Comparative Analysis of the Social Determinants and Health in Bulgaria and the Republic of South Africa: Less or More Similarities and Contrasts?

Abstract

Abstract Aim. The aim of this review is to compare selected social determinants and population health indicators between Bulgaria and the Republic of South Africa (RSA), with a focus on how economic conditions, education, gender equity, and health system access influence health outcomes in both countries with differing historical and structural contexts. Methodology. A document-based comparative review was conducted using data from 2014 to 2024 drawn from international databases, national statistics, and peer-reviewed sources. Indicators were selected according to the Social Determinants of Health framework of the World Health Organization (WHO). The analysis was descriptive, focusing on several key domains (economy, education, gender equality, healthcare access) and significant health outcomes. Results. Bulgaria demonstrates lower maternal and infant mortality rates, higher life expectancy, and more stable healthcare access, although regional inequalities and minority exclusion remain a challenge. The RSA demonstrates more gender-diverse political representation and broader policy commitment to universal healthcare, but faces greater burdens from communicable diseases, high youth unemployment, and persistent poverty. In both countries, rural populations and vulnerable groups continue to experience significant barriers to health equity. Conclusions. Bulgaria and the RSA exhibit different health profiles shaped by social, economic, and historical factors. Reducing health inequalities in both settings will require sustained, context-sensitive, and multisectoral policy interventions.