Day 2: Determinants of Health

Activity 4: The reality of health inequity in the Eastern Cape

2 hours


To help us to:

  • Understand the difference between (in) equity and (in) equality and why these matter
  • Look at the South African health inequity gap through exploring three cities/towns in the Eastern Cape
  • Deepen our understanding of the consequences of health inequity

Task 1:
Group work: Understanding inequity and inequality

15 minutes  

Inequity and inequality have specific meanings and while related are not interchangeable. Let’s try and understand this.  With others at your table, study the diagram below. 

Based on this, what do you think is the key differences between inequity and inequality?

Inequity refers to a lack of equity, which means “justice” or “fairness”, these avoidable differences arising from poor governance, corruption or cultural exclusion. Where there’s inequity in a community, it means injustice, unfairness, and bias are being perpetuated.

That might sound exactly like inequality, but inequities are what cause inequality. Inequality refers to the uneven distribution of health or health resources.

As an example, let’s say two people have a heart attack. One lives in a city and reaches a good hospital quickly. The other lives in a rural area where healthcare access and possibly quality is poorer. Because of this inequity, there’s an unequal outcome.

Task 2
Health inequity through an Eastern Cape lens

45 minutes

Step 1 – Analysis

Working in three groups, you will be allocated a town/city in the Eastern Cape and a set of key health statistics from there:

  1. Spend some time locating your town/city and where it may fall on the comfort/deprivation index.
  2. Study the different statistics provided, some are accurate, some are not, and agree which stats belong to your town/city.
  3. Build a puzzle for your city, piecing together the location and stats.

Comfort and deprivation indexes

The Institute of Race Relations (IRR) releases a comfort/deprivation index annually, assessing 44 municipal and 8 metropolitan districts on standards of living.  We could spend a considerable amount of time debating the merits and demerits of their analysis and how they reach this, as well as their general conservative and sometime reactionary analysis of issues, but we want to use their data for our own analysis. It is useful data for helping us look at health inequity in the Eastern Cape.  We hope that it provides you with an opportunity to provide your own critique!

The diagram below is a summary version of the outcomes of their index for the Eastern Cape.

The Comfort Index was drawn up on the following five pointers:

  1. Attainment of higher education;
  2. Ownership of a refrigerator;
  3. Use of electricity for heating;
  4. Having a flush/chemical toilet; and
  5. Individual monthly income of R25,601 or more.

The Deprivation Index was compiled using these indicators:

  1. People with no schooling;
  2. The unemployment rate;
  3. No access to piped water;
  4. No access to a toilet; and
  5. A monthly income of R1,600 or less.


Based on this data, we have selected three towns/cities in the Eastern Cape and we will study their health access and outcomes a bit more closely.  These towns/cities are:

  • Buffalo City
  • Cacadu
  • Mount Ayliff 

On the wall is a map of the Eastern Cape, when you have finished building your puzzle, place the pieces onto this map, building a bigger puzzle connecting to the other towns/cities that have also been explored.

Task 3
Plenary: Bringing our Puzzles to Scale

1 hour

In plenary, we will take a step back on the puzzles of the three towns/cities.  The facilitator will correct any misplaced/incorrect stats built into the puzzle.  Once done, we will take a step back and answer the following questions:

  1. What are you seeing in terms of race, class and gender?
  2. What does the big puzzle tell us about the consequences of health inequity?
  3. What, if anything, can you draw from this for South Africa?

The facilitator will draw together the discussion demonstrating how health inequities lead to worse outcomes for many, particularly if you are black, poor and a woman!  There are many angles to health inequity, and just a few key angles are:

  • Unequal distribution of disease 
  • Higher maternal and infant mortality rates
  • Lower life expectancy
  • Less access to good mental health services.