Inequality is at the core of the health care challenges South Africans continue to face, said Dr Judy Dlamini, Chancellor of the University of the Witwatersrand.

“Inequality in general is the root cause of a lot of challenges we face as a country, so when you talk about access to quality healthcare. When you talk about healthcare, there are so many other social determinants of health,” said Dlamini. “Health is not a stand-alone, it is influenced by housing, sanitation, by just equal opportunities for all.”

Dlamini was speaking  during the Sefularo-Sheiham Memorial Lecture on Health Equity held on 20 April. The theme of the lecture was ‘COVID-19 and the social determinants of health: Reflections on ethical leadership for health equity and a socially just recovery.’

While poverty and inequality are rife in the country, Dlamini said it is clear the COVID-19 pandemic has worsened this.

“South Africa remains one of the most unequal countries in the world, a grim reality that has been further exposed and exacerbated by COVID-19. Poverty and inequality in South Africa are both multi-dimensional and intersectional. Poverty is generational and inherited with inaccessible social economic opportunities for the majority, despite legislation that seeks to redress,” she said.

Women bear the brunt

Dlamini pointed to the statistics as further evidence: women earn on average 30% less than men, according to Statistics South Africa. In 2015, that figure was 23%.

“I believe it is likely to increase post the pandemic, unless there is a direct intervention,” she said.

Even as the country made strides after the end of apartheid, black women remain the most disadvantaged, she said.

“Men are more likely to find employment and more likely to get executive positions than women are, with black women being the most disadvantaged. While poverty has declined in the end of the apartheid due to initiative by this government, females remain more likely to be poor than men. Additionally, poor females tend to live further below the poverty line than their male counterparts, suggesting greater vulnerability,” said Dlamini.

Black people hit the hardest

The pandemic has already worsened South Africa’s already high unemployment rate. The official unemployment rate increased in eight of the nine provinces, with the largest increase recorded in Northern Cape (5,6%) followed by Mpumalanga (up by 5,2%) and North West (up by 5%),, according to Stats SA. Gauteng recorded the lowest increase of 0,4%, while Free State recorded a decrease of 2,1%.

“Research shows that it is Africans or Black South Africans in rural, peri-urban and informal settlements who are hit hardest by the COVID-19 pandemic. This group has suffered the highest job loses or have risked their lives to keep their jobs as frontline workers,” said Dlamini.

“Women bear the brunt of inequality and pandemics; it could be prudent to have women at the centre of finding solutions. We need ethical leadership to drive the change that our country needs.”

A holistic response

To address the inequity in health care, the country’s policies must address fundamental issues of poverty and unemployment. In both government and academia, Dlamini urged a holistic solution to an intersection challenge.

“When we try to resolve the challenges of inequality in the country, it is my submission that, unless we have holistic understanding, it is important that those of us that are in academia are able to identify the whole spectrum of the root causes, the intersectionality of the root causes, because if we look at one problem at a time, our diagnoses will not be able to address the challenges that we face as a country,” she said.

“So collectively we need ethical leadership, because ethical leadership seeks human rights, ethical leadership does what is right, regardless of social identity of a person, ethical leadership that diverse views are embraced, it ensures that the culture is inclusive,” she added. – Health-e News