Addressing the social determinants of health in the COVID-19 pandemic:

High poverty, NCD & HIV burden settings

Khayelitsha, Cape Town in South Africa as a case study

Vera ScottSchool of Public Health, University of the Western Cape

5 March – first case in South Africa

11 March – first case in Western Cape

28 March – first case in Khayelitsha

The evolution of the Covid pandemic in South Africa

https://ourworldindata.org/coronavirus/country/south-africa?country=~ZAF

Socio-economic context

General household survey, 2013

https://www.imf.org/en/News/Articles/2020/01/29/na012820six-charts-on-south-africas-persistent-and-multi-faceted-inequality

Davies, M-A et al, 2020. Western Cape Burden of Disease Rapid Review Update 2019. Western Cape Department of Health

Socio-economic context of Khayelitsha

Source: Census 2011

data

0

200

400

600

800

1000

1200

1400

160010

-Mar

13-M

ar16

-Mar

19-M

ar22

-Mar

25-M

ar28

-Mar

31-M

ar03

-Apr

06-A

pr09

-Apr

12-A

pr15

-Apr

18-A

pr21

-Apr

24-A

pr27

-Apr

30-A

pr03

-May

06-M

ay09

-May

12-M

ay15

-May

18-M

ay21

-May

24-M

ay27

-May

30-M

ay02

-Jun

05-J

un08

-Jun

11-J

un14

-Jun

17-J

un20

-Jun

23-J

un26

-Jun

29-J

un02

-Jul

05-J

ul08

-Jul

11-J

ul14

-Jul

17-J

ul20

-Jul

23-J

ul26

-Jul

29-J

ul01

-Aug

04-A

ug07

-Aug

10-A

ug13

-Aug

16-A

ug19

-Aug

22-A

ug25

-Aug

28-A

ug31

-Aug

03-S

ep06

-Sep

09-S

ep12

-Sep

15-S

ep18

-Sep

21-S

ep24

-Sep

27-S

ep30

-Sep

03-O

ct06

-Oct

09-O

ct12

-Oct

15-O

ct18

-Oct

21-O

ct24

-Oct

27-O

ct30

-Oct

COVID Cases Cape Metro March to October 2020

Khayelitsha City of Cape Town Total Data extracted from WC DoH Covid Dashboard: Natacha Berkowitz

Constraints to implement public health prevention, even during lockdown

SDHE 1 – Differentiated exposure

Photo credit: unknown Khayelitsha resident Photo credit: MUCHAVE/SOWETAN

Poverty and impoverished living conditions limited the sustained implementation of public health strategies

SDHE 2 – Differentiated vulnerability

3.8%

5.9%

6.1%

7.7%

13.2%

14.6%

14.8%

15.8%

18.1%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0%

MATERNAL/PERINATAL/NUTRITION

INFECTIOUS PARASITES

DIABETES

UNINTENTIONAL INJURY

CARDIOVASCULAR DISEASE

OTHER NCDS

INTENTIONAL INJURY

CANCERS

HIV/AIDS/TB

% Premature mortality - YYL

Davies, M-A et al, 2020. Western Cape Burden of Disease Rapid Review Update 2019. Western Cape Department of Health

Graphic: Mary-Ann Davies on behalf of the Western Cape Department of Health. Western Cape: COVID-19 and HIV / Tuberculosis 9 June 2020

Accepted manuascript: Boulle A, Davies M-A, Hussey H. Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1198/5899044

Analysis of the Social Determinants of NCDs in South Africa

Source: Scott VE, Schaay N, Schneider H & Sanders D. Addressing social determinants of health in South Africa: The journey continues. In: Padarath A, Barron P, editors. South African Health Review 2017. Durban: Health Systems Trust; 2017. [Online], Available: URL: http://www.hst.org.za/publications/south-african-health-review-2017

SDHE 3 - Differentiated access to care

https://coronavirus.westerncape.gov.za/covid-19-dashboardAccessed: 2 Nov 2020

https://coronavirus.westerncape.gov.za/covid-19-dashboardAccessed: 2 Nov 2020

SDHE 4 - Differentiated impact of Covid-19

Source: NIDS-CRAM WAVE 1 SYNTHESIS REPORT: OVERVIEW AND FINDINGS

Source: NIDS-CRAM WAVE 1 SYNTHESIS REPORT: OVERVIEW AND FINDINGS

• Western Cape Government Corona-19 Dashboard https://coronavirus.westerncape.gov.za/covid-19-dashboard• Accessed: 3 November 2020• South Africa: Coronavirus Pandemic Country Profile https://ourworldindata.org/coronavirus/country/south-

africa?country=~ZAF Accessed: 2 November 2020• CHILD POVERTY IN SOUTH AFRICA: A Multiple Overlapping Deprivation Analysis June 2020

http://www.statssa.gov.za/publications/03-10-22/03-10-22June2020.pdf• Mary-Ann Davies, Erna Morden, Thato Mosidi et al. BURDEN OF DISEASE RAPID REVIEW UPDATE 2019. Western

Cape Department of Health• Mary-Ann Davies on behalf of the Western Cape Department of Health. Western Cape: COVID-19 and HIV /

Tuberculosis 9 June 2020• StatsSA. Census 2011.• Nic Spaull , Cally Ardington, Ihsaan Bassier, et al. NIDS-CRAM WAVE 1 SYNTHESIS REPORT: OVERVIEW AND

FINDINGS. http://resep.sun.ac.za/nids-cram-wave-1-synthesis-report-overview-and-findings/• IMF. Six Charts Explain South Africa's Inequality.

https://www.imf.org/en/News/Articles/2020/01/29/na012820six-charts-on-south-africas-persistent-and-multi-faceted-inequality. Accessed 2 Nov 2020

With thanks to Natacha Berkowitz, Epidemiologist, City of Cape Town, for support in accessing reports and dashboards