Non-communicable diseases and economic outcomes in South Africa: a cohort study for the period of 2008-2018

Master Thesis


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Background: The total number of people living with non-communicable diseases in South Africa currently is unknown even though non-communicable diseases (NCDs) was accountable for 60% of the top ten causes of death in South Africa for the year 2015. In 2016, according to Stats SA, noncommunicable diseases were accountable for 57.4% of all deaths in South Africa. In 2011 they were accountable for 23% of years of life lost and 33% of disability adjusted life years. Government total expenditure is also unknown but it is estimated at more than one billion rands per annum for low to middle income countries such as South Africa. NCDs negatively impact the labour market by decreasing labour productivity, increasing employee turnover and early retraction from the labour market. This further decreases individual and household income especially for the urban poor who carry the heaviest non-communicable disease burden in South Africa and contributes to the medical poverty trap as well as, worsening income inequality in South Africa. Objective: This dissertation investigates the association between non-communicable diseases and labour market participation (LFP) and the effect it has on household income (HHI). Methods: Using the longitudinal data from the National Income Dynamics Study (NIDS) with information on labour force participation, household income and diseases such as high blood pressure, diabetes, cancer, chronic lung disease, heart problems, stroke, arthritis; were used for analysis. The analysis used the 2008 (wave1), 2012 (wave 3) and 2016 (wave 5) data sets from the NIDS. The analysis is restricted to the population aged 18 years to 65years. The Study examines these associations using logistic and linear regression models for NCDs exposed households and non NCDs exposed households, comparing the two for differences and the effect observed on labour force participation and household Income. The control variables include location, age, race, gender, marital status and level of education. The NCDs are treated as exposure variables with labour Force Participation (LFP) and House Hold Income (HHI) being outcome variables. The study is guided by a conceptual framework that views the household as a unitary function. Lastly, the Policy Brief summarises the issues at hand, the findings and concludes with policy recommendations. Results: LFP: Based on the regression results, as a group NCDs show a negative relationship with labour force participation as a non-significant decrease but individually it depends on the type of NCD an individual is exposed to. Cancer, stroke and heart attacks are negatively associated with labour force participation. Asthma, diabetes and hypertension are positively associated with labour force participation. When an individual suffers from one NCD the relationship/association depends on the type of NCD, If and when an individual is burdened by a second or third NCD (Co-morbidities) the relationship with LFP tends to be positive (an increase in LFP). HHI: Counterintuitively as a group NCDs is associated positively with household income; a significant increase of 15% at 5 % level of significance. However, individually, hypertension, cancer, asthma, heart problems and stroke have a negative relationship (a decrease) with household income except Diabetes. Objectively there is insufficient evidence to conclude that NCDs decrease household income via decreasing labour force participation indirectly contributing to poverty in South Africa, as majority of household income comes from wages and remittances. Individually almost all NCDs (with Cancer and Hypertension having significant results) decrease household income but as a group increase household income. This requires further investigation into the NCD burdened household dynamics in South Africa. Conclusion: Therefore, as recommended by the WHO; individual specific interventions will be more effective than population-based interventions to alleviate the ripple effects of the non-communicable disease burden in low to middle income countries (LMIC). Universal Health Care and up scaled prioritisation at Primary Health Care level is needed as NCDs accounted for half the global burden of disease but only received 2% of international donations compared to human immune-deficiency virus (HIV/AIDS) that accounted for 4% of the global burden of disease receiving 29% of international donations and grants.