Document Detail

Inequalities in health and disease: the case of mortality rates for the city of Johannesburg, South Africa, 1910-1979.
MedLine Citation:
PMID:  7141776     Owner:  NLM     Status:  MEDLINE    
This article analyzes crude death and infant mortality rates for the different population groups in Johannesburg, the largest city in the Republic of South Africa. The analysis is based on official statistics collected by the Department of Health between 1910 and 1979. Over this period, death rates have declined for white, black, Colored, and Asian citizens. However, the present situation reflects the gross inequalities in the health status of the different population groups in South Africa, a country where disease patterns and access to medical resources are as stratified as any other index of social class.
This paper explores the relationship of disease to economic, political, and social factors and relates mortality experience to social change through the use of historical data for the years 1910-79 in Johannesburg, South Africa. Present health and environmental services are impressive, yet wide discrepancies remain in the mortality rates of the different population groups. Soweto, constructed after 1950 to absorb the large numbers of black squatters attracted by employment opportunities in the city, today has 2 or perhaps 3 times the population of white Johannesburg. As is true in the white, Colored, and Asiatic areas, preventive and promotive health services remain the responsibility of the local authority. From the outset, mortality rates in Johannesburg showed a racial hierarchy reflecting the socioeconomic status of the population groups. In 1910-11 whites had the lowest crude death rate (13.3), followed by Asiatics (19.7), Colored (31.1), and blacks (33.6). Difficulties in measuring black mortality have persisted from 1910 to the present and will continue as long as rural black migration to urban areas remains illegal, causing migrants to evade census takers. By the end of World War II the white crude death rate was as low as in any advanced industrial country, and Colored and Asiatic rates also declined as economic opportunities for these groups expanded. By 1977, whites and Asiatics were suffering from the diseases of affluence, such as coronary heart disease, and Coloreds occupied an intermediate position, while blacks had fewer such diseases and a mortality pattern typical of developing countries. The same problems hampering calculation of black adult mortality rates also apply to infant mortality. Increased notification of births by doctors, hospitals, and midwives and official calculation of black infant mortality rates from birth notifications rather than registration have yielded lower rates since 1972, but it is impossible to separate out the improvement in environmental and health conditions from the change in computation, and black infant mortality rates are certainly far higher than those for whites.
B Unterhalter
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  International journal of health services : planning, administration, evaluation     Volume:  12     ISSN:  0020-7314     ISO Abbreviation:  Int J Health Serv     Publication Date:  1982  
Date Detail:
Created Date:  1983-01-19     Completed Date:  1983-01-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1305035     Medline TA:  Int J Health Serv     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  617-36     Citation Subset:  IM; J    
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MeSH Terms
African Americans
African Continental Ancestry Group
Asia / ethnology
European Continental Ancestry Group
Infant Mortality*
Infant, Newborn
Middle Aged
South Africa
Urban Health

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