One in five adults in Cape Town - hundreds of thousands of people - say they cannot afford to eat the correct foods required for health and wellbeing.
And the legacy of apartheid is still devastating, with black squatter families being the worst off in the city.
But Cape Town residents are generally better off than people in other metro areas when it comes to access to basic services.
These are just some of the findings of a Research Surveys study to uncover what it terms the "Everyday quality of life (EQL) of South Africa's city dwellers".
The study was conducted in August among a sample of 3 885 people aged 16 and over countrywide.
Included in the study was a comparison showing how access to basic amenities in the Cape Town metro measured up against other cities.
The study found that in the city:
- Around 80 percent have water from a municipal source in their homes compared to 81 percent on average in all metro areas.
- And 91 percent have a flush toilet against 88 percent in all metro areas.
- Access to a landline phone system is limited to 53 percent of households - but this is still much higher than the overall metro average of 26 percent.
- Half the households have a car, against 32 percent in all metro areas.
- According to the study, 93 percent of people have tarred roads in their neighbourhoods compared with 73 percent nationally.
- And 59 percent of households have a hospital nearby, up on the 51 percent across all metro areas.
The calculations include socio-economic status, with special reference to poverty; urbanisation; health (which includes nutrition, exercise and fitness, as well as fitness orientation, stress and pressure); quality of environment; and satisfaction of human needs.
An index which runs from zero to 100 is used, where a high score indicates the poorest.
The average for Cape Town was 21, significantly better than the national metro average of 26.
In Cape Town, eight percent of people score above 50 on the index (compared to 13 percent across all metro areas); three percent score above 60 (seven percent across all metro areas;) and less than one percent score above 80, compared with two percent in all metro areas.
Research Surveys said in its summary: "Clearly, Cape Town is better off in terms of poverty and access to basic amenities than the average South African metro area."
However, there are still significant disparities:
- Whites score an average of just six - indicating this group is extremely well off.
- Coloured people score 18.
- Black people score 37 overall - and 24 percent score 50 or more, 12 percent over 60 and two percent fall into the extreme hardship bracket.
- People living in informal settlements score 53, with two-thirds living in poverty and six percent in extreme hardship.
"The need for the improvement of the lives of people in urban squatter shacks is urgent as EQL improves immensely once people have a formal dwelling in which to live. People in formal houses in the former townships score a better 30 with only six percent above 50," Research Surveys says.
"One in five adult residents of the city say that they cannot afford to eat the correct foods. This rises to one in four people over 50 years old and one in three of those at the bottom end of the income ladder and those who are unemployed."