‘Basic freedoms don’t exist [in South Africa]; basic freedom is not the freedom to vote. It’s the freedom that your stomach is full every day – that’s the basic freedom. So, in the absence of that, you cannot [be free],’ said Dr Pali Lehohla, Former Statistician-General of South Africa. He was speaking in the Tekano-led panel discussion titled “The Triple Challenge of Poverty, unemployment and Inequality as a Social Determinant of Health”. The discussion took place at the Human Rights Festival hosted by Constitution Hill.

René Sparks
The discussion delved into the interconnected challenges that contribute to health disparities, focusing on the triple challenge framework that encompasses poverty, inequality, and unemployment. He further mentioned that:

“Poverty is not consistent with a knowledge society, you can’t be a knowledge society and be poor unless there’s something fundamentally wrong in the system. So, one of the things that we have as a problem is that our knowledge system or our aspiration to be a knowledge society is highly defective…we are busy producing and reproducing poverty as black society…blacks and coloureds form 90% of the population, you can’t have a country with only 15 – 16% of its population skilled. It’s going to fail, there’s no other way. If we have been stuck in that groove since 1994, and for 30 years we haven’t made progress in these two populations that make up 90% of the population and only 10% have made serious progress then we are dead. 63% of our problems are based on unemployment and lack of education. For the youth (those between 15 – 34), the situation is worse, 60% of their problems are based on not attaining the right education. Their poverty is created that way, by not having the right education, the right skill – you have created poverty.”

René Sparks

Researcher and Tekano Fellow, Kealeboga Ramaru, added that poverty and inequality affect women differently.

“Inequality itself and poverty are very gendered things; they’re not gender neutral. Sometimes we write policies and say, ‘If I put in 2 cents here, there will be 5 cents at the end, and that will be the end of poverty. That’s not how the world works. Because of our history of apartheid, segregation, and colonialism in this country, if we are saying there’s inequality, that inequality doesn’t affect all black people the same way. It affects women differently. This is why we have gender-based violence in our communities, because of this idea of how inequality plays itself out. We also know that women bear the burden of care. There’s a comrade who asked if we are saying that this idea of women cleaning houses is now work… Imagine if you had to wake up, get your child ready in the morning, make breakfast, make skaftin (lunchbox), get yourself ready, take the kid to school, work in a factory all day, come back, and cook. Then, if you minus the job, you are the only parent, and you do all this with R350 from the government because we also know, from the statistics that the Dr has presented, that unemployment is looking scary in this country. People are not only navigating life for R350 but there’s also umama who is taking care of a whole family of 4-6 people, which is typically what the household looks like in South Africa. Right now, in South Africa 51% of households are women-led. So, when we speak about communities that are not functional, within this context of systems that don’t work, no water, and all of these things that we need for our health, women also have this responsibility of caring for other people on top of themselves when it comes to their own health”.

Nokwanda Sihlali, a Researcher at the Land and Accountability Research Centre based at the University of Cape Town, stated that the issue of land (which is another social determinant of health) is not just about access to land.

“You don’t actually think about land as part of your health, except when it comes to food production… so according to the UN High Commissioner for Human Rights, your health is the complete physical, mental, social wellbeing, and absence of disease… this is just some of the definitions that emphasise that just because you are not sick, it doesn’t mean you are healthy. The definition further states that the right to health includes factors that assist us to live healthy lives. We need water and sanitation, we need food and nutrition, housing, healthy working and environmental conditions, education and information, and gender equality… so when I talk about land, it is one of the social determinants of health. It’s not only about having access to land but decision-making power over what happens to your land. But the way we look at land in South Africa is all about the price tag or the cost of that land. We don’t always have to look at land in those terms; the fact that my ancestors are here gives it a cultural meaning. If something happens where I can potentially be dispossessed if that person forcefully takes that land from me, he/she or they take away my ancestors, my whole identity. That’s one of the reasons why we say that the government will see land and see money, they talk about productivity, they talk about rural development: You want the land, what are you going to do with it? This is one of the things that we need to change the language around the land and how we view it”.

She further added that nearly 19 million South Africans make up the rural population, where customary law is practised.

“In 1996, parliament passed the Interim Protection of Informal Land Rights Act (PIRA) and it protects people who live in rural areas…you don’t necessarily need a title deed because you are protected by PIRA. PIRA says it’s an informal land right. This is not to say that title deeds don’t exist in rural areas, but it is to say that usually, we practice customary law… we have actually found that title deeds, while they are very good at securing your land rights in a formal way, but at times they lead to more land disposition. That’s why we say PIRA is something that we need to pay specific attention to because every year they say they renew PIRA, so we don’t have a permanent law that protects rural citizens and their land rights. So, this is one of the things that we fight for when we talk about the Stop the Bantustan Campaign. We are tired of these Bantustan laws that coming up, we have the Traditional Courts Bill, The Traditional Khoisan and Leadership Bill and we have the Ngonyama Trust case last year where we show that land rights are property rights, especially customary land rights, so you can’t just remove people from a particular land without consultation.”

The panellists argue that all these social determinants of health need to be addressed in our efforts to tackle health inequity.

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