Health-related inequalities in life satisfaction in South Africa: a decomposition analysis

Abstract

While health-related inequalities in subjective well-being have been explored using cross sectional data in developed countries, it has not been well explored within a developing country context. This research paper investigates health-related inequalities in life satisfaction as well as its change over time in South Africa from 2009 to 2017. Evidence from two waves of the National Income Dynamics Survey revealed that health-related inequalities exist in self-reported life satisfaction and that the overall contribution of health-related inequalities had increased inequality in life satisfaction over the period 2009-2017 in South Africa. Decomposing the health-related inequalities related to life satisfaction provided insights on factors that are associated with health-related inequalities in life satisfaction and provides scope for targeted policy implementation aimed at reducing inequalities in life satisfaction in South Africa. Oaxaca-type decomposition is used to analyse the change in contribution of various health and socio-demographic factors in reducing inequalities in life satisfaction The results of the analysis found that health-related inequalities exist in self-reported life satisfaction and that the overall contribution of health-related inequalities had a slight widening of inequality of life satisfaction over the period 2009-2017 in South Africa. In particular, notable positive concentration indices in waves I and V were excellent health, ages 15-24, males, and quintile 5 total income groups. The notable negative concentration indices in waves I and V were ages45-64, females, Africans and inactive employment status factors. The indication is that there is greater life satisfaction among individuals with a lower probability of having poor, fair and good self-reported health status responses in both waves I and V. The concentration curves and indices further indicated that life satisfaction was concentrated more highly on individuals with a higher probability of having an excellent self-reported health status also in both waves I and V. Results from wave I, saw that notable positive absolute contributions to decreasing inequality in life satisfaction were excellent health status, African race group, employed employment status and the quintile 1 total income group. The most notable negative absolute contribution in wave I was the male factor. Wave V had the only notable positive contribution in the form of excellent health status, while small negative contributions were from individuals aged 25-44 and the African race group possibly explained by a widening inequality in life satisfaction over the period due to poor policy implementation in reducing inequality that is racially divided because of South Africa’s racially segregated history prior to the country becoming a democracy close to thirty years ago. The decomposition of changes in excellent self-reported health status and inactive employment status indicated a contribution towards the reduction of inequality in life satisfaction. Changes to individuals aged 15-24 and 25-44 years old, individuals classified as African, and quintile 1 total income had contributions towards increased inequality in life satisfaction