Hunger meets healthcare: investigating the barriers to public healthcare access for food insecure patients in a low-resourced Cape Town suburb

Weaver, Shannon Beth

Hunger meets healthcare: investigating the barriers to public healthcare access for food insecure patients in a low-resourced Cape Town suburb

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Environmental and Geographical Science

Faculty

Faculty of Science

Abstract

Food insecurity is a significant barrier to public healthcare in South Africa, affecting childhood development, non-communicable disease (NCD) management, and the complexities of HIV/AIDS and Tuberculosis (TB) care. Addressing the social variables impacting health within South Africa remains a challenge for the formal health system. Low-income neighbourhoods, affected by rapid urban development and historical marginalisation, continue to grapple with poverty, hunger, housing instability, and poor health outcomes. Inadequate access to nutritious food creates profound challenges within public healthcare. Addressing these challenges necessitates not only targeted interventions, but also systemic changes in healthcare policies and enhanced collaboration between community support services and the formal health system. This study aims to examine the perspectives of healthcare workers regarding hunger as a barrier to healthcare. It investigates how a community clinic and social support services collaborate to address issues related to hunger, malnutrition, food insecurity, and health equity. This thesis is contextualised through two conceptual frameworks: UNICEF's systems-thinking approach to maternal and child nutrition, and the World Health Organisation's (WHO) Social Determinants of Health (SDOH) framework. Key findings from this case study reveal that food insecurity significantly impedes patients' adherence to TB and HIV/AIDS medication regimens. Diet-related issues contribute to the lack of improvement in patients with high blood pressure and diabetes who are on medication, demonstrating a direct link between poor diets and the ineffectiveness of standalone treatment. Additionally, there is a disconnect in basic health information, limiting patients' understanding and agency over their illnesses. Health stigma is prevalent, underscoring the need for support groups, and the absence of socio-economic context in medical staff training affects their initial contextual knowledge on the social issues faced by patients within the area as well as knowledge on available social services offered in the area. Addressing food insecurity and related barriers is crucial for improving healthcare access and outcomes. Effective communication and integration within healthcare and community support systems are essential to address the complex nature of these issues. This research highlights the need for healthcare models that incorporate a social perspective to effectively address the challenges faced by individuals in low-income areas.

Keywords

food insecurity

healthcare

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