Public Health Problems in Apartheid South Africa http://www.aluka.org/action/showMetadata?doi=10.5555/AL.SFF.DOCUMENT.nuun1979_08 Use of the Aluka digital library is subject to Aluka’s Terms and Conditions, available at http://www.aluka.org/page/about/termsConditions.jsp. By using Aluka, you agree that you have read and will abide by the Terms and Conditions. Among other things, the Terms and Conditions provide that the content in the Aluka digital library is only for personal, non-commercial use by authorized users of Aluka in connection with research, scholarship, and education. The content in the Aluka digital library is subject to copyright, with the exception of certain governmental works and very old materials that may be in the public domain under applicable law. Permission must be sought from Aluka and/or the applicable copyright holder in connection with any duplication or distribution of these materials where required by applicable law. Aluka is a not-for-profit initiative dedicated to creating and preserving a digital archive of materials about and from the developing world. For more information about Aluka, please see http://www.aluka.org Public Health Problems in Apartheid South Africa Alternative title Notes and Documents - United Nations Centre Against ApartheidNo. 7/79 Author/Creator United Nations Centre against Apartheid; Fullerton, Anne Publisher United Nations, New York Date 1979-03-00 Resource type Reports Language English Subject Coverage (spatial) South Africa Coverage (temporal) 1979-00-00 Source Northwestern University Libraries Description Morbidity and Mortality. Health services. Provision of health services. Financing of health services. Discrimination within health. Format extent 18 page(s) (length/size) http://www.aluka.org/action/showMetadata?doi=10.5555/AL.SFF.DOCUMENT.nuun1979_08 http://www.aluka.org NOTES AND DOCUMENTS* NOTES AND DOCUMENTS* MARCH 1979 PUBLIC HEALTH PROBLEMS IN APARTHEID 'I SOUTHAFRICA **by Anne Fullerton, School of Public Health, University of Michigan ** This paper was submitted to the Conference on Apartheid or Health held in London on 3 February 1979 under the auspices of the Anti-Apartheid Health Committee. The views expressed are those of the author. * All material in these notes and documents may be freely reprinted. 79-26135 Acknowledgement, together with a copy of the publication containing the reprint, would be appreciated. 7/79 Introduction In 1967, the world was amazed when South Africa announced that a young surgeon, Dr. Christian Barnard, had just completed the first successful human heart transplant at Groote Schuur Hospital in Cape Town. In 1967, the rate of kwashiorkor in the African population of South Africa was 66.6 cases per 100,000 although kwashiorkor ceased to be a notifiable disease that year because the white rate had dropped to 0.19:100,000. In 1967, a critically injured white man Jay unconscious on Ulazi Bridge near Durban 1 1/2 hours because the first ambulance sent to his aid was for non-whites and could not carry him. An ambulance for whites was later sent. The man died a few days after this incident. No single year in South African health history more clearly demonstrates the paradox of this country where 7 per cent of the population benefit from a health care system which rivals those of the developed world while the vast majority of the South African people labour under the heavy burden of largely preventable diseases combined with high infant mortality rates and woefully indadequate health services. The question "apartheid or health" has been posited precisely because the apartheid system in South Africa is antithetical to the production of a healthy society. Apartheid has created a structure which maintains most of the black South African majority in abject poverty with its concommitant disease burden: malnutrition illnesses, infections diseases aggravated by malnutrition, parasitic illnesses generated by poor sanitary conditions, and vaccine-preventable diseases due to inadequate preventive health services. Apartheid has also created created a stressful social structure. Forced population removals, migrant labour, lack of freedom of expression and the daily threat of Government harrassment have led to high rates of mental illness and stress-related chronic diseases. Apartheid has generated a dual pathology of poverty and violence which prevents South Africa from achieving an optimal level of health. Apartheid has also an impact on the availability of health care. White South Africa enjoys a health care system similar to those of Western nations. Most South Africans, however, must be content with a system characterized by overcrowded facilities, a chronic shortage of medical personnel, and numerous other barriers to access, both financial and structural. As with other professions, apartheid affects the health field. The African does not have equal access to medical education and this -2- differential persists throughout his/her career in the form of wage discrimination. Finally, petty apartheid remains pervasive in the health area and particularly affects the system's ability to provide rapid and efficient emergency services to all groups. If apartheid is incompatible with the production of a healthy society then it follows that the pursuit of bantustanization (as a fulfilment of separate development) can only exacerbate the existing problems. With bantustanization, migrant labour and familial separation become the norm. With bantustanization, the dual economy of health services achieves its fullest expression in the complete geographic separation of black and white health facilities. With bantustanization, a horrific scenario emerges: apartheid may wash its hands of the diseases it has wrought by dumping the diseased back on the bantustan health services whose strained resources cannot bear the burden. With bantustanization, labour is not only cheap but disposable. This paper will examine the impact of apartheid on health and health services in South Africa. We will show first that apartheid has an impact on health and disease and we will look generally at the morbidity and mortality patterns, then more specifically at three public health problems: malnutrition, occupational illness and mental disease. This will be followed by an examination of the impact of apartheid on delivery of health services in South Africa. Apartheid, we will conclude, cannot produce an adequate functional level of health, let alone optimal experiental health. -3- PART I Morbidity and mortality The vital statistics for the Republic of South Africa give the impression of two completely different societies. While the crude death rates for the white population has remained low and fairly constant over the last two decades (indicating that they have achieved a minimum possible mortality rate), the African and Coloured rates have declined (with the control of infectious diseases) but continue to be substantially higher than the white rates. White life expectancy (male) stands at 64,5 years while African life expectancy has been estimated at 52 years. The infant mortality rates, however, are most indicative of the difference in black and white health status. Infant mortality for white South Africans in 1974 was 18,4 deaths per 1,000 live births. Coloureds had an infant mortality rate (imr) of 115.5 in 1974. For Africans, the most recent figures range from 77 in Durban to 216 in the Transkei. 1/ The causes of infant mortality are conmpletely diferent as well. Prematurity is the leading cause of white infant deaths while diarrhoeal disease is the leading cause of Coloured infant mortality. Diarrhoeal disease is not a leading cause of death for white infants; neither is measles - although it is a leading cause of death in Coloured and Asian infants. This pattern can only be attributed to apartheid. Diarrhoea and measles are normal diseases of childhood across the world but combined with malnutrition, poverty and inadequate health care, they can be fatal. Diarrhoea leads to further nutritional malabsorption and death from dehydration in children already weakened by malnutrition; measles can develop into pneumonia in the malnourished child. Many of the infant deaths in the black population may probably have malnutrition as their secondary cause. A survey of the post mortem records from King Edward VIII and Addington Hospitals from 1973-75 shows that while 30 per cent of African and Asian deaths in children under 10 years were due to malnutrition, no white children died from malnutrition during those years.2/ As infant mortality rates are high for black South Africans, it also follows that infant deaths represent a high proportion of all deaths. Perinatal diseases is a leading cause of death in the Coloured and Asian population but not among the whites. The adult white mortality pattern is similar to those in developed countries with a preponderance of heart disease, strokes and neoplasms. I/ 'Implications of apartheid on health and health services in South Africa", Notes and Documents No. 18/77,June 1977. Cardiovascular diseases account for 46.4 per cent of white (male) deaths but only 17,5 per cent of Coloured deaths. Infections and parasitic diseases account for 24,6 per cent of Coloured deaths but only 1,9 per cent of white deaths. Cancers account for fewer deaths in the Coloured community but this is due primarily to the fact that many cancers have a latency period of over 20 years and with the low life expectancy, many black South Africans do not live long enough to die of cancer. The King Edward VIII and Addington Hospital survey also shows that while adult Africans and Asians died of turberculosis and typhoid (which are vaccine preventable) there were few white deaths from these diseases. The morbidity patterns are also different across the different racial groups. Some diseases, such as polio, have changed in their relative incidence rates. Prior to the major 1961 polio immunization campaign, the white rates for polio were higher than the rate for Africans, while the African rate at present is higher.