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Social Determinants of Health Inequalities in South Africa: A Decomposition Analysis


  • Kehinde O. Omotoso

    (Department of Economics, University of Pretoria, Pretoria, South Africa)

  • Steven F. Koch

    (Department of Economics, University of Pretoria, Pretoria, South Africa)


This study uses information collected on social determinants of health (SDH) and on a variety of health indicators in the 2004 and 2014 questionnaires of the South African General Household Surveys (GHSs) to explain how changes in the SDH have impacted health inequalities over the last decade, the second since the end of Apartheid. Specifically, the Oaxaca-type decomposition of change in a concentration index is used to illustrate how changes in health inequalities over time are attributable to changes in inequality in the determinants of health, and changes in their elasticities. This study finds that rising inequalities in ill-health are largely explained by widening inequalities among those residing in the urban areas and in the relatively richer provinces. Meanwhile, rising inequality in medical aid coverage and utilisation of private health care are mainly attributable to inequalities in educational attainment and racial composition. However, changing elasticities in SDH, rather than rising inequalities, are found to be important factors in explaining inequality in the utilisation of public health care.

Suggested Citation

  • Kehinde O. Omotoso & Steven F. Koch, 2017. "Social Determinants of Health Inequalities in South Africa: A Decomposition Analysis," Working Papers 201716, University of Pretoria, Department of Economics.
  • Handle: RePEc:pre:wpaper:201716

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    References listed on IDEAS

    1. Martin Wittenberg & Murray Leibbrandt, 2017. "Measuring Inequality by Asset Indices: A General Approach with Application to South Africa," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 63(4), pages 706-730, December.
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    6. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
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