In stark contrast to global trends, life expectancy in SA was worse in 2023 than two decades earlier, as a rising tide of non-communicable diseases (NCDs) undermined the country’s gains against HIV/Aids.
Life expectancy in SA fell to 66.55 years in 2023 compared with 67.73 in 1990, according to The Lancet’s Global Burden of Disease study, launched on Sunday at the World Health Summit in Berlin. Global life expectancy increased by almost 10 years over this period, rising from 64.64 years in 1990 to 73.84 in 2023.
“SA’s health trajectory has been uniquely shaped by the catastrophic HIV epidemic that pushed life expectancy down from [almost] 70 years in 1990 to about 55 years by 2007,” said study principal collaborator Charles Wiysonge, extraordinary professor of global health at Stellenbosch University.
“The remarkable recovery since then is one of the great success stories of modern public health, but this recovery is now held back by the relentless rise of NCDs. These results show progress is possible, but it is neither guaranteed nor permanent,” he said.
“The challenge is to sustain the infectious disease gains while tackling the growing NCD epidemic, a double burden that demands prevention, early diagnosis and equitable health system responses,” Wiysonge said.
The key contributors to SA’s reduced death toll from infectious diseases were the government’s programmes to prevent and treat HIV/Aids, and the national childhood immunisation programme, he said.
Shift in SA’s top killers
The leading cause of death in SA in 2023 was HIV/Aids, followed by stroke and diabetes.
The triad reflects a distinct change from the 2016 Global Burden of Disease study, which found the top three causes of death in SA were HIV, lower respiratory tract infections and road traffic accidents. NCDs did not feature.
The study found NCDs now account for nearly two-thirds of the world’s death and illness, led by heart disease, stroke and diabetes. Nearly half of all death and disability could be prevented by modifying risk factors such as reducing obesity and high blood sugar, it found.
Key Points
- Life expectancy in SA dropped to 66.55 years in 2023, lower than in 1990.
- Global life expectancy rose nearly 10 years over the same period.
- HIV/Aids remains SA’s top cause of death, followed by stroke and diabetes.
- Non-communicable diseases now drive most illness and death in SA.
“The rapid growth in the world’s ageing population and evolving risk factors have ushered in a new era of global health challenges,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation, which co-ordinated the study.
A network of 16,500 scientists and researchers contributed to the work.
Globally, causes of death are shifting from infectious diseases to NCDs, the report said.
The top three risk factors contributing to disability-adjusted life years in 2023 were high blood pressure (8.36%), air pollution (8.16%) and smoking (5.78%).
Disability-adjusted life years measure the overall burden of disease by combining the years of life lost to premature death with the years lived with illness or disability.
In SA the impact of both HIV and NCDs loomed large. The top three risk factors contributing to disability-adjusted life years in 2023 were unsafe sex (20%), obesity (6%) and high blood sugar (5.8%).
• Disclaimer: Kahn’s trip to the World Health Summit was sponsored by Vital Strategies
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