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November 20, 1991, Vol 266, No. 19 >
ARTICLE | November 20, 1991

Medical Apartheid: Title and subTitle BreakAn American Perspective FREE

Durado D. Brooks, MD; David R. Smith, MD; Ron J. Anderson, MD
[+] Author Affiliations

Reprint requests to COPC, 6263 Harry Hines Blvd, Suite 401, Dallas, TX 75235 (Dr Brooks).


JAMA. 1991;266(19):2746-2749. doi:10.1001/jama.1991.03470190094036
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References

The suppressive policies and practices of apartheid in South Africa have directly contributed to preventable morbidity and mortality in black Africans. Due to socioeconomic segregation ("functional apartheid"), America's citizens of color also suffer excess death and disability. Health status measurements in the United States confirm the failure of the current fragmented health care system to recognize or respond to the unmet need or the barriers that exist. Predictably, the changes needed to improve the health status of black South Africans are similar to those that are necessary to remedy the situation in the United States. Community-Oriented Primary Care is a health service provision model that holds promise as a comprehensive community-based strategy that can begin to address some of the shortcomings of the current medical care systems of both nations.

(JAMA. 1991;266:2746-2749)

REFERENCES

1 +
Nightingale EO, Hannibal MA, Geiger J, Hartmann L, Lawrence R, Spurlock J.  Apartheid medicine: health and human rights in South Africa. JAMA . 1990;;264:2097-2107.
2 +
Trevino FM, Moyer ME, Valdez RB, Stroup-Benham AS.  Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans. JAMA . 1991;;265:233-237.
3 +
Hadley J, Steinberg EP, Feder J.  Comparison of uninsured and privately insured hospital patients. JAMA . 1991;;265:374-379.
4 +
Abkiewicz SR, Ahmed AS, Alli MA, et al.  Conditions at Baragwanath Hospital. S Afr Med J . 1987;;72:361.
5 +
Dietrich HJ, Biddle VH. The Best in Medicine: How and Where to Find the Best Health Care Available . New York, NY: Harmony Books; 1990;:18.
6 +
Texas Hospital Association. Women and Children First: A Plan for Improving Texas' Maternal and Child Health Outcomes in the 1990s . Austin, Tex: Texas Hospital Association;1991;:14.
7 +
Schwartz E, Kofie VY, Rivo M, Tuckson RV.  Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia, 1980-1986. Int J Epidemiol . 1990;;19:591-598.
8 +
McCord C, Freeman HP.  Excess mortality in Harlem. N Engl J Med . 1990;;322:173-177.
9 +
Council on Scientific Affairs, American Medical Association.  Hispanic health in the United States. JAMA . 1991;;265:248-252.
10 +
Botha JL, Bradshaw D.  African vital statistics: a black hole? S Afr Med J . 1985;;67:977-981.
11 +
Molteno CD, Kibel MA.  Postneonatal mortality in the Matroosberg Divisional Council Area of the Cape Western Health Region. S Afr Med J . 1989;;75:575-578.
12 +
Children's Defense Fund. The State of America's Children . Washington, DC: Children's Defense Fund; 1991;:60.
13 +
Knutzen V, Bourne D.  The reproductive efficiency of the Xhosa. S Afr Med J . 1977;;51:392-394.
14 +
Yach D.  Infant mortality rates in urban areas of South Africa, 1981-1985. S Afr Med J . 1988;;73:232-234.
15 +
Rip MR, Bourne DE.  The spatial distribution of infant mortality rates in South Africa, 1982. S Afr Med J . 1988;;73:224-226.
16 +
Wyndham CH.  Mortality rates of black infants in Soweto compared with other regions of South Africa. S Afr Med J . 1986;;70:281-282.
17 +
Seedat YK, Naicker S, Rawat R, Parsoo I.  Racial differences in the causes of end-stage renal failure in Natal. S Afr Med J . 1984;;65:956-958.
18 +
Gold CH, Isaacson C, Levin J.  The pathological basis of end-stage renal disease in blacks. S Afr Med J . 1982;;61:263-265.
19 +
Eggers PW, Connerton R, McMullan M.  The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival. Health Care Financing Rev . Spring 1984;;5( (3) ):69-88.
20 +
Rostand SG, Kirk KA, Rutsky EA, Pate BA.  Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med . 1982;;306:1276-1279.
21 +
Bourne BE, Rip MR, Woods D.  Characteristics of infant mortality in the RSA, 1929-1983. S Afr Med J . 1988;;73:230-232.
22 +
Kettles AN.  Differences in trends of measles notifications by age and race in the western Cape, 1982-1986. S Afr Med J . 1987;;72:317-320.
23 +
Mji D, Vallabhjee KN.  Health in post-apartheid South Africa. S Afr Med J . 1990;;78:122-123.
24 +
 Policy statement on discrimination in medical practice. S Afr Med J . 1989;;75:560.
25 +
Dana MR, Tielsch JM, Enger C, Joyce E, Santoli JM, Taylor HR.  Visual impairment in a rural Appalachian community. JAMA . 1990;;264:2400-2405.
26 +
Council on Ethical and Judicial Affairs, American Medical Association.  Black-white disparities in health care. JAMA . 1989;;263:2344-2346.
27 +
Connor E, Mullan F, eds. Community Oriented Primary Care: New Directions for Health Services Delivery . Washington, DC: Institute of Medicine, National Academy Press; 1983;.
28 +
Nutting PA, Wood M, Conner EM.  Community-oriented primary care in the United States. JAMA . 1985;;253:1763-1766.
29 +
Kark SL. The Practice of Community-Oriented Primary Health Care . New York, NY: Appleton-Century-Crofts; 1981;.
30 +
Klopper JML, Tibbit L.  The Mamre Community Health Project. S Afr Med J . 1988;;74:319-320.
31 +
 Heart disease study launched in western Cape. S Afr Med J . 1990;;77:12.
32 +
Otten MW, Teutsch SM, Williamson DF, Marks JS.  The effect of known risk factors on the excess mortality of black adults in the United States. JAMA . 1990;;263:845-850.
33 +
Workforce 2000, Work and Workers for the 21st Century: Executive Summary . Washington, DC: Hudson Institute Inc;1989;:89-95.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Nightingale EO, Hannibal MA, Geiger J, Hartmann L, Lawrence R, Spurlock J.  Apartheid medicine: health and human rights in South Africa. JAMA . 1990;;264:2097-2107.
2 +
Trevino FM, Moyer ME, Valdez RB, Stroup-Benham AS.  Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans. JAMA . 1991;;265:233-237.
3 +
Hadley J, Steinberg EP, Feder J.  Comparison of uninsured and privately insured hospital patients. JAMA . 1991;;265:374-379.
4 +
Abkiewicz SR, Ahmed AS, Alli MA, et al.  Conditions at Baragwanath Hospital. S Afr Med J . 1987;;72:361.
5 +
Dietrich HJ, Biddle VH. The Best in Medicine: How and Where to Find the Best Health Care Available . New York, NY: Harmony Books; 1990;:18.
6 +
Texas Hospital Association. Women and Children First: A Plan for Improving Texas' Maternal and Child Health Outcomes in the 1990s . Austin, Tex: Texas Hospital Association;1991;:14.
7 +
Schwartz E, Kofie VY, Rivo M, Tuckson RV.  Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia, 1980-1986. Int J Epidemiol . 1990;;19:591-598.
8 +
McCord C, Freeman HP.  Excess mortality in Harlem. N Engl J Med . 1990;;322:173-177.
9 +
Council on Scientific Affairs, American Medical Association.  Hispanic health in the United States. JAMA . 1991;;265:248-252.
10 +
Botha JL, Bradshaw D.  African vital statistics: a black hole? S Afr Med J . 1985;;67:977-981.
11 +
Molteno CD, Kibel MA.  Postneonatal mortality in the Matroosberg Divisional Council Area of the Cape Western Health Region. S Afr Med J . 1989;;75:575-578.
12 +
Children's Defense Fund. The State of America's Children . Washington, DC: Children's Defense Fund; 1991;:60.
13 +
Knutzen V, Bourne D.  The reproductive efficiency of the Xhosa. S Afr Med J . 1977;;51:392-394.
14 +
Yach D.  Infant mortality rates in urban areas of South Africa, 1981-1985. S Afr Med J . 1988;;73:232-234.
15 +
Rip MR, Bourne DE.  The spatial distribution of infant mortality rates in South Africa, 1982. S Afr Med J . 1988;;73:224-226.
16 +
Wyndham CH.  Mortality rates of black infants in Soweto compared with other regions of South Africa. S Afr Med J . 1986;;70:281-282.
17 +
Seedat YK, Naicker S, Rawat R, Parsoo I.  Racial differences in the causes of end-stage renal failure in Natal. S Afr Med J . 1984;;65:956-958.
18 +
Gold CH, Isaacson C, Levin J.  The pathological basis of end-stage renal disease in blacks. S Afr Med J . 1982;;61:263-265.
19 +
Eggers PW, Connerton R, McMullan M.  The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival. Health Care Financing Rev . Spring 1984;;5( (3) ):69-88.
20 +
Rostand SG, Kirk KA, Rutsky EA, Pate BA.  Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med . 1982;;306:1276-1279.
21 +
Bourne BE, Rip MR, Woods D.  Characteristics of infant mortality in the RSA, 1929-1983. S Afr Med J . 1988;;73:230-232.
22 +
Kettles AN.  Differences in trends of measles notifications by age and race in the western Cape, 1982-1986. S Afr Med J . 1987;;72:317-320.
23 +
Mji D, Vallabhjee KN.  Health in post-apartheid South Africa. S Afr Med J . 1990;;78:122-123.
24 +
 Policy statement on discrimination in medical practice. S Afr Med J . 1989;;75:560.
25 +
Dana MR, Tielsch JM, Enger C, Joyce E, Santoli JM, Taylor HR.  Visual impairment in a rural Appalachian community. JAMA . 1990;;264:2400-2405.
26 +
Council on Ethical and Judicial Affairs, American Medical Association.  Black-white disparities in health care. JAMA . 1989;;263:2344-2346.
27 +
Connor E, Mullan F, eds. Community Oriented Primary Care: New Directions for Health Services Delivery . Washington, DC: Institute of Medicine, National Academy Press; 1983;.
28 +
Nutting PA, Wood M, Conner EM.  Community-oriented primary care in the United States. JAMA . 1985;;253:1763-1766.
29 +
Kark SL. The Practice of Community-Oriented Primary Health Care . New York, NY: Appleton-Century-Crofts; 1981;.
30 +
Klopper JML, Tibbit L.  The Mamre Community Health Project. S Afr Med J . 1988;;74:319-320.
31 +
 Heart disease study launched in western Cape. S Afr Med J . 1990;;77:12.
32 +
Otten MW, Teutsch SM, Williamson DF, Marks JS.  The effect of known risk factors on the excess mortality of black adults in the United States. JAMA . 1990;;263:845-850.
33 +
Workforce 2000, Work and Workers for the 21st Century: Executive Summary . Washington, DC: Hudson Institute Inc;1989;:89-95.

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