Abstract:
Background: Many low- and middle-income countries are experiencing an epidemiological transition from
communicable to non-communicable diseases. This has negative consequences for their human capital
development, and imposes a growing economic burden on their societies. While the prevalence of such diseases
varies with socioeconomic status, the inequalities can be exacerbated by adopted lifestyles of individuals. Evidence
suggests that lifestyle factors may explain the income-related inequality in self-reported health. Self-reported health
is a subjective evaluation of people’s general health status rather than an objective measure of lifestyle-related illhealth.
Method: The objective of this paper is to expand the literature by examining the contribution of smoking and
alcohol consumption to health inequalities, incorporating more objective measures of health, that are directly
associated with these lifestyle practices. We used the National Income Dynamic Study panel data for South Africa.
The corrected concentration index is used to measure inequalities in health outcomes. We use a decomposition
technique to identify the contribution of smoking and alcohol use to inequalities in health.
Results: We find significant smoking-related and income-related inequalities in both self-reported and lifestylerelated
ill-health. The results suggest that smoking and alcohol use contribute positively to income-related
inequality in health. Smoking participation accounts for up to 7.35% of all measured inequality in health and 3.11%
of the inequality in self-reported health. The estimates are generally higher for all measured inequality in health (up
to 14.67%) when smoking duration is considered. Alcohol consumption accounts for 27.83% of all measured
inequality in health and 3.63% of the inequality in self-reported health.
Conclusion: This study provides evidence that inequalities in both self-reported and lifestyle-related ill-health are
highly prevalent within smokers and the poor. These inequalities need to be explicitly addressed in future
programme planning to reduce health inequalities in South Africa. We suggest that policies that can influence poor
individuals to reduce tobacco consumption and harmful alcohol use will improve their health and reduce health
inequalities.
