality in self-reported health. CONCLUSION: This study provides evidence that inequalities in both self-reported and lifestyle-related ill-health are highly prevalent within smokers and the poor. These inequalities need to be explicitly addressed in future programme planning to reduce health inequalities in South Africa. We suggest that policies that can influence poor individuals to reduce tobacco consumption and harmful alcohol use will improve their health and reduce health inequalities.
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    Price and tax measures and illicit trade in the FCTC: what we know and what research is required
    (Nicotine and Tobacco Research, ) van Walbeek, Corne; Blecher, Evan; Gilmore, Anna; Ross, Hana
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    Smoking cessation in South Africa: cigarette prices, plain packaging, and illicit trade
    (2022) Vellios, Nicole; van Walbeek, Cornelis; Ross, Hana; Guindon, Emmanuel
    The dangers of smoking are well-known and no longer contested. Despite this, many smokers struggle to quit smoking. The aim of this thesis is to investigate quitting behaviour in South Africa. In the second chapter, I investigate, using survival analysis techniques, whether cigarette prices affect smokers' decision to quit smoking. The analysis was done using nationally representative data, the National Income Dynamics Study (NIDS). Self-reported information for onset age and cessation age was used to create smoking histories from 1970 to 2017. Each smoker was followed from the time they started smoking, either until they quit, or until the last interview if they did not quit. Monthly price data, sourced from government documents, was merged with NIDS data. Various model specifications were estimated to test the robustness of the results. In the third chapter, I investigate whether the type of cigarette packaging, a matter which is currently being considered in South Africa, reduces the utility of cigarettes. Preferences were elicited using a discrete choice experiment. Data were collected in 2021 from University of Cape Town students. Both smokers and non-smokers were sampled. Intention to buy, intention to try, and perceptions of harm were investigated using conditional logit models. The attributes included packaging, price, and warnings on individual cigarettes. The design of the experiment accounted for illicit cigarettes so as to reflect current market conditions closely. The willingness to pay for cigarette packs with different attributes was also estimated using a Becker–DeGroot– Marschak auction. Since increasing excise taxes increases the demand for low-priced, untaxed cigarettes, smokers may switch to low-priced cigarettes instead of quitting. In the fourth chapter, I investigate the illicit cigarette market using gap analysis. Gap analysis is based on a comparison of consumption estimates (from survey data) with legitimate sales (as declared to the excise tax authority). The gap between self-reported consumption (scaled up to account for underreporting) and legitimate sales is an indication of the size of the illicit market. Self-reported consumption was estimated using two nationally representative surveys, NIDS and the All Media and Products Survey, allowing a long period (2002 to 2017) to be investigated. I also investigate the relationship between excise tax increases and illicit trade. The results from the second chapter indicate that price is a significant determinant of smoking cessation. A 10% increase in the price of cigarettes was estimated to result in a 5.5%−8.6% increase in smoking cessation. Females are more likely to quit than males. Respondents with higher education are more likely to quit compared to those with less education. Results from the third chapter indicate that plain packaging would be effective in reducing people's utility for cigarettes. I found that smokers reported preferring not to buy plain packs and non-smokers preferred not to try plain packs. In terms of health risk, both smokers and non-smokers perceived plain packs to be the most risky to health. My estimates from chapter 4 show that, between 2002 and 2009, the illicit cigarette market accounted for around 5% of the total market. Since 2009, the illicit cigarette market has increased sharply: by 2017 illicit trade accounted for 30%−35% of the total market. I found no evidence that excise tax increases were linked to an increase in illicit trade. When excise taxes were increasing rapidly, illicit trade was stable (2002−2009). On the other hand, when excise tax increases were relatively modest, illicit trade increased rapidly (2009−2017). The results have several policy implications. South Africa should continue to increase the price of cigarettes through excise tax increases to encourage smoking cessation. If consumers are able to buy cheaper illicit cigarettes, the impact of price increases is likely to be reduced. The South African government should therefore implement measures to reduce the illicit trade in cigarettes, as outlined by the WHO's Protocol to Eliminate Illicit Trade in Tobacco Products. The 2018 South African Control of Tobacco Products and Electronic Delivery Systems Bill, which, amongst other things, obliges tobacco manufactures to remove all branding and to include a graphic health warning, should be implemented.
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    The societal costs of methamphetamine use in Western Cape Province
    (2016) Darsamo, Arnalda Vanessa; Van Walbeek, Corne; Ross, Hana
    Methamphetamine (meth) use results in various costs accruing to the meth user, society, and government. Internal and external costs of the pandemic are widespread, affecting the healthcare and social welfare systems, policing, private security, and the judicial and corrective services system. This study quantifies these costs for the Western Cape; identifying the magnitude of the cost of illness and additional social costs by category and determines which interventions are likely to reduce these overall costs. This study used a combination of a top-down and a bottom-up approach for the costing of various categories. The meth prevalence rate used was derived from the number of primary meth users who sought meth treatment in 2013 as reported to SACENDU. Additional data on expenditure and costs were obtained from government annual reports, personal interviews and data from previous studies.
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    Tracking and Tracing Tobacco Products in Kenya
    (2017-06-06) Ross, Hana
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    Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries
    (2021-03-04) Rossouw, Laura; Ross, Hana
    Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.