Story of South Africa’s inequality highlighted by Covid-19 statistics

The confluence between race and inequality in South Africa has been starkly illustrated through hospital admissions over the course of the coronavirus pandemic.

Black people living in the country were likely to be hospitalized at a younger age, less likely to have access to intensive care units and ventilators and had higher mortality from the disease than White residents, according to a study led by the National Institute for Communicable Diseases. Indian and mixed race South Africans, locally known as Colored, also fared worse.

“Blacks, Indians and Coloreds were more likely to die,” Waasila Jassat, a researcher with the NICD and one of the authors of the study, said in an interview on Tuesday. The study shows “the interplay between race, age, sex and socio-economic status” and how different groups experienced Covid-19, she said.

South Africa, with more than 100,000 official deaths from the coronavirus and as many as three times that if death rates are measured against historical averages, is the country on the continent worst hit by the disease. At the same time its history of racial segregation has made it the most unequal of countries for which data are available, according to the Thomas Piketty-backed World Inequality Lab.

Of the nation’s 60 million people, 81% are Black people and 7.8% are White South Africans. On average, according to Statistics South Africa, employed Black people earn just over a quarter of what their White peers do. A far greater proportion of Black people than White residents are unemployed and depend on welfare.

That wealth disparity is reflected in a myriad of ways, including access to health care and health itself, with Black South Africans showing a higher prevalence of co-morbidities such as diabetes and hypertension. A greater proportion of Black residents also have HIV or tuberculosis.

Indicative of the wealth gap and its link to vulnerability to Covid-19 infection and illness is that in South Africa women under the age of 40 had higher mortality than men, according to the study.

Black women in the country are the most economically marginalized group.

On average, Black South Africans admitted to hospital with the coronavirus were 1.3 times more likely to die than White people, data in the study showed. Those of Colored or Indian descent had a 1.2 times greater chance of dying.

Younger admissions
Highlighting the different experiences, people treated in the Eastern Cape, the poorest province, were 1.9 times more likely to die than those in the Western Cape, which has more private hospitals and better government services.

The median age of hospitalized Black people was 50. The median age of Colored residents and Indian South Africans put in hospital was 53 and 54 respectively, while for White people it was 61. Black South Africans over 80 years old infected with the virus were more than twice as likely to both be hospitalized and to die than White residents.

About 53% of the total 440,000 hospital admissions analyzed were in public hospitals, while the rest were in private facilities. That distinction, the researchers said, played a role in how likely Black, and often poor, patients were to receive ventilation, oxygen or treatment in an intensive care unit. About 20% of the local population has access to private health care.

In public hospitals, 89.7% of those who died weren’t in ICU. That proportion fell to 39.9% in the private sector. Across all facilities, the proportion of Black patients admitted to ICU was less than half that for White patients.

ICU, ventilation
Even within the public sector, Black people were less likely to have access to ICU treatment or ventilation. This was likely due to the fact that a greater proportion of Black South Africans live in remote rural areas with poorer quality medical facilities, according to Jassat.

The four waves of infection covered by the study also highlighted the unequal nature of South African society.

A higher percentage of Black people were hospitalized in the first wave of infections, when the government imposed strong restrictions on movement, because they were more likely to work in essential services, use public transport or live in crowded accommodation.

“People who were well off were better able to shield themselves,” Jassat said.

© 2022 Bloomberg L.P.