The devastating impacts of ongoing climate change are already being felt in South Africa, with some researchers describing the region as a climate change hotspot. President Cyril Ramaphosa attributed the catastrophic floods in KwaZulu-Natal - which killed 448 people and displaced over 40 000 people in April this year - to climate change. Similar floods in the Eastern Cape left over 1 000 people homeless.
Although the health sector has the potential to play an important role in mitigating the impact of climate change, the climate crisis is putting strain on our already fragile public healthcare system. Hospitals, clinics, and other health providers bear the burden of caring for people experiencing the health consequences of climate change. Ours is a health system that faces complex and pressing public health challenges that are made worse by socio-economic realities that include poverty, malnutrition, and some of the highest rates of HIV and TB globally.
Deepening inequalities
A study published in 2021 in the journal GeoHealth reviewed 16 studies and found that women's health is at higher risk due to their vulnerability to climate change, especially in low-and middle-income countries. The study found that women were more affected than men by nutritional deficiencies like malnutrition and anaemia due to food insecurity. Moreover, pregnant women were found to be more likely to experience miscarriages and stillbirths with rising temperatures and food insecurity. Women in rural areas where renewable energy was not available were at increased risk of developing respiratory conditions as they used hazardous traditional biomass to cook foods, leading to the inhalation of toxic pollutants. Women in rural areas were also more likely to be at risk of vector-borne diseases because they are likely to be in close proximity to rivers when they collect water, and increasing temperatures will only exacerbate these risks.
The effects of climate change on women's health are not uniform, as women in under-resourced communities bear the greatest risk of harm to their health and well-being.
Already impacting SA
In South Africa, the climate crisis is already impacting health and the realisation of human rights. While the effects of climate change affect all who live or work in South Africa, Black women and women who live in poverty and/or have precarious employment are most at risk of shouldering the burden of the crisis.
Gendered social norms and inequalities have resulted in women holding positions burdened by environmental change, like water collection and smallholder farming. These are roles that immediately feel the impacts of drought and disaster. Furthermore, women make up 60 - 80% of the agricultural labour force in our country, and with the increasing occurrence of droughts caused by climate change, failed harvests threaten women's ability to feed and provide for their families.
Section 27 of the Constitution provides that everyone has the right to have access to healthcare services, including reproductive healthcare services. Unfortunately, the April floods in KZN destroyed 85 healthcare facilities in the province, resulting in closures and concerns expressed by the Health MEC about the state of health facilities in the province. In the Eastern Cape, 12 healthcare facilities faced extensive flood damage. This occurred in communities where women have long lamented restricted access to healthcare. In the Eastern Cape, there are numerous reports of women camping outside health facilities to access abortion services. KwaZulu-Natal, meanwhile, has the lowest proportion of women who received a timely postnatal health check in the country - most maternal and infant deaths occur in the first month after birth.
Towards women-centred climate change decision-making
Princess Tsakani Nkambule - a member of the Presidential Climate Change Commission - called for women-centred climate change decision-making as "they endure most of the adverse effects of climate change" and have the least ability to adapt and recover from the losses suffered and damage caused. Moreover, in June this year, Ramaphosa announced at the G7 Leaders' Summit that South Africa will inculcate gender-responsive budgeting in our processes.
Climate policymaking and budgeting have the power to address the root causes of gender inequality by prioritising the most marginalised and realising the rights of the most vulnerable groups in South Africa - ensuring women are not persistently trapped in an inescapable cycle of poverty and disadvantage. Fiscal policy and spending allocations have the power to equip healthcare systems to be climate-resilient, protecting access to healthcare for women in the country, particularly those most vulnerable to increased barriers owing to climate change. Given this potential, it is troubling that the national budget is characterised by cuts to spending that constrains the health system's ability to position itself to respond adequately to climate change's threat to women's health.
While the Women's Maternal and Reproductive Health budget's average growth rate is 6.7% from 2018 to 2022, the public health sector faces an average 0.2% increase in funding over the next three years. Inflation in the country escalated from a projected 4.5% to a peak of 7.4% in June 2022, meaning cuts to healthcare expenditure in real terms.
When the projected growth in public healthcare users is factored in, the Budget 2022 proposals mean a reduction in funding per healthcare user from R5 267 in 2021/22, to R5 036 per user in 2022/23, and then a very sharp drop to R4 538 per user in 2023/24, and R4 465 in 2024/25 (in constant 2022/23 Rands).
Equipping the healthcare system with financial resources to mitigate the inequalities entrenched by climate change will require gender equitable allocation of this funding.
Moreover, the 2022 budget only proposed a 1.2% increase in compensation of healthcare employees over the next three years before accounting for inflation. This is concerning in general but especially for the realisation of women's healthcare. Health worker shortages reported as 10 000 nurses and 1 330 doctors in the public sector earlier this year, limit access to healthcare services. Indeed, the Eastern Cape Health Department attributed its limited ability to provide abortion services in some clinics in the province to high staff turnover, leading to reduced services.
In a climate crisis context, this is especially worrying as extreme weather events impact social and environmental determinants of health requiring a larger, climate-ready health workforce. National Treasury itself notes in the 2022 Budget Review that cuts to the personnel budget may "limit the ability of provincial health departments to employ more frontline staff" and encourages provinces to, "if needed, reduce personnel numbers to sustainable levels".
The current healthcare system is already struggling to maintain quality of care at these 'sustainable' levels and without intervention, will continue to struggle as the climate crisis worsens.
To effectively equip health facilities with the ability to mitigate the effects of the climate crisis on women's health, the health system must be provided with the financial resources to do so.
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Equipping the healthcare system with financial resources to mitigate the inequalities entrenched by climate change will require gender equitable allocation of this funding. This means both increasing overall investment in health and also National Treasury gender tagging the health budget to identify programmes which have gender as a principal or significant objective, and areas which would need to be protected as the climate crisis worsens.
Promoting the collection of gender-disaggregated data to promote equitable social spending, as well as establishing gender-sensitive benchmarks and indicators, will further enable the equitable allocation of funding. This process should include consultation with a variety of women-led organisations to promote gender perspectives in climate policy-making.
As we conclude Women's Month, it is worth reflecting on how gender-responsive policy and budgeting can help equip our healthcare system to respond appropriately to climate change. But limited resource allocation to social spending means that the most vulnerable communities who rely on public health facilities will continue to bear the brunt of climate change. This will disproportionately impact women. Policy and budgets can and must be used to build health systems that do not just exacerbate gender inequality during this crisis. Although the ongoing climate crisis is daunting, it can serve as an opportunity for budgeting and policy-making processes to centre the most vulnerable and protect women's right to healthcare.
*Lencoasa is a budget researcher at SECTION27.
Note: This article is written by an employee of SECTION27. Spotlight is published by SECTION27 and the TAC, but is editorially independent - an independence that the editors guard jealously. The views expressed in this article are not necessarily those of Spotlight.
