title: The burden of non-communicable diseases in South Africa.
abstract: 15 years after its first democratic election, South Africa is in the midst of a profound health transition that is characterised by a quadruple burden of communicable, non-communicable, perinatal and maternal, and injury-related disorders. Non-communicable diseases are emerging in both rural and urban areas, most prominently in poor people living in urban settings, and are resulting in increasing pressure on acute and chronic health-care services. Major factors include demographic change leading to a rise in the proportion of people older than 60 years, despite the negative effect of HIV/AIDS on life expectancy. The burden of these diseases will probably increase as the roll-out of antiretroviral therapy takes effect and reduces mortality from HIV/AIDS. The scale of the challenge posed by the combined and growing burden of HIV/AIDS and non-communicable diseases demands an extraordinary response that South Africa is well able to provide. Concerted action is needed to strengthen the district-based primary health-care system, to integrate the care of chronic diseases and management of risk factors, to develop a national surveillance system, and to apply interventions of proven cost-effectiveness in the primary and secondary prevention of such diseases within populations and health services. We urge the launching of a national initiative to establish sites of service excellence in urban and rural settings throughout South Africa to trial, assess, and implement integrated care interventions for chronic infectious and non-communicable diseases.
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. bongani.mayosi@uct.ac.za
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Flisher
authors.forename: Umesh G
authors.initials: UG
authors.lastname: Lalloo
authors.forename: Freddy
authors.initials: F
authors.lastname: Sitas
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Tollman
authors.forename: Debbie
authors.initials: D
authors.lastname: Bradshaw
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000453:epidemiology; D006292:Health Priorities; D006301:Health Services Needs and Demand; D019456:Health Transition; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D011057:Politics; D011159:Population Surveillance; D011320:Primary Health Care; D011322:Primary Prevention; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D055502:Secondary Prevention; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology