The sobering festive season road accident figures released by the Transport Minister were a stark reminder that for many, our festive season is anything but. Road accidents are but one of the December/January heightened mortality risks including:

• Higher alcohol consumption: Festive drinking leads to a spike in accidents, health emergencies, and violence as South Africans spend on average 30% more on liquor in the month of December compared to other months.
• Stress-related health issues: Conditions like heart attacks rise due to overindulgence in food and alcohol, along with increased stress.
• Increased road hazards: Drivers face as much as a 60% higher risk of fatal accidents during December compared to other months. This festive season was particularly bad, witnessing 1,502 fatal crashes, with pedestrian fatalities accounting for 41% of deaths.

Eighty20 Consulting, a consumer insights and data science company has looked more broadly at causes of death in South Africa, and how accidents and other external causes contribute to South Africa’s mortality rate.

Main causes of death in South Africa (2020)

The main reported causes of death in South Africa are:

• Diseases of the circulatory system (blocked arteries, stroke) – 18% of all deaths
• Not classified – 16.5%
• Infectious diseases (including Covid-19, malaria) – 13.5%
• External causes (murder, accidents) – 9.6%
• Respiratory diseases (tuberculosis, pneumonia) – 8.8%

With a considerable proportion of causes not classified, death rates in South Africa suffer from data quality issues. This is typically due to delayed registrations, incomplete records, and misclassification of causes (75% of non-natural causes of death are not adequately classified).

❝ 75% of non-natural causes of death are not adequately classified

In addition, the complexity of death certificates listing up to six factors can obscure accurate reporting. For example, a death certificate could list traumatic brain injury as the immediate cause, a motor vehicle collision as the underlying cause and alcohol intoxication as a contributing factor. Mortality and causes of death tables are not updated every year.  For this article we have used the latest data, which is 2020.

Three main categories

• Roughly, half a million South Africans die in any given year, with the major causes falling into three categories: non-communicable diseases, communicable diseases and injuries.
• South Africa has followed a global trend of shifting death rates from communicable, or infectious diseases like malaria, tuberculosis or Covid-19 to non-communicable diseases, such as heart disease, diabetes, and cancer.  Since 2009, the latter, also referred to as ‘lifestyle’ diseases, have become more prevalent and now account for nearly 60% of all deaths in South Africa.
• The one recent exception being Covid-19 which temporarily emerged as the second leading cause of death globally in 2021, and first leading cause in South Africa.

Non-communicable causes of death

This main cause of death clusters the various underlying causes into broad groups, and in South Africa, the leading cause of death in 2020, after COVID-19, was diabetes, surpassing tuberculosis, which previously held the top spot. Over the decade from 2008 to 2018, deaths due to diabetes increased by 36.5%. The International Diabetes Federation predicts that by 2030, 5.4 million South Africans will be living with the disease. This rise is attributed to factors such as urbanization, sedentary lifestyles, unhealthy diets, and increasing obesity rates.

Communicable causes of death

For this category the big killers after Covid in 2020, were influenza & pneumonia, tuberculosis, and HIV, killing nearly 20,000 people each and together accounting for 12% of all deaths. However, for people who are HIV+, the cause of death could be recorded as any of these.

Since the implementation of universal ARV therapy in 2004, life expectancy in South Africa has significantly increased. From 2006 to 2017 (see chart), life expectancy rose from 54 to over 65 years. This improvement is largely due to the reduction in AIDS-related deaths.

Non-natural causes of death

Non-natural deaths, including accidents, assaults, and self-harm, have risen significantly, especially among young males. In 2019, 45% of male deaths in the 20-24 age group were from non-natural causes. With the proportion of deaths due to non-natural causes increasing from 8.7% in 2009 to 12.4% in 2019.

Road transport deaths

Road traffic injuries remain a top cause of death, particularly among young people. South Africa effectively experiences 33 road fatalities per day, with a cost to the economy estimated at R43 billion in 2018. The country also faces high levels of driving under the influence, with offenses increasing by 22% from 2020/21 to 2021/22 with a post-pandemic increase in driving. With an estimated 95% of crashes due to transport violations, Transport Minister Barbara Creecy correctly states: “The number of people who died on our roads this festive season has increased because people continued to behave badly.”

Rising life expectancy in South Africa

When looking at mortality, however it isn’t all bad news. The life expectancy at birth in South Africa has shifted significantly over the past two decades. It dropped to a low of just under 55 years in 2005, from 63.37 years in 1990. However, since 2005, the median age of death has steadily increased, reaching 66.3 years by 2024, albeit with a major dip during Covid.

• 

 

1. “Life expectancy in South Africa has been increasing due to several key factors: Improved Healthcare: particularly better access to anti-retroviral medicine; a reduction in Infectious Diseases, particularly tuberculosis and malaria; and economic growth leading to better living conditions and access to healthcare.  Government has implemented successful public health campaigns focusing on vaccination, maternal health and nutrition.” Concludes Eighty20.

---