Laura Rossouw

Bio: Laura Rossouw is an academic researcher from University of the Witwatersrand. The author has contributed to research in topics: Public health & Health equity. The author has an hindex of 5, co-authored 17 publications receiving 87 citations. Previous affiliations of Laura Rossouw include University of Cape Town & Stellenbosch University.

Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries.

Abstract: Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.

An international analysis of the price and affordability of beer.

Abstract: Aims To apply methods for measuring the affordability of beer in a large cross section of countries, and to investigate trends in affordability of beer over time. Methods We use the Relative Income Price (RIP), which uses per capita GDP, to measure the affordability of beer in up to 92 countries from 1990 to 2016 (69 countries were included in 1990, however the survey has since grown to include 92 countries). In addition to affordability, we also investigate trends in the price of beer. Results While beer is, on average, similarly priced in high-income (HICs) and low- and middle-income countries (LMICs), it is significantly more affordable in HICs. There is significant variation in both price and affordability in HICs and in LMICs. Beer has become cheaper in real terms in 49% (18/37) of HICs and 43% (20/46) of LMICs. Beer became more affordable in most HICs (RIP: 30/37 or 81%) and LMICs (RIP: 42/44 or 95%) Conclusions The increased affordability over time of beer in most countries raises concerns about public health. Governments need to increase taxes on beer so that it becomes less affordable over time, in an effort to improve public health.

Poor Health Reporting? Using Anchoring Vignettes to Uncover Health Disparities by Wealth and Race

Abstract: In spite of the wide disparities in wealth and in objective health measures like mortality, observed inequality by wealth in self-reported health appears to be nearly nonexistent in low- to middle-income settings. To determine the extent to which this is driven by reporting tendencies, we use anchoring vignettes to test and correct for reporting heterogeneity in health among elderly South Africans. Significant reporting differences across wealth groups are detected. Poorer individuals rate the same health state description more positively than richer individuals. Only after we correct for these differences does a significant and substantial health disadvantage of the poor emerge. We also find that health inequality and reporting heterogeneity are confounded by race. Within race groups—especially among black Africans and to a lesser degree among whites—heterogeneous reporting leads to an underestimation of health inequalities between richest and poorest. More surprisingly, we also show that the correction may go in the opposite direction: the apparent black African (vs. white) health disadvantage within the top wealth quintile almost disappears after we correct for reporting tendencies. Such large shifts and even reversals of health gradients have not been documented in previous studies on reporting bias in health inequalities. The evidence for South Africa, with its history of racial segregation and socioeconomic inequality, highlights that correction for reporting matters greatly when using self-reported health measures in countries with such wide disparities.

The Economic Cost of Smoking in South Africa, 2016.

Abstract: Introduction Chronic, non-communicable diseases are on the rise globally, with tobacco consumption being an important contributing risk factor. These increases result in significant economic costs due to increased healthcare costs, productive lives lost, and productive days lost due to illness. Estimates of these economic costs are scarce in low- and middle-income countries. Methods Drawing on a diverse range of data sources, direct healthcare costs and productivity losses due to illness and premature deaths were estimated using the cost-of-illness approach. The present value of lifetime earnings was used to estimate productivity losses from premature deaths. Results We estimate that 25 708 deaths among persons aged 35-74 in 2016 are smoking-attributable. The economic cost of smoking was R42 billion (US$2.88 billion) of which R14.48 billion was for healthcare costs (hospitalization and outpatient department visits). The economic cost of smoking amounted to 0.97% of the South African GDP in 2016, while the healthcare cost of smoking-related diseases was 4.1% of total South African health expenditure. The costs are lower for women because of their lower smoking prevalence. Conclusion The economic burden of smoking calls for a further scaling-up of tobacco-control interventions in South Africa. Implications This article addresses the paucity of research on the detailed economic costs of smoking in low-and middle-income countries, including South Africa. Our calculations, based on an extensive range of recent data, provide the most detailed estimate to date, and include quantification of the direct and indirect costs of smoking in South Africa. We found that the magnitude of the costs related to smoking in South Africa is larger than in the previous estimates, and that for every Rand received in the form of cigarette tax, society loses 3.43 Rands. This article provides an economic case for evidence-based tobacco-control in South Africa.

The fertility transition in South Africa: A retrospective panel data analysis.

Abstract: Since 1960 South Africa has seen a steep fall in fertility levels and currently its total fertility rate is the lowest on the African continent. Given the high prevailing levels of fertility in African countries, a better understanding of the factors behind the fertility transition will be valuable not only for South Africa, but also more widely for other African countries. This paper uses the National Income Dynamics Study data to construct a retrospective panel to investigate reasons for the decline in fertility. The analysis attributes a large share of the observed fertility decline across birth cohorts to improvements in education levels and the lower prevalence of marriage. However, a considerable segment of the transition is ascribed to unobservables. These may include HIV/AIDS, the increased use of contraceptives and changes in both intra-household relationships and the social role of women.

Reducing social inequalities in cancer: evidence and priorities for research

Abstract: This volume summarizes the current scientific evidence and identifies research priorities needed to decrease social inequalities in cancer. The publication, based on the expert knowledge of more than 70 international scientists from multiple disciplines, undertakes a populations-within-populations approach, highlighting the large variations in cancer incidence, survival, and mortality that exist between countries and, within countries, between social groups. Several factors may lead individuals with low social status to adopt unhealthy behaviors, to be exposed to a wider range and a higher intensity of cancer risk factors, and to have reduced access to health-care services, compared with their fellow citizens. A special focus is given to how the phenomenon of inequalities in cancer evolves and is reshaped over time, driven by economic, social, political, legislative, and technological forces; it affects everyone, but the most disadvantaged individuals are particularly hard hit. This IARC Scientific Publication was developed to serve as a reference for policy-makers and public health officials, linking to specific examples of interventions that may reduce future inequalities in cancer.

Access to health care in post-apartheid South Africa: availability, affordability, acceptability.

Abstract: We use a reliable, intuitive and simple set of indicators to capture three dimensions of access - availability, affordability and acceptability. Data are from South Africa's 2009 and 2010 General Household Surveys (n=190,164). Affordability constraints were faced by 23% and are more concentrated amongst the poorest. However, 73% of affordability constraints are due to travel costs which are aligned with findings of the availability constraints dimension. Availability constraints, involving distances and transport costs, particularly in underdeveloped rural areas, and inconvenient opening times, were faced by 27%. Acceptability constraints were noted by only 10%. We approximate acceptability with an indicator measuring the share of community members bypassing the closest health care facility, as we argue that reported health care provider choice is more reliable than stated preferences. However, the indicator assumes a choice of available and affordable providers, which may often not be an accurate assumption in rural areas. We recommend further work on the measurement of acceptability in household surveys, especially considering this dimension's importance for health reform.