Johan Fourie, Jonathan Jayes: Health inequality and the 1918 influenza in South Africa, in: CAGE Online Working Paper Series No. 532 (January 2021), pp. 1-35.
The 1918 influenza – the “Spanish flu” – killed an estimated 6% of South Africans. Not all were equally affected. Mortality rates were particularly high in districts with a large share of black and coloured residents. To investigate why this happened, the authors transcribed 39,482 death certificates from the Cape Province. Using a novel indicator – whether a doctor’s name appears on the death certificate – the authors argue that the unequal health outcomes were a consequence of unequal access to healthcare. Their results show that the “racial” inequalities in health outcomes that existed before October 1918 were exacerbated during the pandemic. Access to healthcare, as Fourie and Jayes expected, worsened for black and coloured residents of the Cape Province. Unexpectedly, however, the authors found that other inequalities were unchanged, or even reversed, notably age, occupation and location. Living in the city, for instance, became a health hazard rather than a benefit during the pandemic. These surprising results contradict the general assumption that all forms of inequality are exacerbated during a crisis. The authors analyses suggest explanations for the widening “racial” gap in healthcare access during the 1918 pandemic, from both the demand and the supply side. Fourie and Jayes could find, however, no evidence of “racial” prejudice. Their findings confirm the importance of taking the category “race” into account in studying the effects of the 2020 Covid-19 pandemic or other world crises.