Race, gender and internal migration shape how individuals seek out healthcare in South Africa, study finds

LAWRENCE — According to the World Health Organization, South Africa has the best healthcare system on the African continent. But that doesn’t always equate to individuals getting the treatment they need.

“Despite healthcare being widely available, you might be surprised how often people don’t use it,” said Tyler Myroniuk, assistant professor of sociology at the University of Kansas.

“That’s the case with a lot of countries where there is public health insurance and clinics available. Regardless of the availability, people often don’t take advantage of them, which is the first important step in taking care of one’s health.” 

He addresses this issue in an article titled “How race, internal migration and gender are associated with consistency in healthcare-seeking behaviour in South Africa: Nationally representative longitudinal evidence from 2008 to 2015.” It finds the country’s Black residents and men have the lowest chances of seeking out healthcare. The article appears in the South African Journal of Public Health.

“It’s very clear that Black migrant men — those who have moved somewhere else in the country in the past seven years, which was between 2008 and 2015 in the data — are the least likely to consistently seek out primary healthcare,” he said.

“Black women are the next least-likeliest group when compared to ‘Coloured’ residents, which is the racialized term for mixed-race individuals that goes back to the apartheid era. Black women and Black men collectively face greater difficulties and consistency in accessing healthcare than Coloured men and Coloured women.”

His research helps explain the discrepancy.

“As is the case in most countries, the biggest users of healthcare are women, in large part because of reproductive healthcare. But as I find in the paper, being an internal migrant has something to do with the likely disruption of routines, and there’s still quite a bit of racial disparities in the access. South Africa is a country where people are constantly on the move for work. And amidst all that, they may not take care of their health,” Myroniuk said.

The professor utilized South Africa’s National Income Dynamics Study (NIDS), which began in 2008, that employs data to examine differences in the consistency of healthcare seeking behavior between Black and Coloured residents, internal migrants and nonmigrants, and men and women. It is one of only a few longitudinal nationally representative datasets in sub-Saharan Africa with high-quality migration and health data. 

“South Africa is a middle-income country now, even though there’s a considerable amount of inequality,” he said.

“Yet it has undergone this epidemiologic transition whereby people are no longer dying of infectious diseases nearly as much as they used to, as you might see in other sub-Saharan African countries. People now have the privilege of dying of cardiovascular disease, strokes, heart attacks and other things that come with aging.”

As such, residents aren’t as accustomed to seeing doctors for routine healthcare such as regular checkups or screenings. Myroniuk stressed the necessity for the country’s government to simply advertise the advantages of seeking out primary care.

“Now that health insurance is becoming widely available at low-to-no cost, they should make it known that it’s time for people to schedule a quick checkup. I don’t think it would be too difficult to promote, whether it’s through radio or social media,” he said.

A KU faculty member since August, Myroniuk has spent a significant amount of time doing research in South Africa.

“As a young kid, I learned about apartheid and instantly knew that it sounded wrong. I was fascinated by South Africa and Nelson Mandela,” he said.

A social demographer, the professor focuses on internal migration and health outcomes. He is also a faculty affiliate of the Institute for Policy & Social Research and the Kansas Population Center.

Myroniuk said, “The biggest takeaway of this article is that despite the major advances South Africa has made in terms of its healthcare system and the strides it’s made in becoming a democracy post-1994, the most traditionally marginalized groups are still the least likely to seek out health care.”