Journal of Socia/Development

in Africa (1994), 9, 2, 87-98

The Impact of Poverty on Health in
Urbanising Communities
FIDELIA MAFORAH *
ABSTRACI'
SouthAfrica, in a similar way to other developing countries, is experiencing rapid
urbanisation, resulting in the growth of slums and squatter settlements where
peoplelive under appalling conditions of poverty and deprivation. People in these
settlements live in substandard housing with inadequate water supply, sanitation
and other basic necessities. Associated with this lack of services is an increase in
disease and ill-health of these growing peri-urban populations. This paper draws
attentionto the relationship between poverty and health in the peri-urban environ-
ments.The discussion clearly indicates that the principal causes of ill-health and
social maladjustment which include infections, inadequate nutrition, and faulty
chi1drearingpractices are products of poverty, ignorance and lack ofresources. The
effectsof poverty on women and children's health is explored; and the new gov-
ernment's policy for dealing with poverty is highlighted.
Introduction

Atthebeginning of the 19th century, only three per cent of the world's population
livedin towns. By 2030, more than half of the world's population of about 10,000
millionpeople will be trying to survive in cities, mainly in the urban fringes. Itis
estimatedthat of this 10,000 million people, more than 8,000 million will be living
in developing countries (Stambouli, 1991) Thus, urb~mproblems in developing
countries have become more acute in recent years as more people flock to cities,
puttingsevere pressure on the urban infrastructure and physical environment. The
directresult of this urban expansion has been a tremendous increase in 'shanty'
townsor 'squatter' settlements where living conditions and hygiene are appalling.
Themost widely observed and acutely felt urban problem in developing countries
isthe large number of poor and unemployed people in the cities. These countries
accountfor two-thirds of the total (world) population and well over three-fourths
ofthepopulation living in poverty. It is forecast that by the end of the20th century,
the urban poor may represent a quarter of humanity (Harpham; Lusty & Vaughan,
* PhD, Specialist Scientist, National Urbanisation and Health Progranune, Medical

Research COlUlCil, POBox

19070, Tygerberg 7507, South Africa.

Fidelia Maforah

to provide adequate nutrition".

88
1988). Commenting on the dimensions of Third World poverty, Ahluwalia, et al
(1979: 306) concluded that: "...almost 40 percent of the population of the devel-
oping countries live in absolute poverty defined in terms of income levels that are
insufficient
forty-five
percent of the population, of which approximately 3,5 million are children,
live in
poverty (Editor: Barometer, 1991). Yet the urban poor are largely unseen and
unheard. The majority of the poor avoid official contacts and investigations
because they distrust the motives of the inquirers. The relatively affluent people
simply do not see or hear the poor who are their neighbours because they do not
share the same experiences.

In South Mrica

about

The urban poor are caught in a web of insecurity, low income, environmental
hazards and unsatisfied human needs. They face unsanitary living conditions,
malnourishment, exposure to infectious organisms and toxic chemicals, and lack
of health services. Worsening environmental conditions in many areas threaten to
reverse whatever minimal gains have been made in public health (Harpham; Lusty
& Vaughan, 1988; Gilbert & Gugler, 1992; WHO, 1991). Hardoy, et al (1990:4)
estimates that "...at least 600 million people living in urban areas of the Third
World live in what might be termed life- and health- threatening homes and
neighbourhoods" .

infectious diseases) with those of urban development

The health of the urban poor combines the problems of rural poverty (malnu-
trition,
(environment:3I
pollution, violence, sexually transmitted diseases, and many others). On the other
hand, the poorest of the urban poor seem to endure at one and the same time the
effects of poverty and the worst by-products of industrialisation and urbanisation
(Maxwell, 1991; Hardoy, et aI, 1990; Harpham & Stephens, 1991). A review of
literature on urbanisation trends in developing countries shows that the urban poor
have a different health profile from other groups, both in terms of mortality and
morbidity. A number of these studies indicate that intra-urban differentials
in
health have increased substantially over the past 5 years (Rossi-Espagnet,
1983;
Harpham & Stephens, 1991 [WHO, 1984]). This is clearly illustrated in the
following examples. In Manila the infant mortality rate (IMR) for the whole city
was 76 per 1,000 against 210 per 1,000 in Tondo, a squatter settlement.
In Quito,
IMR rate in upper-class districts was 5 per 1,000, while for children of manual
workers in the squatter area the IMR was 129 per 1,000.

South Africa is in no better position. While statistics for whites show similar
values for those of upper-middle income countries with regard to health indicators
(life expectancy and infant mortality rate), the pattern of disease for the majority
of South Africans is similar to those found in other developing countries (Zwaren-
stein & Bradshaw, 1989; Jacobs, 1991; Yach, et ai, 1989; Gie, et aI, 1993).

The Impact of Poverty on Health in UrbanisingCommunities

89

In the discussion below,

the concept of poverty as well as the relationship
between poverty and health is considered. A c1<?serlook is taken at poverty and
health in South Africa with emphasis on women and children. The national policy
framework for dealing with poverty is also considered.

Definition of Poverty

While Tolley & Thomas (1987) tend to measure poverty in terms of income and
economic development, Harpham; Lusty & Vaughan (1988) are of the opinion that
the measurement of poverty is difficult and may prove deceptive, especially if
income is the sole criterion. Because income statistics tend to be unreliable and the
majority of poor people may be unemployed and not have access to an income, a
better picture can be obtained by using non-monetary criteria. While the 'poverty
line' may have administrative uses, it has no absolute validity as the percentage of
a population above or below that line can be large or small depending on the
assumptions and concepts used. Thus, the distribution of income values serves as
a better indicator as it provides a better approach and permits the selection of a
poverty line appropriate for a specific purpose.

Ferge& Miller (1987: 15), on the other hand, see poverty as a self-evident phe-
nomenon of everyday reality which is difficult to grasp in a scientifically manage-
able way. According to this author poverty may be defined in absolute or relative
terms. Defined in absolute terms, poverty means the inability of individuals or
families to maintain,
through lack of adequate resources, a socially minimal or
acceptable level of living. In the relative sense, poverty is one aspect of social ine-
quality. It means that part of the population lacks the resources which assume full
social membership in the given society, or at least which would assure living
conditions customary in a given society. From these defmitions it is clear that
poverty in the absolute sense may be considerably reduced or even overcome if all
sections of the poor could profit from economic growth, while the reduction of
poverty in the relative sense is related not only to an increase in resources, but also
to structural changes in the allocation of resources. In the latter sense, poverty is
not only a condition of economic insufficiency but also of social and political
exclusion. This is true for South Africa where the apartheid policies have had a
profound impact on the nature of services provided. On the whole the areas of
operation in service provision were dictated by a system which promoted advance-
ment of the interests of whites at the expense of the black majority, leading to a
marked erosion in their health status and quality of life. With a per capita gross
national product (GNP) of more than R8,500, South Africa is classified as an upper
middle class income country which could afford to feed, house, educate and
provide health care for all its all its citizens, yet statistics show that about forty-five
percent of the population, of which approximately 3,5 million are children live in
poverty (Barometer, 1991 ).

90 

Fidelia Maforah

The Impact of Poverty on Health

The poor urban environment affects various sectors of the community in different
ways. Included in these are the youth, unemployed or underemployed men, the
urban workers and the elderly. Due to lack of parental supervision, the urban young
poor who constitute a high proportion of the urban population often end up as drop-
out with limited skills necessary for competition in die job market. Coupled with
inevitable stresses and strains of adolescence, this situation often results in low
self-esteem and sometimes depression. Other common problems of the urban poor
include unwanted pregnancies, illegal abortions, sexually transmitted diseases,
malnutrition, psychological disturbances, substance abuse and dependence, sui-
cide, violence and accidents. Unemployment and lack of opportunities is a constant
threat to the stability of poor urban men and their families. A number of studies
have shown a link between unemployment of the father and the severity of child
abuse as well as an elevated stress among the wives. Unemployed men have also
been  found  to  be  aggressive  and  to  indulge  in  alcohol  and  other  addictive
substances resulting in abusive and violent behaviour (Hammarstrom, 1994). Most
poor urban dwellers end up in poorly  and insecurely  paid jobs, often  lacking
occupational health and other welfare services. More and more old people who are
moving to the cities, either to follow their children or to find employment, end up
struggling for survival in squatter settlements, without adequate psychosocial and
economic support from family or community. All too often, their overall situation
is deplorable as they are seen begging on street comers or doing a multitude of odd
jobs for survival.

The urban environment is particularly cruel to women and their children, par-
ticularly infants and young children. In South Africa, as in most communities in
third  world  countries,  mothers  and  children  make  up  over  two-thirds  of  the
population, while one-fifth of the population is under fifteen years. Likewise it is
among these vulnerable groups that disease and death take their toll. The impact
of poverty on women and children's health is reviewed below.

Urban poverty  and children
While great progress has been made in promoting the health of children in South
Africa, it has become evident that in most black communities, poverty, ignorance
and disease still go hand-in-hand and medical services are either still rudimentary
or are lacking. Minimum sanitary facilities that the affluent, privileged communi-
ties take for granted, a reliable supply of safe drinking water and arrangements for
safe disposal of human waste are frequently non-existent. Family diets generally
provide less than the accepted minimum allowances of protective foods necessary
to maintain health and fight off disease.  In the squatter camps surrounding towns

The Impact of Poverty on Health in Urbanising Communities

91

facilitates

are even worse,

low birthweight,

for overcrowding

the health conditions

and cities,
the
spread of infectious
diseases. Many of these diseases are poverty-related. These
as well as indoor pollution from
diseases include malnutrition,
domestic fuel combustion
and tobacco use. Instead of electricity, most households
resort
to fuels such as wood, coal and paraffm for heating, cooking and lighting
purposes. The design and construction materials used in informal housing, such as
plastic, wood,
Indoor air pollution
of fuels may exceed outdoor pollution resulting in high
associated with combustion
(Samet, et ai, 1987; Von Schirnding, et ai,
levels of acute respiratory
infections
1991 ). Women and children are at particular
risk as they spend a lot of time in the
home.

etc, do not allow for adequate ventilation.

to address

impossible

and accessible

told Parliament

In view of the causal

relationship
such conditions

50% of black and "coloured"

and low birth weight Similarly,

the Minister of Health and Population Development,

between poverty and disease,
prevail are the principal

the children
sufferers. Proper
who grow up where
in most peri-urban and rural areas,
prenatal care is often lacking, and until recently,
a large number of children are still delivered by traditional birth attendants, as they
are the only affordable
source of maternal health care (Ntoane,
1991; Jacobs, 1991). Infant mortality is high and most preventable diseases are still
rife. Since their control depends on correcting the unfavourable
environment, up
In 1992, Dr Rina
to now it has been almost
this situation.
Venter,
that
figures for neonatal deaths in 1989, in 1987 an
although there were no available
average of approximately
resulted from
the infant mortality rates (deaths per
prematurity
in the first year) were estimated at 63 fOf Africans with the cor-
1,000 live births
responding
and 7,470 cases of
kwashiokor were also reported in 1987. Furthermore,
the Minister pointed out that
the incidence of such diseases were probably higher than the stated figure for 1989.
An official of the Department, Mr Vugarellis,
reported that in view of the high
incidence of measles
(13,629 notified cases and 290 deaths) in 1989, the Depart-
ment of National Health and Population Development would launch an intensive
immunisation
In March 1990 it was reported that
Transkei was experiencing
a measles epidemic, and that one in four children who
the disease died (Cooper, et ai, 1990). The statistics, according to Ep-
contracted
idemiological Comments of April 1989 , also confirm that the high infant mortality
rates result
from preventable
respiratory
disease (18,9 %), nutritional
respiratory disease (18,9%), nutri-
tional disease (12,2%) and viral diseases (11,1 %), adding up to 74,5% of all known
cases.

figure of 9 for whites. 2,242 cases of marasmus

diseases:
disease (12,3%),

the disease.

Sutter
disability
found in other developing
limited resources,

(1982:66)
found in most black communities

is of the opinion that patterns of ill-health and subsequent
to those
situation and
accessibility to and use of health facilities, malnutri-

in terms of the socioeconomic

in Sooth-Africa

are similar

inadequate

intestinal

infections

(32,3%),

campaign

against

deaths

countries

Fidelia Maforah

disabled or retarded by malnutrition

92
tion, poor hygiene and disease. She states that «...many childrenfail
many who do survive are left permanently
communicable
ing countries.

to survive and
and
diseases" . Figure I demonstrates the cycle of poverty in develop-

Figure 1: Cycle of Poverty and Disease in Developing Countries

FAILURE TO COPE

POOR

EDUCATION --

INADEQUATE
FOOD
PRODUCTION

CAUSATIVE
FACTORS

PREVENTABLE
ILL-HEALTH

SEQUELAE

INADEQUATE

HEALTH FACILITIES

INFECTIOUS
DISEASES

HIGH
CHILD
MORTALITY

MENTAL
RETARDATION
AND OTHER
HANDICAPS

Adapted from E. Sutter (1982) Rehabilitation
pp65 -70.

in South Africa, Volume 26: 3,

The Impact of Poverty on Health in UrbanisingCommunities

93

Poverty and women's health
In discussing poverty and health, a point that deserves special emphasis is that
poverty is very much a women's issue, atleast
in part because of women's double
roles. Women with young children are much more likely than men to be poor, and
their burdens are usually greater as they must care for children and the household
and also earn a living. Poor women have needs and make contributions that are
different to those of poor men; thus their problems require different solutions
(Pietila & Vickers, 1990; Perales & Young, 1988).

Women make up more than 50% of the world's population, yet their position
is inferior to that of men. Women from lower socioeconomic backgrounds have
even less power than do other women. Because of the lower social and legal status
accorded tothem, poor women are usually less educated, have fewer opportunities,
poorer health care and less control over their lives. Poor women also have less
access toland, capital and technology and this lack of access leads to greatly dimin-
ished efficiency of production both outside and inside the house. Less education
entails cost to society, not only because of the loss of women's potential for higher
productivity in the labour market, but also because women as mothers make the
fIrSt investment
in the nutrition, health and education of children and these
investments are critical to the country's future economic growth.

The pattern of ill-health extends to poor women, not only in the form of high
maternal mortality, but also in the form of high morbidity. According to WHO
(1980; 1992), the maternal mortality rate reaches as high as 1,000 per 100,000 live
births in developing countries, compared with 5 to 30 per 100,000 in industrialised
countries. Likewise, UNICEF reports that about 500,000 women die from condi-
tions related to pregnancy and childbirth (UNICEF, 1981; 1991). These statistics
are too important to ignore. Poverty reflects many unfavourable associations with
childbirth which affect infant survival. Poor women are said to suffer from what
is termed 'maternal depletion', as a result of early mating, continuous cycles of
pregnancy and inadequate diets, often made worse by food prejudices, and unin-
terrupted overwork leading to anaemia or general malnutrition with premature
ageing and early death (Williams, et ai, 1985; Travis, 1976; Ntoane, 1991). Jacobs
(1991) points out that in South Africa, the maternal mortality is further aggravated
by the suffering of women who, having little control over their health and limited
access to abortion as a means of reproductive control, are forced to seek backstreet
abortions with disastrous outcomes. The recent estimates indicate that between
125-200,000 maternal deaths occur every year due to unsafe induced abortions
(WHO, 1992; Sundstrom, 1993).

Poverty lays a particularly heavy burden on black women in South Africa,
because of their dual roles in the economy. Often women work inside and outside
the home. At home they are usually responsible for house chores, food preparation

94

Fidelia Maforah

and child care. For poor rural and peri-urban women, home production
can also
include such gruelling chores as gathering fIrewood and carrying water; plowing
and harvesting; building houses, grinding and milling grains and caring for animals
(Ntoane, 1991; Wilson and Ramphele,
1989). Poor women also tend to have more
children which adds considerably

to their chores.

Many of these women are physicaI1y depleted from these chores and have very
and

a situation which leads

to child abuse

little time to care for these children,
neglect.

Consideration

and stigmatised,

treated timeously

rate of sexually transmitted

because of fear of being prejudiced

mention of an ever-increasing
not
though these are generally passed on from husbands,
migrant workers. With the spread of the epidemic AIDS,
women and their newborns

of the health status of poor women will be incomplete without
diseases. These are often
even
those who are
the lives of these poor
1991; Rees,
1991).
it merits concerns
that
such as lead or solvents which may
and childhood
or abortion
the basis for intervention

women's
poa-women
affect
cancer. Research is urgently needed in order
in this important

(Ntoane,
Another area of inquiry which has not received the attention

lead to foetal damage, miscarriage
to provide

issues related to the workplace. The available

are exposed to workplace hazards

are in even more danger

their fertility,

information

particularly

suggests

area.

in addition,
lack the
countries. Due to the

of the

is

African culture has disappeared

from the big cities which,

an increase

urbanisation

consequence

in the number

of female-headed

studies conducted

is the general weakening

family with its protective

in the country (Cooper, et at 1992). Their poverty

in the industriaIised
the extended
family unit. Another
of traditional

family
households
to Todaro (1986) South Africa is one of the countries

structures
(TuIchin,
in which
are headed by women. This finding was also coninined

social services available
to city dwellers
harsh reality of the urban environment,
structure is often replaced by the nuclear
rampant
resulting.in
1986). According
about 40% of households
in recent
only the most obvious
tageous
(of which 3,4 million are children)
(Barometer,
it exposes a signifIcant number of children topoverty-related
leave for work before their children
1991 ). It often occurs that employed mothers
wake up in the morning and find them sleeping when they return,
either because
of their long working hours or public transport delays. These children are often on
school
their own, unattended, without proper nutrition
attendance
for
children
abuse. An alarming increase in numbers of"streetchild.ren"

or homework. This situation is responsible
juvenile

that about 45% of the population
this situation

for high rates of truancy,
delinquency

can be disadvan-
in South Africa
as
is lamentable

and substance
attests tothis situation.

symptom of how the urban environment

to women. Considering

live in poverty,

or supervision

for illiteracy,

of either

becoming

dropouts,

diseases

The Impact of Poverty on Health in Urbanising Communities

95

family upheaval and violence, overcrowding,

Investigations show that street children the world over share a common aetiology
- poverty, unemployment,
alcohol
abuse among parents and school
It is estimated that
Africa alone has five million street children. These children live among prostitutes.
these children are the
derelicts and drug-pushers on the streets. Very simply put,
victims of urbanisation.

failure (Cockburn,

1991).

circumstance

and a long list of problems,

Mass poverty is the single most powerful

inhibiting human,
social and economic development,
such as those
mentioned above, are, in fact, the products of poverty. Society in general and the
family in particular, stand to benefit
if women's physical, mental and social being
are improved. Any efforts aimed at coming near to achieving health for all by the
year 2000, should addresS the adverse effects of poverty which militate against
favourable maternal health, as well as the general health and optimal growth of the
majority of South African children. Oearly the solution requires a political ap-
proachat the highest government
levels, with women participating in the establish-
ment of priorities and the implementation
of programmes. This includes under-
standing the environment of the poor and an examination
of the socia-political
process necessary for the improvement
The new gOVenl-
ment's Reconstruction and Development Programme (RDP) promises to be such
a tool. Its mission statement clearly states that mass poverty is the single greatest
burden of South Africa and that its alleviation should be the frrst priority of the new
its objectives and some
government
of the specific strategies for dealing with poverty are considered.

Inthe section below, a closer look at theRDP,

of that environment

The Reconstruction and Development Programme

The RDP is a policy framework which seeks to mobilise the people and resources
of the country towards
the fmal eradication of apartheid and the building of a
democratic, non-racial and non-sexist
future (African National Congress {ANC},
1994). It promotes the idea that poverty is a social problem rather than a problem
of personal failure, and that it requires a strategy that necessitates a broad attack on
the fundamental causative conditions. This strategy advances the interests of dis-
advantaged groups, emphasises redistribution of power and influence, encourages
enhancement of coping mechanisms of target populations and aims to strengthen
Itaims at fmding ways of working with
community participation and inte~on.
people in extreme poverty that will enhance
instead of
reinforcing their dependence. The strategy for meeting basic needs rests on the
following four pillars:

independence

their

%

(1)

(2)

(3)

(4)

Fidelia Maforah

Creating opportunities for all South Africans to develop to their full
potential.
Boosting production and household income through job creation,
productivity and efficiency, improving conditions of employment, and
creating opportunities for all to sustain themselves.
Improving living conditions through better access to basic physical and
social services, health care, and education and training for urban and rural
communities.
Establishing a social security system and other safety nets to protect
poor, the disabled, the elderly and other vulnerable groups.

the

It is encouraging to note that the RDP specifically identifies women and children
as sectors of society that require special attention. The new health policy is already
providing free health care services for mothers and children under the age of six.
The efforts to improve women's health extend to reproductive rights. The aim is
to ensure that reproductive health care services promote people's right to privacy
and dignity - which includes a woman's right to choose whether or not to have an
early termination of pregnancy. Institutions, and other oppressive practices and
in line with
laws that discriminate against women are being revised and brought
national policy. These measures will go a long way in ensuring that the health of
in
children is taken care of. This attention to optimal growth and development
childhood represents an investment in future health and in national productivity.

References

African National Congress fANC} (1994) The Reconstruction

and Develop-

ment Programme: A Policy Framework, ABC Books, Cape Town.

Ahluwalia, M S; Carter, G N & Cheney, B H (1979) "Growth and Poverty in

in Journal of Development Economics, 6,3,

Developing Countries",
pp299- 342.

Barometer: Editorial (October, 1991) "Community Development Part of a

Lasting Solution", in Barometer, 6, 3, pp 1-16.

Cockburn, A (1991) "Street children: An overview of the extent, causes, charac-
teristics and dynamics of the problem, in Child Care Worker, 9, 1, pp 12-13.

Cooper, C; McCaul, C; Hamilton, R; Delvare, I; Moonsamy, J G & Muerller,

R K (1990) Race Relations Survey (1989/90), South African Institute of Race
Relations, Johanneshurg.

Cooper, D; Myers, J; Hoffman, M & Klopper, J (1992) "A Study of the effects of

Urbanisation on the health of women in Khayelitsha, Cape Town. In-depth

The Impact of Poverty on Health in Urbanising Communities

97

interviews with residents in Khayelitsha and their value in informing and
complementing quantitative research", Department of Community Health,
University of Cape Town.

Epidemiological Comments (1989) Measles Eradication,

in Epidemiological

Comments,16,

9, 2, April.

Ferge, Z S & Miller, S M (1987) Dynamics of Deprivation, Gower Publishing,

London.

Gie, R; Klein. M & Wesley, A (1993) "Death from Pneumonia in Young

Children".

in South African Medlcal Journal

(in press).

Gilbert, A & Gugler,J

(1992) Cities, Poverty and Development: Urbanisation

in the Third World, 2nd ed, Oxford University Press, Oxford.

Hammarstrom, A (1994) "Health Consequences of Youth Unemployment-

Review from a Gender Perspective",
pp699-709.

in Social Science and Medicine, 38, 5,

Hardoy, J E; Caincross, S & Satterthwaite, D (1990) The Poor Die Young:

Housing and Health in Third World Countries, Earthscan, London.
Harpham, T & Stephens, C (1991) "Urbanisation and Health in Developing

Countries",

in World Health Statistics Quarterly, 44, 2, pp 62-69.

Harpham, T; Lusty, T & Vaughan, P (1988) In the Shadow of the City:

Community Health and the Urban Poor, Oxford, London.

Jacobs, M (1991) "A Time for Action: The State of South Africa's Children". in

Progress: Reports on Health and Development
Summer/Spring, pp 12-20.

in Southern Africa.

Maxwell. R J (1991) "The present is appalling, the future is bleak", in World

Health, April, 11-13.

Ntoane. C (1991) "Rural Women and Health" in Critical Health.

June, 34,

pp 71-74.

Pietila. H & Vickers, J (1990) Making women matter: The role of the United

Nations, Zed Books. London.

Perales. H & Young, L S (1988) Women, Health and Poverty. Haworth Press.

New York.

Rees. H (1991 ) "The Abortion Debate in South Africa". in Critical Health, June,

34, pp 20-26.

Rossi-Espagnet, A (1983) Health and Urban Poor, World Health, Geneva.
Samet, J M; Marbury, M C & Spengler, J D (1987) "Health Effects and Sources of

Indoor Air Pollution: State of Art", in American Review of Respiratory
Diseases, 136, pp 1486-1508.

Stambouli, F (March-April, 1991) "The False Lure of the City Lights", in World

Health, pp 28-29.

98 

Fidelia  Maforah

Sundstrom, K (1993) "Unplanned Pregnancies and Abortion", World Bank Best

Practices on Women's Health, pp 13-14.

Sutter, E (1982) Community Participation in the Prevention of Disability, in

Rehabilitation in South Africa, 26, p 3.

Todaro, M P (1986) Economic Development in the Third World  (3rd ed)

Longman, New York.

Tolley, S G & Thomas, V (ed) (1987) The Economics of Urbanisation and

Urban Policies in Developing Countries ,The World Bank, Washington D C.
Travis, G (1976) Chronic Illness in Children: Its Impact on Child and Family,

Stanford University Press, California.

Tulchin, J S (1986) Habitat, Health and Development: A new way of looking

at  cities in the Third world, Rienner, Colorado.

UNICEF (1981) Assignment Children, 53/54, UNICEF, Geneva.
UNICEF (1991) Challenges for children and women in the 1990s: Eastern and

Southern Africa in profile, UNICEF, Nairobi.

Von Schirnding, Y ER; Yach, D & Klein, M (1991) "AcuteRespiratory Infections

as an Important Cause of Childhood Deaths in South Africa", in South
African Medical Journal, 80.

Williams, C D; Baumslag, N & Jellife, D B (1985) Mother and Child Health:

Delivering the Services (2nd ed), Oxford University Press, Oxford.

Wilson, F & Ramphele, M (1989) Uprooting Poverty -  The South African

Challenge, NW Norton & Co, New York.

World Health Organisation (1980) Sixth Report of the World Health Situation

1973-1977, Part 1, Global Analysis, WHO, Geneva.

World Health Organisation (1984) Urbanisation and its implication for child

health: Potential for action, WHO, Geneva.

World Health Organisation (1991) Urbanisation and the Urban Environment,

WHO Statistical Quarterly, 44.

World Health Organisation (1992) Women's Health: Across Ages and

Frontiers, WHO, Geneva.

Yach, D; Strebel, P M  & Joubert, G (1989) 'The Impact of Diarrhoeal Disease on

Childhood Deaths in the RSA, 1968-1985", in South African Medical
Journal, 76,476-475.

Zwarenstein, M & Bradshaw, D (1989) "An Overview of Health Status and

Health Care Provision in South Africa", in The Case for a National  Health
Service, A series of lectures organised by Extra-mural  Studies andNAMDA,
C P Owen (ed),NAMDA, Cape Town.