Analysis of apartheid history explains how Hanover Park has become what it is today. It was established on August 14th, 1958, as part of the Group Areas Act, which aimed to physically segregate the population based on race. Large central areas near to the resources of the metropolitan centre were allocated to white communities. Black Africans were pushed to the peripheral sites and coloured people were placed between the two. Nearly 150,000 coloured people were displaced to what would become known as the Cape Flats. Neighbourhoods, such as Hanover Park, were equipped with precincts, basic public facilities and arterial roads but no efforts were made to establish local industrial estates, employment centres or small business units1. Neither was there any governmental effort to develop local infrastructure for education, healthcare or public transport. Communities were forcefully relocated and provided with no support to rebuild a flourishing society. The quality of living in the relocated communities was further compromised by additional apartheid regulations such as Project Coast and gendering of the work force. Project Coast was initiated in 1981 and was motivated by the necessity for better crowd control and defensive agents. The South African white minority regime believed they were being threatened, and politicians and military leaders concurred that the country was at war. Chemical warfare was deemed as the most appropriate method to handle both internal and external conflict. Analysis of Project Coast after the fact however reveals it was primarily to target anti-apartheid riots erupting in the townships. In 1986, Dr. Basson, a leader of the project, allegedly introduced Mandrax into the townships via existing drug dealers. The exact purpose of introducing street drugs remains unclear but regardless, with employment opportunities being scarce, dealing street drugs became an appealing option to generate income2. Consequently, gangs formed, and turf wars commenced. Gendering of the workforce also contributed to the formation of gangs. The apartheid government prioritized colored women in the skilled labor industry. It was justified by the belief that women were less prone to unionize and stand up for labor rights. Between 1970 to 2000, the employment growth for men was 33% whereas for women it was 129%. Men consequently became financially dependent on the women in their lives. Gangs formed as an effort to survive and provide income either through drug dealing or by coordinated robbery efforts. Gangsterism, unemployment, drug abuse and poverty remain major concerns for present residents of Hanover Park. It is labeled as one of the most dangerous areas on the Cape Flats5 with 57% of the population affected by crime6. 9- to 13-year-olds are the most efficient hit men7. Over the course of 2012, 1 in 10 people were targeted by gang violence8. It is also an area that struggles with education and employment. 20.9% of the adult population have achieved a matric qualification while only 3.2% have achieved a qualification higher than matric. Low levels of education correlate with a high unemployment rate of 35.5%. Minimal employment results in 57.7% of households having a monthly income of R3,200 or less. The low socioeconomic status (SES) generated by apartheid traditions restricts the ability of residents to relocate to better communities and as such perpetuates the cycle of poverty, gangsterism and trauma.

Low socioeconomic status (SES) is a perpetuator of poor health in the community of Hanover Park. The link between the two can be explained by fundamental cause theory. SES encompasses resources of money, knowledge, power, prestige and beneficial social connections. These resources are defined as flexible resources because they can be deployed in numerous situations to avoid certain outcomes. For example, those with flexible resources can access and afford healthy food options to prevent health outcomes such as hypertension and diabetes. However those that lack the resources, lack the ability to sustain a healthy diet. As such, they are disproportionately impacted by related health conditions. Residents of Hanover Park experience a higher prevalence of non-communicable disease (i.e. hypertension and diabetes), malnutrition, HIV/AIDS and tuberculosis because they lack the resources required to prevent these health outcomes10. Interventions to address these conditions must contextualize risk factors and understand how the living environment generates them. Programs that are implemented should be independent of resources and be equally accessible to all regardless of SES.

The health concerns in Hanover Park persist because there is limited access to healthcare services and gaining access to the community to implement interventions is restricted by the complexities of working on gang territory. Hanover Park Day Hospital is only open from 7H00 to 19H00. To see a doctor at 7H00 requires residents to line up at 4H00, regardless of the weather conditions. Once residents are finally able to see a doctor, the quality of care they receive is subpar. Doctors are overwhelmed with the volume of patients and do not provide adequate care. If a resident requires medications or further services, they must wait yet another couple of hours or even days. It is no surprise that residents will simply not seek medical care. Attending the hospital is a time-consuming process that ultimately does not benefit the individual. It is also a financially consuming process because it entails transportation costs and potentially having to take time off work. For families that are financially strained, spending money on inadequate healthcare services is not a priority; buying food is. External initiatives to increase availability of medical services often fail in Hanover Park because of the intricacies of operating on gang territory. It places the entire team at risk unless a working relationship is developed with the gang. The community must understand that the medical staff entering the area are there to aid and not cause any harm or challenge anyone. If a mutual understanding and respect is not cultivated between community members, gang members and the intervention team, then efforts will prove futile. Residents of Hanover Park will remain impacted by apartheid traditions and the resulting health challenges unless access to the community is granted and multi-faceted interventions can be implemented.

The focus of Helping Health is to increase availability of medical services for individuals with limited access and target barriers to better health. The project will adopt a bio-psychosocial concept of health to account for the interrelatedness between medical outcomes and the living conditions of individuals. We will focus on addressing general physical health, mental health and nutrition through health screening days. Youth, elderly and those with diversabilites will be the primary focus of the program. A scoping pilot project will be executed in Hanover Park to develop a model that can be implemented in similar communities and rural areas across South Africa. Hanover Park will be the region for the pilot because Humanitas has identified the need for access to quality healthcare services in the community and has taken the necessary steps to ensure a program can be safely and effectively implemented. We have working relations with Women-to-Women, Cycle of a Women, and other community members so that our team is able to safely gain access to Hanover Park. Both Women-to-Women and Cycle of a Women are grassroot, non-profit organizations focused on assisting women who are victims of gender-based violence. They have agreed to assist in community introductions and in cultivating respect between community members, the gang members and our team.