Battling Cardiovascular Diseases in a Perfect Storm

Abstract

A lmost 25 years after a peaceful transition from apartheid to democracy, South Africa (SA) has a complex and dysfunctional 2-tiered healthcare sys- tem. The chronically underfunded, understaffed public system serves 84% of the population. The wealthiest 16% have access to private health care, consum- ing 58% of the gross domestic product expenditure on health.1 More than 70% of doctors in SA are employed in the private sector. Furthermore, the healthcare system has to contend with several colliding epidemics: HIV and tuberculosis; car- diovascular disease (CVD), mental health, and other noncommunicable diseases (NCDs); substance abuse and violence; and an unacceptably high mortality caused by maternal and childhood disease. Of the country’s population of 57 million, >12% are HIV infected. SA has the world’s largest antiretroviral therapy program, subsidized by the government and provided free of charge. The high HIV prev- alence drives the tuberculosis burden, which remains enormous despite improv- ing treatment outcomes. As a result of the HIV epidemic, life expectancy has not changed much over the past 25 years, with the 2018 life expectancy being 67.3 years for women and 61.1 years for men.2 Between 2002 and 2006, there was a drop in life expectancy. CVD is the leading cause of death after HIV/AIDS.2