Population health in South Africa: dynamics over the past two decades.

South Africa has experienced a rapid and complex health transition over the past two decades. Mortality has worsened in virtually all age groups, driven largely by HIV and AIDS. The morbidity profile comprises coexisting infectious and non-communicable diseases--including new infections such as HIV and AIDS, and emerging conditions such as vascular illness and diabetes--together with persisting child diarrhea and malnutrition, and high levels of interpersonal violence and accidents. Risk factors for cardiovascular disease are high even in rural parts of the country, with high levels of obesity rendering women at greater risk for metabolic disease. Reducing the negative impacts of the health transition will require targeted efforts within the health and social sectors, as well as broader development initiatives. Government should provide strong leadership, and priorities for action must be underpinned by a robust evidence base.