Health is not a luxury; it is a fundamental human right. Yet in a society marked by persistent inequality, the right to health is not experienced equally. Human Rights Day reminds us of the struggle for dignity and justice in South Africa’s history. It is also an opportunity to reflect on the inequalities that continue to shape daily life. This Human Rights Day, we at The Noakes Foundation highlight how economic disparities influence health outcomes in South Africa and why advancing health equity remains essential.
Every year on 21 March, South Africa observes Human Rights Day, a national public holiday honouring those who fought for freedom, equality, and human dignity during apartheid (1). The day commemorates the Sharpeville Massacre of 1960, when thousands gathered in a peaceful protest against the apartheid pass laws. These laws required Black South Africans to carry passbooks, known as “dompas”, which strictly controlled their movement (2). Protesters deliberately left their passes at home and presented themselves for arrest to challenge the unjust system. Police opened fire on the unarmed crowd, killing 69 people and injuring around 180 others, many shot in the back as they tried to flee (2). The violence shocked the nation and exposed the brutality of the apartheid regime to the world. After the first democratic elections in 1994, President Nelson Mandela declared 21 March as Human Rights Day to honour those who lost their lives and to celebrate the constitutional rights now guaranteed to all (2).
But what do we mean when we speak about “human rights”?
Human rights are the basic rights and freedoms that every person has simply because they are human. They are universal, not granted by governments, and cannot be taken away unjustly. These rights apply to all people, regardless of nationality, race, sex, religion, language, or any other status (3). They protect both survival and well-being, including the rights to life, liberty, food, education, work, and health (3). In 1948, the United Nations adopted the Universal Declaration of Human Rights (UDHR), establishing a shared global standard of rights and freedoms (4). It contains 30 articles outlining these protections. Several articles relate directly to health. Article 25 states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services…” (5)
Health is more than medical treatment. It includes adequate nutrition, safe housing, and social support. Therefore, food and healthcare should not be luxury goods, but essential human rights that enable people to live with dignity. In South Africa, these principles are protected in the Constitution through the Bill of Rights, which guarantees equality, human dignity, the right to life and other fundamental freedoms (6). However, recognising health as a human right does not mean that everyone experiences it equally. Health inequalities are measurable differences in health outcomes between population groups. When these differences are systematic, avoidable, and unfair, they are described as health inequities. They arise from the conditions in which people are born, grow, live, and work, including education, income, and access to resources (7).
Global evidence shows that social and economic factors strongly shape health. In all countries, people with lower socio-economic status face a higher risk of poor health (8). According to the World Health Organization (WHO), those born in the country with the lowest life expectancy live on average 33 years fewer than those in the country with the highest life expectancy (8). Income plays a central role. Higher income improves access to nutritious food, healthcare, and safe living conditions, while lower income is linked to food insecurity, poorer food quality, and greater disease risk. As a result, disadvantaged communities experience shorter life expectancies (8). Indeed, improving health equity is a global priority. Health equity means the absence of unfair and avoidable differences in health between groups (9). Achieving it requires fair opportunities for health and is both a public health goal and a matter of social justice.
South Africa remains one of the most unequal countries in the world (10). Despite policy efforts since the end of apartheid, income and wealth inequality remain extremely high, with the wealthiest 10% receiving around 70% of total income (11). These disparities are evident in health, as access to healthcare differs between the private and public sectors and across regions. Food security also varies widely, with many low-income households unable to afford diverse, nutritious foods. This challenge is compounded by low earnings, as the national minimum wage is approximately R25.42 per hour, or around R4,067 per month for full-time work (12), which must cover essential needs such as housing, transport, food, healthcare, and education. As a result, many households rely on cheaper, energy-dense and nutrient-poor diets, contributing to both undernutrition and rising rates of obesity and diet-related diseases. These dietary inequalities are closely linked to poorer health outcomes and reinforce significant disparities in life expectancy across communities (13).
These economic realities show that health disparities in South Africa are deeply rooted in structural conditions. Addressing them requires improving access to income, education, and economic opportunities, as well as strengthening individuals’ ability to use these resources effectively, since these social determinants are key drivers of health outcomes (14).
In a country where income strongly influences access to food and healthcare, health literacy becomes essential. Health literacy is the ability to obtain, understand, and use health information to make informed choices (15). Without it, even available services may not lead to better outcomes. Health is therefore not only about access, but also about empowerment. People must understand their rights and have the skills to act on them.
As The Noakes Foundation, we believe that knowledge is a powerful driver of change. Our mission is to foster lifelong health through evidence-based nutrition education and practical healthy food choices. Through our outreach programme, Eat Better South Africa, we work directly with low- and middle-income communities to provide accessible and relevant nutrition education. By equipping individuals and families with skills, confidence, and understanding, we aim to help close health gaps shaped by economic inequality.
Health is not a privilege. It is a human right.
On this Human Rights Day, we are reminded that economic inequality continues to shape health outcomes. Advancing health equity means ensuring that income does not determine who has the opportunity to live a healthy life. By improving access to healthy food, strengthening health literacy, and empowering communities with knowledge, we take practical steps toward reducing the health gaps rooted in inequality.
A more equitable South Africa begins with the recognition that health belongs to everyone.
Raja Pfisterer
Raja Pfisterer is a qualified nurse from Basel, Switzerland, currently pursuing a Master’s degree in Health Sciences with a major in Economics and Policy at the University of Lucerne. She combines clinical nursing experience with a strong interest in public health and is passionate about linking health and nutrition to support individual wellbeing and more sustainable healthcare approaches.
Raja is currently interning with The Noakes Foundation in Cape Town, where she is gaining practical experience in public health and learning about nutritional approaches to chronic disease in under-resourced communities through Eat Better South Africa.
Her interests include health equity, strengthening sustainable healthcare systems, and developing public health policy interventions that improve health outcomes while promoting health literacy and empowering individuals to take an active role in their own well-being. She hopes to dedicate her future career to understanding the social determinants of health, addressing health inequalities, and improving population health, particularly among vulnerable groups.
Through her work with The Noakes Foundation, Raja believes people can be empowered to take control of their health step by step, helping build healthier communities and support long-term well-being.
References
(1) Public Holidays. (2026). 21 March public holiday South Africa: Why Human Rights Day matters. https://publicholidays24.co.za/frequently-asked-question-about-public-holidays-in-south-africa/21-march-public-holiday-south-africa-why-human-rights-day-matters/
(2) African Travel Canvas. (2020). What is Human Rights Day and why we celebrate on March 21. https://africantravelcanvas.com/experiences/history-and-politics/what-is-human-rights-day-and-why-we-celebrate-on-march-21/
(3) United Nations Office of the High Commissioner for Human Rights. (2026). What are human rights? https://www.ohchr.org/en/what-are-human-rights
(4) Deutsches Institut für Menschenrechte. (2026). Geschichte der Allgemeinen Erklärung der Menschenrechte. https://www.institut-fuer-menschenrechte.de/menschenrechtsschutz/allgemeine-erklaerung-der-menschenrechte/geschichte-aemr
(5) United Nations. (1948). Universal Declaration of Human Rights. https://www.ohchr.org/sites/default/files/UDHR/Documents/UDHR_Translations/eng.pdf
(6) Republic of South Africa. (2026). Human Rights Day. https://www.gov.za/news/events/commemorative-events/human-rights-day-1
(7) World Health Organization. (2018). Health inequities and their causes. https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes
(8) World Health Organization. (2025). Health inequities are shortening lives by decades. https://www.who.int/news/item/06-05-2025-health-inequities-are-shortening-lives-by-decades
(9) World Health Organization. (2024). Health inequality monitor. https://www.who.int/data/inequality-monitor
(10) International Monetary Fund. (2026). [Article on economic analysis]. https://www.elibrary.imf.org/downloadpdf/view/journals/002/2026/035/article-A002-en.pdf
(11) Manyane, M. (2025). Inequality in South Africa: Wealthiest 10 percent receive 70 percent of the total income. https://iol.co.za/news/south-africa/2025-12-08-inequality-in-south-africa-wealthiest-10-percent-receive-70-percent-of-the-total-income/
(12) Africa Careers. (2026). Minimum wage in South Africa. https://africarrieres.com/south-africa/en/guide/droit-du-travail/minimum-wage
(13) Harper, K. M., Mutukumira, A. N., & Jideani, V. A. (2022). The food environment and dietary intake in South Africa: A systematic review. International Journal of Environmental Research and Public Health. https://dgmt.co.za/the-triple-burden-of-malnutrition-that-haunts-south-africa-and-stunts-development/
(14) World Health Organization. (2023). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health
(15) World Health Organization. (2025). Health literacy. https://www.who.int/news-room/fact-sheets/detail/health-literacy
