Household characteristics in relation to COVID-19 risks in Gauteng
- Dr Alexandra Parker, Dr Julia de Kadt
- Date of publication: 30 June 2020
The structure of our households, the infrastructure we have access to, and where we come from, all shape our daily lives, and influence our access to various resources and forms of support. This visualisation explores the relationships between various household characteristics and exposure to factors that are expected to impact vulnerability in the face of the COVID-19 pandemic. This analysis, in turn, supports the provision of interventions tailored to different types of households and ensures that groups that may be particularly vulnerable are not overlooked. The visualisation draws on GCRO’s Quality of Life V (2017/18) survey data, which defines the household as those people living in the same dwelling, and eating together for four nights or more per week. We focus on the following household characteristics: household size; households with children; multi-generational households; household headship; and dwelling conditions. We also look at the exposure to risk factors in households where our respondents are over 60 years old, primary caregivers or migrants. These three categories are not necessarily household characteristics but understanding the dimensions of the vulnerability faced by households that contain elderly members, primary caregivers or migrants is important to ensuring that key services reach them and their households.
Our work follows the analysis established in the March 2020 Map of the Month, which outlines two indices of factors anticipated to increase vulnerability related to the COVID-19 pandemic. Index 1 considers risk factors related to preventative measures such as maintaining high levels of personal hygiene and practising social distancing. These risk factors include living in a crowded dwelling; the absence of piped water; shared or inadequate toilet facilities; dependence on public health care facilities; limited access to communication tools; and reliance on public transit.
Index 2 examines risk factors related to lockdown conditions that are likely to increase health and socio-economic vulnerability. These factors include existing health conditions, and socio-economic conditions such as risk of hunger, ability to save money and access to medical aid. Each index ranges from 0-100, with 0 representing the lowest and 100 representing the highest level of risk.
Our indices were compiled to capture the multiple forms of risk during the COVID-19 pandemic, and the detailed analysis provided here shows how these risks shift and overlap for different household characteristics. For example, households living in informal dwellings are exposed to a particular form of risk because they are less likely to have piped water into their home or yard, and are more likely to have shared or inadequate sanitation. At the same time, these same households are more likely to be single person households, which this analysis shows, reduces the likelihood of hunger. Residents in these dwellings are also more likely to be migrants (both South African and foreign nationals), who are less likely to suffer from pre-existing health conditions.
In the three interactive charts below we compare the vulnerabilities and risks experienced by different household structures and living situations. Figure 1 provides an overview of how different household characteristics compare on the two indices. Figures 2 and 3 dive into key factors for each of the indices and for each of the household dimensions to enable viewers to see how risk factors vary for different household characteristics.
Figure 1 shows how the different household characteristics compare on the overall COVID-19 risk indices. This provides us with an overall picture of which households score higher or lower on Index 1 and Index 2. Risk levels increase from left to right so that households or respondents with higher scores on the indices are closer to the right hand side of the chart. The dotted line represents the provincial average. Hover over each dot to see the index values for each group.
Households living in informal dwellings face the greatest risk in relation to Index 1 of risk factors to maintaining high levels of personal hygiene and practising social distancing. Their risk level of 50% is substantially higher than other household characteristics. The details of this vulnerability are expanded upon below, but this is strongly connected to poor infrastructure and high levels of crowding in many informal settlements. While respondents in informal dwellings may be more at risk in terms of preventative practices, they are less at risk to social and health issues (Index 2) than other household characteristics.
Households with five or more people are more exposed to the risk factors included in both Index 1 and Index 2, compared to smaller households. Similarly, households with five or more children also have higher risks in terms of both indices. The size of the household is only one characteristic and the composition of the household can also have a relationship to COVID-19 risks. For example, multigenerational households have a slightly higher score on Index 2 than other household characteristics.
Roles and responsibilities within the household also have a relationship with COVID-19 risks. Female-headed households show an increased risk for both indices compared to households headed by males or households headed by adults together. Female respondents who identified themselves as the primary carers of their dependent children live in households which score higher on both indices than the households of male primary carers, joint carers, or respondents who do not have dependent children.
Lastly, whether people were born in Gauteng or migrated to the province shows a mixed picture in relation to COVID-19 risks. Migrants from other provinces in South Africa have higher scores in Index 1 than migrants from outside South Africa and those respondents born in Gauteng. Internal migrants, along with respondents born in Gauteng, are also slightly more at risk according to Index 2 than international migrants. Key contributors to variations in risk scores across migrant groups are better overall health status, living in households with fewer pre-existing health conditions, and lower risk of hunger. However, these indices may understate the vulnerability of foreign migrants, as these groups have been excluded from many governmental pandemic support initiatives, such as grant increases and food parcels.
The vulnerability of each of these household characteristics is explored in more detail in the interactive charts below. These charts highlight some of the risk factors that vary substantially for each index. In the first chart (Figure 2), the focus is on access to piped water, access to sanitation, reliance on public healthcare and dependence on public transport. On Figure 2, select the household characteristic from the dropdown menu to compare these key risk factors across the different groups.
Figure 2: Further exploration of the interactions between household characteristics (dropdown menu) and Index 1 risk factors (listed on the vertical axis).
Figure 2 (‘dwelling’ dropdown option) shows that households in informal dwellings are much more likely to have access only to inadequate or shared sanitation services, as are single person households and respondents who are migrants either from within South Africa or outside South Africa. Similarly, it is also respondents in informal dwellings, single-person households, and migrants who are more likely to have no access to piped water. Efforts to provide these services will support these households, in particular, in implementing preventative measures against the spread of COVID-19.
Households with five or more people and households with five or more children are more likely to rely on public healthcare services along with respondents in informal dwellings, female-headed households, and female primary carers (see ‘household size’ and ‘children in household’ dropdown options in Figure 2). Female-headed households and female primary carers are more likely to live in larger households and with more dependent children (‘primary carer’ option). These households may struggle to access important chronic or urgent medical care during the pandemic for various reasons, or may be more at risk of contracting the coronavirus during visits to health services due to longer queues and higher levels of crowding. Health services need to ensure that routine medical care such as vaccinations or dispensary services remain safely accessible to people during the pandemic.
Respondents who rely on public transport are more likely to live in households with five or more children, or live in female-headed households, or are more likely to be female primary carers or migrants from other South African provinces. Preventative measures on public transport, such as sanitising and limited passenger numbers, will be particularly beneficial to these households and individuals, although given widespread reliance on public transport they will also be more broadly beneficial.
Figure 3: Further exploration of the interactions between household characteristics (dropdown menu) and Index 2 risk factors (listed on the vertical axis).
For Index 2 on lockdown vulnerabilities the risk factors that vary substantially across household characteristics are pre-existing health conditions and the risk of hunger and so Figure 3 focuses on these two factors. Select the household characteristic from the dropdown menu to compare these risk factors across the different groups.
Levels of pre-existing health conditions vary across different household structures and living conditions. Pre-existing conditions are most prevalent in households with five or more people, and those with five or more children (Figure 3, ‘household size’ and ‘children in household’ dropdown options). Female primary carers, respondents 60 years and older, and those born in Gauteng are also more likely to live in households with pre-existing health conditions (‘primary carer’, ‘age’, and ‘migrants’ options). Continuing to provide safe and accessible health care, including chronic and preventative care, will be particularly important to these groups during the pandemic.
The final risk factor is the risk of hunger and this is where food parcels, other feeding schemes and relief measures can have significant impact. Households of five or more people and those with five or more children, multigenerational households, those living in informal dwellings, and female-headed households are at higher risk of hunger relative to other household characteristics. Female primary carers are also particularly likely to live in households at risk of hunger. As many of these households include children, ongoing provision of food support is particularly crucial.
These interactive charts show that risks and vulnerabilities associated with the COVID-19 pandemic vary between different household characteristics. For example, respondents in informal dwellings are less likely to have access to piped water and therefore, may struggle to achieve preventative hygiene but are also less likely to live in households suffering from pre-existing health conditions, which exacerbate illness with COVID-19. There is not one particular household characteristic that has the greatest risk across all the factors. Interventions and preventative measures need to be tailored and informed by an understanding of household structure, as well as local conditions and challenges.
This analysis builds on earlier work on Income vulnerability in Gauteng and Gauteng's elderly in the context of COVID-19 as part of the Responding to the COVID-19 pandemic in Gauteng project.