Changes in public health in South Africa from 1876

Abstract

The present population in South Africa, roughly 43 million inhabitants, is made up of Africans (77.2%), whites (10.5%), Coloureds (mixed race) (8.8%) and Indians (2.5%). In 1900 the infant mortality rate (IMR) among Africans was 330 per 1,000 live births; this has now fallen to 50-60. In Soweto, a primarily African city, IMR averages 20-25. Life expectancy in the past was only 25-30 years; by 1995, this reached 63 years. However, this could fall again due to the rapidly spreading HIV/AIDS epidemic. Life expectancy could fall to 40-45 years by 2010 with the AIDS epidem ic being the cause of half of all deaths - a disastrous change from the pre vious relatively commendable public health situation. Formerly, the most common causes of deaths in young people were infections, diseases asso ciated with malnutrition and gastroenteritis. Adults died almost solely from infections, including typhoid, dysentery, malaria and tuberculosis (TB). Even though diseases associated with malnutrition are less com mon today, many infections still remain a major problem, particularly TB, which is increasing. As late as 1970, Africans who reached 50 years had longer life expectancy than whites due to the low prevalences of the chronic diseases of lifestyle. This is no longer so, due to the recent rises in non-communicable disorders/diseases, principally obesity in women, hypertension, diabetes, stroke and the cancers of prosperity. In the not so distant future, the level of control of HIV/AIDS related diseases will be the major health/disease regulating factor among Africans. Among white, Coloured and Indian populations, there have been falls in the mor tality rates of the young and, despite rises in lifestyle diseases, increases in life expectancy are continuing. For all populations other important pub lic health regulatory factors include water supply, sanitation, clinic/hospi tal services and personal environmental factors, employment, dietary pat tern and intake, smoking practices and alcohol consumption and physical activity, particularly in urban dwellers. Unfortunately, public health expen diture, also a highly regulating factor, has fallen from 8.2% of the gross domestic product in 1994 to 4.1% in 2000.

Keywords

Changes health history ill-health public health South Africa

Get full access to this article

View all access options for this article.

References

Albonico M. , Crompton D.W. and Savio-Li L. (1999). Control strategies for human intestinal nematode infections. Adv Parasitol; 42, 278-320

Anonymous (1900). Water supply in South African towns. Lancet; ii, 1300-1301

Anonymous (1905). Public Health in Johannesburg. Lancet; i, 875-876

Anonymous (1912). News from South Africa. Lancet; i, 1651-1652

Anonymous (1997). Trends in the prevalence and incidence of self-reported diabetes - United States, 1980-1994 . Morb Mortal Wkly Rep; 46, 1014-1018

Anonymous (1999a). Public health in a new era. Bull World Health Org; 77, 202-203

Anonymous (1999b). Ten great public health achievements - United States, 1900-1999. Morb Mortal Wkly Rep; 48, 241-243

Anonymous (2000). Cause specific adult mortality. Evidence from community based surveillance - selected sites Tanzania, 1992-1998. Morb Mortal Wkly Rep; 49, 416-419

Baleta A. (1999). South Africa is to redouble efforts to control the spread of HIV. Lancet; 354, 844

10.

Birley H D L (1995). Human papillomaviruses, cervical cancer and the developing world. Ann Trop Med Parasitol; 89, 453-463

11.

Bourne L.T. , Langenhoven M.L. , Styn K. , Jooste P.L. , Laubscher J.A. and Van Der Vyver E. (1993). Nutrient intake in the urban population of the Cape Peninsula, South Africa. The BRISK study. Cent Afr J Med; 39, 238-247

12.

Bourne L.T. , Langenhoven M.L. , Styn K. , Jooste P.L. , Nesamvuni A.E. and Laubscher J.A. (1994). The food and meal pattern in the urban African population of the Cape Peninsula, South Africa: the BRISK study. Cent Afr J Med; 40,140-148

13.

Bradshaw D. , Masiteng K. and Nannan N. (2000). Health Status and Determinants. South African Health Review, pp. 89-124. Durban: Health Systems Trust

14.

Chinyadza E. , Moyo I.M. , Katsumbe T.M. , Chisvo D. , Mahari M. , De Cock A., et al (1993). Alcohol problems among patients attending five primary healthcare clinics in Harare city. Cent Afr J Med; 39, 26-32

15.

Coetzee R. (1982). Funa: Food from Africa, p. 3, 32. Durban: Butterworth and Co

16.

Coutsoudis A. , Pillay K. , Spooner E. , Kuhn L. and Coovadia H.M. (1999). Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. Lancet; 354, 471-476

17.

Crisp N. and Ntuli A. (1999). Overview. South African Health Review. Durban: Health Systems Trust

18.

Dorrington R. , Bradshaw D. , Bourne D. and Abdool-Karim S. (2000). HIV surveillance results. S Afr Med J; 90, 452-453

19.

Ernst E. (2000). The role of complementary and alternative medicine . BMJ; 321, 1133-1135

20.

Floyd K. , Reid R.A. , Wilkinson D. and Gilks C.F. (1999). Admission trends in a rural South African hospital during the early years of the HIV epidemic. JAMA; 282,1087-1091

21.

Friedman I. (1999). Poverty, Human Rights and Health. South African Health Review. Durban: Health Systems Trust

22.

Gottlieb S. (2000). UN says up to half the teenagers in Africa will die of AIDS. BMJ; 321, 67

23.

Hahn R.A. Teusch S.M. , Rothenberg R.B. and Marks J.S. (1990). Excess deaths from nine chronic diseases in the United States, 1986. JAMA; 264, 2654-2659

24.

Harvey-Pirie J.H. and Murray W.A. (1927). Plague in the North West of the Cape Province . S Afr Med J; 1, 50-59

25.

Hewat M. (1895). Annual health report of Mowbray municipality, year 1894. S Afr Med J; 2, 319-320

26.

Izindaba (2000). Half Botswana's deaths from AIDS. S Afr Med J; 90, 1170-1171

27.

Jacobs D.R. , Adachi H. , Mulder I. , Kromhout D. , Menotti A. , Nissinen A., et al (1999). Cigarette smoking and mortality risk. Arcb Intern Med; 159, 733-740

28.

Keil J. , Sutherland S.E. , Knapp R.G. and Tyroler H.A. (1992). Does equal socioeconomic status in black and white men mean equal risk of mortality? Am J Public Health; 82, 1133-1136

29.

Labadarios D. , Walker A R P , Blaauw R. and Walker B.F. (1996). Traditional diets and meal patterns in South Africa. World Rev Nutr Diet; 79,70-108

30.

Laidler P.W. and Gelfand M. (1971). South Africa: Its Medical History 1652-1898. Cape Town: C Struik (Pty) Ltd

31.

Last J.B. (1981). Scope and Method of Prevention. Public Health and Preventive Medicine, pp. 3-8. (Edited by Maxcy-Rosenau). New York: Appleton-Century-Crofts

32.

Logie D. (1999). AIDS cuts life expectancy in sub-Saharan Africa by a quarter. BMJ; 319, 806

33.

Matthews H. (1998). HIV vaccine partnerships offer hope to the developing world. BMJ; 317,1543

34.

Morris K. (2000). Authorities fiddle while HIV burns in South Africa . Lancet; 356, 1912

35.

Oginni L L M , Worsfold M. , Oyelami O.A. , Sharp C.A. , Powell D.E. and Davie M W J (1996). Etiology of rickets in Nigerian children. J Pediatr; 128, 692-694

36.

Omar M A K , Seedat M.A. , Motala A.A. , Dyer R.B. and Becker P. (1993). The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks. S Afr Med J; 83, 641-643

37.

Oxorio P. (1992). Drinking increases along with alcohol production . World Health; April, 30

38.

Potter J.D. (1997). Hazards and benefits of alcohol. N Engl J Med; 337,1763-1764

39.

Seftel H.C. (1985). Southern African perspective : alcohol and alcoholism . Med Int; 30, 336

40.

Sharp B. , Craig M. , Curtis B. , Mnzava A. , Maharaj R. and Kleinschmidt I. (2000). Malaria. South African Health Review, pp. 351-364. Durban: Health Systems Trust

41.

Simkins C. and Van Heyningen E. (1989). Fertility, mortality, and migration in the Cape Colony, 1891-1904. Int J Afr Historical Studies; 22, 79-111

42.

Sitas F. , Madhoo J. and Wessie J. (1998). Cancer in South Africa, 1993-1995. National Cancer Registry of South Africa. Johannesburg: South African Institute for Medical Research

43.

Skordis J. (2000). South Africa. Mail and Guardian July 21, 1

44.

Smith L.R. and Douglas R.M. (1995). High and low roads to Aboriginal health. Med J Aust; 163, 97-99

45.

Smith S.C. (2000). Putting prevention into practice. Med Clin NAmer; 84, 267-268

46.

South Africa (1998-99). Official Year Book of the Republic of South Africa. History, pp. 23-26. 14thEdition. Cape Town: CTP Publishers

47.

South African Demographic And Health Survey ( 1998). Preliminary Report, pp. 28-37. Cape Town: Medical Research Council

48.

South African Health Review (1997). Durban: Health Systems Trust

49.

South African Health Review (1999). Durban: Health Systems Trust

50.

South African Health Review (2000). Durban: Health Systems Trust

51.

Steinberg M. , Kinghorn A. , Soder-Lund N. , Schierhout G. and Conway S. (2000). HIV-facts, Figures and the Future. South African Health Review, pp. 301-326. Durban : Health Systems Trust

52.

Thankappan K.R. and Valiathan M.S. (1998). Health at low cost - the Kerala model. Lancet; 351, 1274-1275

53.

Trowell H.C. (1960). Non-Infective Disease in Africa. London: Edward Arnold Ltd

54.

Us Department Of Health And Human Services ( 1993). US Department of Health and Human Services. Public Health Service. Centers for Disease Control and Prevention. National Center for Health Statistics

55.

Van Heyningen E.B. (1989). Public Health and Society in Cape Town in 1880-1910. Doctor of Philosophy Thesis. Department of History, University of Cape Town

56.

Van Rensburg H.J. (1995). South African Year Book. Cape Town, South African Communication Service, pp. 27-38

57.

Vorster H.H. , Venter C.S. , Menssink E. , Van Staden D.A. , Labadarios D. , Stry-Dom A J C, et al (1994). Adequate nutritional status despite restricted dietary variety in adult rural Vendas. S Afr J Clin Nutr; 7(2), 3-16

58.

Walker A R P (1981). South African Black, Indian and Coloured Populations . In: Western Diseases : Their Emergence and Prevention, pp. 285-318. (Edited by H C Trowell and D P Burkitt). London: Edward Arnold Ltd

59.

Walker A R P (1997). Public nutrition: who is listening, responding, acring? Nutr Res; 17, 359-373

60.

Walker A R P (1998). Etiology of nutritional rickets: geographic variations . J Pediatr; 132,187-189

61.

Walker A R P , Dini L.A. , Walker B.F. and Frean J.A. (2000). Helminthiasis in African children in a relatively low risk region in South Africa: implications for treatment? S Afr J Epidemiol Infect; 15,98-99

62.

Walker A R P , Dunn M.J. , Dunn S.E. and Walker B.F. (1994). Causes of admissions of rural African patients to Murchison Hospital, Natal, South Africa. J Ray Soc Health; 114, 33-38

63.

Walker A R P and Wadee A.A. (2000). In the rationing of healthcare in indigent African populations, which services should come first? J Roy Soc Health; 120, 152-157

64.

Wolmarans P. , Langenhoven M.L. , Benade A J S , Swanepoel A S P , Kotze T J V W and Rossouw J.E. (1988). Intake of macronutrients and their relationship with total cholesterol and high-density lipoprotein cholesteroL The Coronary Risk Factor Study, 1979. S Afr Med J ; 73, 12-15

65.

Yach D. and Townshend G.S. (1988). Smoking and health in South Africa. S Afr Med J; 73, 391-399