The health of the urban black in the South African context

The state of medicine in South Africa is a mixture of development and under-development. The Whites have the disease patterns typical of highly-industrialised western countries. By reason of their privileged position they have also abrogated to themselves most of the medical resources so that sophisticated health services for Whites can only exist at great cost to the Black population which bears the main burden of disease in the country. Infectious and epidemic diseases due to poor environmental conditions do not occur in the White population and they are also protected from most industrial accidents as they perform work which is largely supervisory, technical or professional. Among Blacks the major health problems relate to poverty, lack of adequate sanitation and water, over-crowded housing and the occupational hazards of low status workers poorly protected in many cases from industrial accidents. The high increase of infectious and epidemic diseases, particularly in the early years of life as well as tuberculosis are indicative of the difference between the two groups. During 1980 and again in 1981 there have been severe outbreaks of cholera among Black rural populations illustrating the failure of the society to provide its citizens with an unpolluted water supply, but this problem does not receive urgent attention in a country which instead pioneers new techniques in heart transplant surgery. However, the health problems of all Blacks in the Republic of South Africa are becoming differentiated today in terms of rural urban dichotomy. Because the modern sector of the economy needs permanently urbanised workers able to produce efficiently as well as reproduce themselves, some measure of attention has been given to the improvement of the environmental conditions and the health services of the worker in the city. This paper proposes that we consider the disease patterns and access to health care in South Africa in terms of three tiers of health with the Whites in the first tier, the urban Black population in the second tier and the rural Black in the third tier. this paper focuses on the position of the Blacks in the second tier and it shows that some of their most urgent health problems have received attention, yet in contrast with the Whites, in the first tier, glaring inequalities remain. But almost two-thirds of the Black population remains rural and the most signicant imbalance in terms of health is not being redressed.