not-yet-known not-yet-known not-yet-known unknown Objectives: This review aims to investigate whether good medication adherence in adults with chronic conditions is associated with a lower mortality risk compared to poor adherence within published literature, and the extent to which this relationship is represented within policy and legislation. Methods: Systematic search of three electronic databases: PubMed, MEDLINE (Ovid), and Scopus, from February to March 2024. South African health legislation and professional guidelines were sourced using search terms aligned with the systematic review strategy and systematically analysed. Results: Twenty-six articles were included in the systematic review. Only 1 of the 17 effect measures reported for good adherence was >1. All 44 effect measures reported for intermediate, poor and non-adherence categories were >1. Pooled estimates for poor adherence and non-adherence had the highest HRs (1.63 and 2.77, respectively). The document review showed a dominance of mortality-related terms (1.323 and 2.98 matches per 1000 words for “mortality” and “death”, respectively) compared to adherence-related terms (0.053 – 2.98 matches per 1000 words). Co-occurrence between medication adherence-related search terms (MARS, adherence, medication adherence, adhere, non-adherence and medication compliance) and mortality-related search terms (death, mortality and survival) was low within all documents analysed. Conclusion: The systematic review demonstrates a clear relationship between good adherence to chronic medication and a lower mortality risk. However, the review of legislative and policy documents suggests that government efforts are focused primarily on surveillance, rather than strategy or preventative measures. This strong evidence should motivate incorporating adherence-based risk assessments into clinical and legal frameworks.