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The advent of the COVID-19 pandemic in South Africa and across the globe posed special challenges and implications for low-income families with children. In this study we explored the experiences of primary caregivers of children receiving a South African social assistance programme, the Child Support Grant (CSG), during lockdown in Cape Town, South Africa, and sought to understand whether and to what extent the underlying logic of cash transfers such as the CSG speaks to the pitfalls of the social protection paradigm and the potential for moving closer to a transformative social policy approach.


We conducted 26 telephonic qualitative interviews with primary caregivers of recipients of South Africa’s CSG that were part of a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security.


Even though primary caregivers of the CSG and their children and households were already living in precarity before the pandemic, COVID-19, and particularly the hard lockdown, worsened their social, economic and living conditions, especially as regards hunger and food insecurity.


Low-income women bore the brunt of the pandemic in their roles as mothers, providers and homemakers. The pandemic has highlighted the inadequacies of the social protection paradigm that underlies the design of cash transfers such as the CSG, which has a narrowed focus on chronic poverty and vulnerability. It has also highlighted opportunities to shift to a transformative social policy framework that incorporates production, redistribution, social cohesion, adequacy and protection.

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The Village Savings and Loan Association (VSLA) model is currently being employed in Uganda for deepening financial inclusion and poverty reduction. Despite its focus on women’s empowerment, concerns have arisen of an under-representation of women on VSLA leadership committees. Human rights-based, economic, and social justice arguments support active participation of women on VSLA leadership committees. The study sought to identify, explicate and characterise the barriers and facilitators to women in VSLA leadership. An exploratory study design using qualitative methods was selected to address the research objectives. Forty-nine focus group discussions were undertaken, featuring both VSLA members and non-members. VSLAs for inclusion in the study were randomly selected from within four regions of Uganda, stratified by: mature (>2 years old) versus new (<2 years old). The study exposed a diverse array of barriers and facilitators to women in VSLA leadership positions, revealing the influence of individual, material, institutional and social factors, in addition to social norms and gender characteristics, on women in VSLA leadership. The findings revealed that the design of interventions to achieve fair representation of women in leadership positions should be informed by an understanding of the different types, relative strengths, support for/against, and intersectionality of the factors impacting women in VSLA leadership.

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This commentary discusses the ways in which the welfare system has responded to the financial and housing needs of Ukrainian citizens coming to the UK since the Russian invasion of Ukraine on 24 February 2022. The focus is on two key areas of policy: social security and housing. The article considers the revised eligibility criteria for welfare benefits and two policies which can provide accommodation: the Ukraine Family Scheme, which allows applicants to join family members in the UK, and the Ukrainian Sponsorship Scheme (known as ‘Homes for Ukraine’) which allows Ukrainian nationals to come to the UK if they have a sponsor who can provide accommodation for at least six months. It provides a comparison of the provision for Ukrainian refugees and the standard asylum system in the UK.

This article concludes that although the UK government quickly introduced emergency provisions for newly arrived Ukrainians which go beyond the scope of support for many other groups moving to the UK, significant areas of concern are evident, with risks that these will increase in future months and years. These concerns centre on discrepancies between the two policies which provide accommodation, risk of exploitation, homelessness caused by the breakdown in provision, and complexity in the welfare benefit system.

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This chapter examines the regional impact of the COVID-19 economic crisis. Through analysing ONS data it examines regional trends in furlough rates, unemployment rates, and wage levels. The chapter shows that the negative economic impacts of the pandemic were higher in the North. Productivity costs to the UK economy from higher COVID-19 mortality (Chapter Two), mental health morbidity (Chapter Three) are calculated and it is found that the North was disproportionately affected. The chapter also explores the differing levels of COVID-19 restrictions and finds harsher lockdown restrictions were experienced in the North.

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This chapter concludes by reflecting on what can be done to reduce health inequalities. Drawing on international case studies of when inequalities in health have been reduced, this chapter outlines what public policy response is needed now to reduce regional health inequalities so that they do not increase for future generations and in any future pandemics.

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This chapter describes the pre-pandemic context of inequalities in health and wealth in England. It provides a brief historical overview of the North–South regional health and economic divide. This chapter also introduces the reader to the core concepts and theories which underpin the rest of the book including: the deprivation amplification thesis, intersectionality, and the syndemic pandemic concept. It discusses common approaches in the field of health geography to understanding place-based health inequalities, including: compositional, contextual, relational and political economy approaches. It concludes by providing a summary for each of the following chapters of the book.

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COVID-19 and Regional Inequalities in Health and Wealth

EPDF and EPUB available Open Access under CC-BY-NC-ND licence.

Whilst the COVID-19 pandemic affected all parts of the country, it did not do so equally. Northern England was hit the hardest, exposing more than ever the extent of regional inequalities in health and wealth.

Using original data analysis from a wide range of sources, this book demonstrates how COVID-19 has impacted the country unequally in terms of mortality, mental health and the economy.

The book provides a striking empirical overview of the impact of the pandemic on regional inequalities and explores why the North fared worse.

It sets out what needs to be learnt from the pandemic to prevent regional inequality growing and to reduce inequalities in health and wealth in the future.

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This chapter examines regional trends and inequalities in the ‘parallel pandemics’ of mental health, hospital pressure, and long COVID. Using mental health survey data, NHS prescribing data, NHS hospital data, and official estimates of long COVID prevalence, the chapter shows that these three parallel pandemics have been regionally unequal with worse outcomes in the North. In addition, the analyses reveal stark intersectional inequalities in self-reported mental health by ethnicity and gender in the North.

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This discussion chapter places the results from the empirical analyses in Chapters Two–Four within the wider conceptual and empirical context. It sets out how the regional inequalities in health and wealth that have been identified during the pandemic reflect longer-term health divides across the country. Drawing on the conceptual material outlined in the introductory chapter, this chapter reflects on how, through the concepts of the syndemic pandemic, intersectionality and of deprivation amplification, COVID-19 had such an unequal regional impact.

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This chapter presents original analyses of regional inequalities in COVID-19 mortality in the first year (pre-vaccine) of the pandemic. Using mortality data and a conceptual model to guide the analyses, this chapter demonstrates that COVID-19 deaths were higher in the North of England. It also demonstrates that this higher mortality in the North was not just a case of higher levels of area-level deprivation, but a case of deprivation amplification.

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