Mortality inequality by municipal income levels: trends in post-apartheid South Africa

Post-apartheid South Africa has placed much focus on reducing inherited disparities in health. In this paper, we use the 2001 and 2011 national Censuses in combination with the 2007 Community Survey to examine whether South Africa, in an era characterized by the rise and fall of the communicable diseases HIV/AIDS and TB, succeeded in redistributing health. In assessing changes in mortality inequality, we rank municipalities by their adult-equivalent per capita income. After splitting these ranked municipalities in groups of equal size, age- and sex specific mortality rates are calculated for each municipality group. Using various health inequality measures, our finding imply that between 2001 and 2011, mortality and absolute mortality inequality increased until 2006, and declined afterwards. Relative mortality inequality, on the other hand, remained mostly stable over the 2001-2011 period. The analysis of age-specific mortality rates shows that for adults aged 18 years and older, mortality and absolute inequality increased substantially between 2001 and 2006, followed by a decrease in the period thereafter. Moreover, we reveal that for the population aged 0-5 and 19-39 year, relative inequality increased between 2006 and 2011. Thus, our results suggest that South Africa's dedication to tackle health disparities has had mixed successes.