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, we transcribed 39,482 death certificates from the Cape Province. Using a novel indicator – whether a doctor’s name appears on the death certificate – we argue that the unequal health outcomes were a consequence of unequal access to healthcare. Our results show that the racial inequalities in health outcomes that existed before October 1918 were exacerbated during the pandemic. Access to healthcare, as we expected, worsened for black and coloured residents of the Cape Province. Unexpectedly, however, we 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. Our analyses suggest explanations for the widening racial gap in healthcare access during the 1918 pandemic, from both the demand and the supply side. We could find, however, no evidence of racial prejudice.
Our findings confirm the importance of taking race into account in studying the effects of the 2020 Covid-19 pandemic or other world crises. Johan Fourie is professor in the Department of Economics and Department of History at Stellenbosch University and project coordinator of the Biography of an Uncharted People project in the Department of History at Stellenbosch University. Fourie completed his PhD in the Department of History and Art History at the University of Utrecht, Netherlands in 2012 under the supervision of economic historian Jan Luiten van Zanden, on the wealth of the eighteenth-century Dutch Cape Colony. In 2015, he was awarded the “Best Dissertation” prize in the category “Early Modern History” at the World Economic History Congress in Kyoto, Japan. He is co-editor of Economic History of Developing Regions, co-founder of the African Economic History Network and coordinator of the Laboratory for the Economics of Africa’s Past (LEAP). He has published in leading local and international journals, including the Economic History Review, South African Historical Journal, Journal of African History, Journal of Interdisciplinary History, Journal of Southern African Studies and European Review of Economic History.
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