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Cape Town Mortality, 2001 Part II Final, Nov 2003

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Cape Town Mortality, 2001 Part II Final, Nov 2003 Cape Town Mortality, 2001 Part II An equity lens – lessons and challenges Vera Scott, David Sanders, Gavin Reagon Equity Gauge Project, University of Western Cape Pam Groenewald, Debbie Bradshaw, Beatrice Nojilana Burden of Disease Research Unit, Medical Research Council Hassan Mahomed, Johan Daniels Cape Metropole Health Information group CITY OF CAPE TOWN ISIXEKO SASEKAPA STAD KAAPSTAD University of the School of Burden of Disease Western Cape Public Health Research Unit November 2003 Copyright information: Copyright 2003, South African Medical Research Council. All materials in the report may be reproduced or copied without permission, citation as to source, is appreciated. ISBN: 1-919809-97-X 1-919809-96-1 Suggested citation: Scott V, Sanders D, Reagon G, Groenewald P, Bradshaw D, Nojilana B, Mahomed H, Daniels J. Cape Town Mortality, 2001, Part II, An equity lens – lessons and challenges. Cape Town: City of Cape Town, South African Medical Research Council, University of Cape Town, University of Western Cape. Copies of the report can be downloaded from: www.mrc.ac.za/bod/bod.htm Acknowledgements We would like to thank the Cape Town Health Information group and their data coders for providing the mortality data for this study. We would also like to acknowledge the invaluable input from Equity Gauge, University of the Western Cape. Last but not least, we would like to thank Elize de Kock for the typing and layout of the document. Contents Introduction............................................................................................................................................1 Mortality and premature mortality.........................................................................................................2 Pre-transitional causes of mortality (Group I) .......................................................................................4 HIV/AIDS ..............................................................................................................................................5 Tuberculosis...........................................................................................................................................6 Non-communicable causes of mortality (Group II)...............................................................................7 Injury causes of mortality (Group III)....................................................................................................8 Gender and age.....................................................................................................................................10 What are the implications for equity? ..................................................................................................13 References............................................................................................................................................17 List of Tables Table 1. Comparison of age standardized rates between males and females for selected causes, Cape Town 2001........................................................................................................11 List of Figures Figure 1: Age standardized mortality rates (per 100 000) in the sub-districts of Cape Town, 2001....2 Figure 2: Premature mortality (Years of Life Lost per 100 000) in the sub-districts of Cape Town, 2001........................................................................................................................................3 Figure 3: Age standardized death rates (per 100 000) persons due to pre-transitional (Group 1) causes including HIV in the sub-districts of Cape Town, 2001 ...........................................5 Figure 4: Age standardized death rates due to HIV/AIDS (per 100 000) persons in the sub-districts of Cape Town, 2001..............................................................................................................6 Figure 5: Age standardized death rates due to tuberculosis (per 100 000) persons in the sub-districts of Cape Town, 2001..............................................................................................................7 Figure 6: Age standardized death rates due to non-communicable diseases (per 100 000) persons in the sub-districts of Cape Town, 2001 ...................................................................................8 Figure 7: Age standardized death rates due to injuries (per 100 000) persons in the sub-districts of Cape Town, 2001 ..................................................................................................................9 Figure 8: Age standardized death rates due to homicide for persons in the sub-districts of Cape Town, 2001 ..................................................................................................................9 Figure 9: Age standardized death rates due to road traffic accidents for persons in the sub-districts of Cape Town, 2001............................................................................................................10 Figure 10: Age specific death rates due to homicide for males and females in the sub-districts of Cape Town, 2001 ................................................................................................................12 Figure 11: Age specific death rates due to HIV males and females in the sub-districts of Cape Town, 2001 ........................................................................................................................13 Introduction There is a growing commitment by both the Provincial and Municipal Government structures to review explicitly the equity of service delivery. In the opening address of the Provincial Parliament, Premier Martinus van Schalkwyk, stressed that the year would be one of implementation and service delivery (van Schalkwyk, 2003) and spoke of the challenge to reduce poverty and inequality. At a meeting of the City Council in December 2002, the Council set as one of its objectives: to introduce and maintain a system of equitable services. In the Mayoral Budget speech (Mfeketo, 2003) on the 28 May 2003 Mayor Mfeketo said: “Given the vast inequities that still exist in our City we have made it a specific objective to bring access to the benefits of urban life to all people in our City”. The Provincial and the City Health Departments have both demonstrated their commitment to equitable service delivery by participating in a partnership - the Cape Town Equity Gauge Project - together with the School of Public Health, University of the Western Cape. The Equity Gauge Project aims to make visible the issue of health inequity through the development of an equity gauge- a monitoring tool - and to use this to advocate for more equity-based policies and budgets. Through a consultative process with health sub-district managers equity has been defined as a concept of social justice. Equity is fairness, not equality (Whitehead, 1992). Sub-districts with greatest needs should have greater service provision than those with less need. In Cape Town the assessment of need has been derived from three types of data: socioeconomic indicators known to impact greatly on health, demography and health status. Morbidity and mortality data measure the latter. Internationally, mortality data have become the cornerstone of burden of disease studies. The mortality data analysed by the Medical Research Council (Groenewald P et al, 2003) allow us firstly, to investigate inequities in the burden of disease and secondly, to discuss the resource allocation implications that this has. Our questions are: · Do geographical inequities exist in the burden of disease across the 11 health sub districts of Cape Town? 1 · Do inequities exist in the burden of disease between women and men? · Are inequities in the burden of disease relatively more pronounced in particular age groups? · If inequities do exist, then what policy and resource allocation implications does this have for Cape Town and health subdistrict managers? Mortality and premature mortality Total mortality varies across Cape Town. While mortality is greatest in Nyanga and Khayelitsha, premature mortality is disproportionately higher in these two sub- districts. Premature mortality, calculated using Years of Life Lost (YLL), is of particular interest to public health managers who work to avoid premature and preventable mortality. It can be seen from figures 1 and 2 that the premature mortality rates (YLLs per 100000 population) do not correspond exactly to mortality rates and some of the differences between districts are highlighted. For example, while mortality is seen to be the greatest in Nyanga and Khayelitsha, premature mortality is disproportionately higher in these two sub-districts. The crude premature mortality rates experienced by Nyanga (19 619) and Khayelitsha (18 932) are approximately 1.5 times higher than in Cape Town overall (12 140). 1400.0 1200.0 1000.0 800.0 600.0 Deaths per 100 000 400.0 200.0 0.0 Central Athlone Nyanga West South Peninsula Tygerberg Helderberg Cape Town Blaauwberg Khayelitsha Oostenberg Mitchells Plain Tygerberg East Figure 1: Age standardized mortality rates (per 100 000) in the sub-districts of Cape Town, 2001 2 20000 15000 10000 YLL per 100 000 5000 0 Central Athlone Nyanga Tyg East Tyg West Helderberg Mitchells P Cape Town Khayelitsha Oostenberg Blaauwberg South Peninsula Group I excluding HIV HIV Group II Group III Figure 2: Premature mortality (Years of Life Lost per 100 000) in the sub-districts of Cape Town, 2001 To understand the causes
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