Andersson N, Marks S
TUC Centenary Institute of Occupational Health, London School of Hygiene and Tropical Medicine, England.
Soc Sci Med. 1988;27(7):667-81. doi: 10.1016/0277-9536(87)90327-3.
The last 5 years have seen dramatic developments in South Africa, with wide-based internal political struggles and international pressure forcing the government into a well publicized if temporary series of reforms. Yet this has not been paralleled by any substantial improvement in the health conditions of the majority of the population. Apart from improvements in black infant mortality in some urban areas, the health gap remains, a material expression of the social inequality that is part of the definition of apartheid. Black children continue to die from preventible afflictions at about 10 times the rate of their white counterparts. Maternal deaths among women classified as black, coloured or Asian continue to occur, mostly due to septic abortions. At national level, blacks are nearly 30 times more at risk of being diagnosed to have tuberculosis than whites, with some age groups being at still worse risk. Black children under the age of 4 years in Cape Town in 1984 were 205 times more likely to have tuberculosis than their white counterparts. The last 5 years has also seen a revival of rhetoric echoing the international support for primary health care in the 1970s, but health care processes have not been modified to cope with the continuing racial stratification of disease and access to health care. A move towards privatization of the health services has only benefited a few.
过去五年间，南非发生了巨大的变化，广泛的国内政治斗争和国际压力迫使政府进行了一系列广为人知但只是暂时的改革。然而，大多数民众的健康状况并未因此得到实质性改善。除了一些城市地区黑人婴儿死亡率有所下降外，健康差距依然存在，这是种族隔离定义中社会不平等的具体体现。黑人儿童因可预防疾病死亡的比率仍是白人儿童的约10倍。被归类为黑人、有色人种或亚洲人的女性中，孕产妇死亡仍时有发生，主要原因是感染性流产。在国家层面，黑人被诊断患有结核病的风险几乎是白人的30倍，某些年龄组的风险更高。1984年，开普敦4岁以下的黑人儿童患结核病的可能性是白人儿童的205倍。过去五年里，也再次出现了类似20世纪70年代国际上对初级卫生保健支持的言论，但医疗保健程序并未因应疾病的持续种族分层和获得医疗保健的机会而做出调整。医疗服务私有化的举措仅使少数人受益。
