Homicide, Gun Violence, and Epidemiology in Detroit

More about the above map HERE

The Detroit Police Department (DPD) has been making strides to improve their operations, including: cracking down on internal corruption, adopting data-driven crime tracking, and utilizing innovative approaches for crime prevention. When Chief James Craig was hired he brought back a data-driven model of policing that tracks where crimes happen, by whom, as well as where police patrols are deployed. This is an important step forward for the DPD to manage the large land area of Detroit while utilizing statistics to plan police asset allocations. Being aware of crime trends and locations is critical to understanding how best to improve safety in Detroit. Last year DPD and Crime Stoppers held a gun buy back event in Detroit and early this year it was reported that a Federal investigation by the ATF (Bureau of Alcohol, Tobacco, Firearms and Explosives) collected a number of illegal guns after setting up a fake barbershop in Detroit. The ATF’s primary goal was to identify key “trigger pullers” in the community who are committing violent crimes.

“What we need to understand gun violence is a #publichealth approach.” – David Satcher #APHA13

— Prevention Institute (@preventioninst) November 4, 2013

These data-driven and community focused approaches are critical to making Detroit safer as well as utilizing police and community resources more effectively. Innovative and effective approaches to crime prevention are desperately needed in Detroit. A crime prevention approach rooted in public health is gaining traction in reducing homicides in other major US cities. The Cure Violence program uses a public health/ epidemiology approach to identify “trigger pullers” who contribute to the spread of homicide and crime in communities by sending violence “interrupters” who are former gang members into the streets to intervene. The Man Up! program in Brooklyn uses this same approach and saw 363 days without a shooting or killing this past year.

My own research shows that homicides in Detroit follow a disease diffusion pattern across the city. Emanating from two key hotspots while continuing and spreading from those areas throughout the year with over 80% of Detroit homicides committed by gun.

It was announced today that $1.6 million will be granted to fund, “36 AmeriCorps volunteers to analyze crime statistics and help neighborhood block clubs and other groups learn how to report crime, keep an eye on the neighborhoods and how to avoid becoming victims.” The Free Press article notes that the program has been in effect in Midtown and East Jefferson over the last three years and they have seen a 44% reduction in crime. Funding ($722,000) for the program comes from the Kresge Foundation, Skillman Foundation, Henry Ford Health System, Jefferson East Inc., and Detroit Medical Center. Does this signal Detroit taking on a public health approach to crime and violence? I sincerely hope DPD and funders push for more public health strategies for crime and homicide prevention.

If anything this is welcome news over involvement from the Manhattan Institute (proponent of increasing incarceration rates to reduce crime) and the expansion Stop-and-Frisk in Detroit. There can be only positives in getting residents and police officers to meet on common ground instead of police officers wantonly stopping and frisking innocent Detroit residents. Hopefully the involvement of Foundations, Health Systems, and community advocacy groups can continue to improve the DPD approach to crime prevention.

The History and Conflict of Food Access in Detroit

The food desert term has been readily applied to Detroit’s food system. However, the majority of academic and other research fails to take a comprehensive look at Detroit’s food system or its history. Following the New York Times article questioning whether the “food desert” term is just media buzz, I decided to share some of my initial findings in Detroit. I began researching Detroit’s food system about a year ago and started surveying grocery stores in Detroit 6 months ago because I could not believe the research coming out of the University of Michigan and other institutions that Detroit was devoid of fresh foods or healthy options. NPR recently published an article titled, What Makes a Food Desert Bloom, but fails to note the importance of food education on healthy eating to accompany increased visibility and access to healthy foods.

Detroit is a Food Desert or Food Swamp?

The map image accompanying this post is not the best illustration, but it is a complication of the best data sources on Detroit’s food system. The map represents the flaws and misunderstandings of outside consulting agencies and more general displays of either out-of-date or misguided information. Rob Linn has been creating some excellent maps of Detroit food stores data and now works with Data Driven Detroit. His maps are more current and show a cleaner picture of the actual data in Detroit. The surveys conducted by outside agencies have missed the mark and have published misguiding research to back up the “food desert” claim. The biggest problem with maps is that they are very “planner” focused and it is very easy to make broad claims based on maps. A recent PhD. out of the UM School of Public Health conducted research on African-American’s perceptions of food choice in Detroit and I’m very excited to read her findings. Understanding community perceptions and choices is going to be more important than placing food stores on a map.

Brief History of Detroit’s Food System

Currently, there is only one black-owned grocery store in Detroit where 4 out of 5 residents are African-American (DFPC Annual Report of Detroit Food System, 2009-2010). Detroit is a city with historic racial and economic divisions. These divisions often played out within the food system and its evolution up to today.

Small neighborhood grocery and convenience stores also hired few blacks. […] Few blacks worked where they shopped. Fewer felt any loyalty to neighborhood stores. Only a decade after the survey, inner-city grocery stores were among the most prominent targets of young looters. White-owned and -operated stores were the most prominent businesses in Detroit’s African American neighborhoods and the most convenient symbol of the systematic exclusion of blacks from whole sectors of the city’s economy. (Sugrue, Origins of the Urban Crisis, 113-114)

The title of “food desert” has been both accepted and refuted in Detroit. The majority of academic researchers lean towards labeling Detroit as a food desert, however others have come to that conclusion without adequate research into price and accessibility of foods the term is not helpful. Counting chain supermarkets and the 1 mile radius around those locations doesn’t give an accurate picture of food availability or access to quality fresh foods. Shannon Zenk (PhD ’04) while at the UM School of Public Health reported that Detroit was a food desert based on her research of “chain” supermarkets and their proximity to large numbers of residents. Her research found that, “supermarkets were farther away from African-American neighborhoods with the highest levels of poverty than they were from white neighborhoods with the highest levels of poverty (SPH Findings Spring/Summer 2009). This is an extremely inadequate picture of healthy food access and environment within the city.

Detroit has a long history of local grocers supplying neighborhoods while there have only been a few chain supermarkets to ever exist within the city limits. As of 1954-55, there were 69 supermarkets operated by Kroger, A&P, and other small local suppliers in Detroit. One of these small local suppliers was Food Fair, which in 1955 merged with Lucky Stores which operated as Food Fair markets under the Borman Food Stores Inc. In 1959, Borman bought up other smaller chains (State Super Markets, American Stores Inc., Lipson-Gourwitz Co.) and expanded to 46 stores in Detroit and Ferndale. In 1966, Borman announced the opening of three superstores under the name of Farmer Jack.

Farmer Jack was A&P’s most profitable division after the merger, but by the 2000s was having trouble competing with larger supermarkets like, Kroger, Meijer, K-mart and Walmart. Farmer Jack is recognized as the last chain supermarket to remain in Detroit before A&P put the stores up for sale and all locations closed in 2007. Kroger acquired twenty former locations while independent grocers collectively bought 21.

The flip side of the grocery and chain supermarket story in Detroit’s food system is that of community and urban gardens. Detroit Public School (DPS) student handbooks from the 1950s included a chapter on how to create a community garden. Urban farming and community gardens is a whole aspect of access to healthy food that needs its own post, so I won’t go into it here.


Detroit Food Map: access and environment

Contrary to popular belief and to oft-cited media, I have found that Detroit is not a food desert in its entirety. Detroit has a few neighborhoods and areas that lack a good number of options, but as a whole Detroit is a food swamp or as some say a “food grassland, rain forest, and jungle” (Rob Linn).

The families that I work with across Detroit tell me a similar story. They access food resources from a plethora of sources. One family told me that they try to get to Kroger whenever they can (outside Detroit), but otherwise get good fresh produce from a food bank since the Caregiver is out of work, they participate in the community garden, and visit an independent grocery store when they need to restock staple foods. Other family’s have told me similar stories of utilizing multiple food access points.

A food desert is defined as:

“any area in the industrialized world where healthy, affordable food is difficult to obtain. Food deserts are prevalent in rural as well as urban areas and are most prevalent in low-socioeconomic minority communities. They are associated with a variety of diet-related health problems. Food deserts are also linked with supermarket shortage.” (wikipedia)

Access is a key word when talking about food deserts and this is where many researchers count the number of stores and measure the distance from supermarkets to given populations. However, this often paints an inaccurate picture. There is more to access than the number of stores and how far away they are. Just because a grocery store is close by doesn’t mean that it has a huge fresh foods section or many healthy options. New research has noted that distance to healthy food may be psychological. This is where greater education on healthy food is necessary to create a more direct connection between people and healthy eating. I have been using the Nutrition Environment Measures Survey (NEMS) in order to attempt to get a more accurate picture of access to healthy foods. NEMS criteria focuses on comparing availability, price, and quality of foods between healthy food options and less healthy food options. Access is more than just distance and can include issues with the stores not stocking healthier food options, the quality of healthy foods available, and most importantly the price: is it cheaper to buy a bag of chips?

I have used the NEMS criteria to survey 20 grocery stores in Detroit (see Detroit Food Map) and what I have found has been entirely different from the large body of research that pegs Detroit as a “food desert.” All of the grocery stores had availability of fresh and healthy foods. Some produce sections were bigger than others and some carried more varieties, but all in all fresh foods were available and in good quality. The only items that were regularly low in quality were strawberries and cantaloupe. Likewise, I found in many stores that price could potentially be a hindrance for purchasing a healthier option, particularly with fruits, baked goods, meats, and juices. I spoke with a number of store owners and employees. Many said that they too have had a hard time with the “food desert” label and want people to know that they carry fresh foods. In some stores the owners noted that customers don’t regularly buy the healthier food options (i.e. ground turkey) or their fresh produce is purchased slowly, so it goes bad more quickly.

“It’s not enough. People always want more. We carry everything, many options, but people would rather shop at the super markets: Meijer, Wal-Mart. . . Is it because we don’t have the options? Look around!” – Staff Interview, Independent Grocer 02/02/12

My coworker, who has lived in Detroit her whole life and has been involved in improving the food system, has seen over the past 2 years an increase in farmer’s markets and community gardens in what she thinks is a response to food desert hype. Potentially, Detroit’s independent grocers have done the same and hopefully will continue improving their price, quality, and availability of healthy and fresh foods.

(image source)

will big box grocers change access to food in Detroit?

You can quote me on this:

“more big box stores will not equal better food choices”

On January 20, 2011, First Lady Michelle Obama launched an initiative with Walmart and the Let’s Move Campaign to increase access to fresh and healthy foods. The program is supposedly bneing evaluated by the Partnership for a Healthier America, whose Chair, James Gavin said he would like to see Walmart double its US store count.

I don’t often shop in Walmart (actually I try to avoid it), but last month I had a reason to be in a Walmart store. Working in childhood obesity research and surveying food outlets for nutritional quality, I took the time to notice the advertisements and products on display. To say the least, none of the food items advertised or on display were healthy or fresh.

There were none.

Behavior Change & Food

My point is that more Walmart stores in “food deserts” doesn’t necessarily mean that more people are going to be eating healthier. I don’t doubt that Walmart making an effort to improve the nutritional quality of its food products and offering more fresh and healthy foods will have a negative impact, however it is going to take more. When a low-income family has the choice between the on-sale advertised frozen dinners or the larger amount of fresh vegetables they are more than likely going to choose the product where they get more for their money (or at least what seems like it).

“there needs to be more education, access, and a american cultural shift towards healthier eating”

Everyday I work with adolescents and their families on managing childhood obesity. We talk about making healthy changes to their food intake and often times we talk about how to shop for healthy foods on a budget. It is possible and varies in difficulty, depending on your situation. Some families that I’ve worked with went the entire six months of the program without changing much in their eating habits. Changing your food choice is not that easy.

Eating healthier is easier if you are wealthier, have greater options, and have been introduced to ideas of healthy eating from a young age or cultural norm. Classism in the slow food movement is another topic, but extremely relevant as we talk about access to healthy food, urban settings, and growing income inequality often reflected in racial disparities.

Grocery Stores in Detroit

The idea of having more big box stores address “food deserts” and the lack of healthy foods isn’t new. The idea easily makes sense; large chain supermarkets are better able to supply larger amounts of fresh produce on a regular basis if they want to. Save-a-Lot released a report on food deserts in April 2010 and has also signed on to First Lady Obama’s campaign.

For Detroit, Save-a-Lot represents a greater potential than Walmart to be able to address the need to greater access to healthy and fresh foods since there are already ten locations in Detroit, Highland Park, and Hamtramack. I have yet to be able to assess the level and quality of fresh food available at a Save-a-Lot store (coming soon).

Anyone following food in Detroit knows that a Whole Foods store is being built in the Midtown district, near the Henry Ford Health System, Detroit Medical Center, Wayne State University and on the way home for downtown workers leaving the city. This was not the step forward that so many people were hoping for when there was talk of bringing in a national supermarket. Whole Foods is a specialty food store that caters to a wealthier clientele (Midtown avg household income: $113,788), I only go there for wine and dessert. It may bring more fresh food to the Midtown area, but won’t help many Detroiters without access to healthy foods.

A new development with more potential to impact the Detroit fresh food scene is the re-purposing of a former Detroit high school into a Meijer supermarket. Meijer often promotes healthy food options, has a partnership to offer healthy kids recipes, and has a fairly well-stocked produce section.

Big Box vs. Small Grocer

Like many locations that lack necessities, people create solutions to address those needs. Detroit has a number of small grocers and food supply stores, not to mention the largest Farmer’s Market in the US. As the #Occupy protests address money in politics and the ills of corporations, we need to be mindful of where and how food is accessed. Food is a critical piece of our national health and unfortunately our national politics.

People’s needs should be placed over profit and neither ketchup nor pizza are vegetables!

privilege is a key determinant of health

In our world of abundance there are growing areas of scarcity, our urban cities. These growing areas of scarcity once used to be bastions of wealth, but are now best known for their decaying infrastructures and lack of resources.

In some cases urban cities have faced industrial decline, in others its an issue of poor residents being marginalized. Either way, the health disparities that accompany low-income and minority communities is abhorrent.

One of the top health indicators related to privilege that can be seen in these communities is access to healthy food options. From Los Angeles to Detroit to Philadelphia, various communities lack basic nutritional resources like fresh produce and as a result have been disproportionately hit by health conditions related to lifestyle such as diabetes, high blood pressure, and obesity.

In the Ramona Gardens projects of Los Angeles, residents have to travel 3 miles by bus to reach the closest supermarket for fresh produce. The other small shops in the community just can’t stock as much as larger stores because they don’t sell the same quantities or they would have to charge higher prices. The health impacts such as hypertension and childhood obesity noted by a free clinic in the community show how critical access to healthy food options can be. The Ramona Gardens project is a great example of privilege playing a role in the health of low-income and minority communities by way of accessibility of resources.

photo credit: Dr. Hillier (NPR)

Similar issues have been found in black, low-income communities of Philadelphia. Like many urban areas, grocery stores fled to the suburbs where there was more space for larger stores and safer neighborhoods, not to mention higher paying customers. As a result of a community mapping survey, almost 20 supermarkets have opened in Philadelphia with the help of state funding. This brought access to healthy food for many low-income communities in the city.

As recently as 2007, large grocery stores have pulled out of Detroit. Not many have attempted to stay and Farmer Jack was the last standing. Detroit is often called a “food desert” because it lacks a major chain supermarket. The problem is not necessarily a lack of supermarkets, but rather the scarcity of healthy food options. Martin Manna, the Executive Director of the Chaldean American Chamber of Commerce of Southfield said,

“There usually is a market within walking distance of nearly every area of Detroit. It might not be a supermarket. That might be why there are so many people eating potato chips rather than wholesome foods in Detroit.”

Other Detroit residents have noted the lack of options at Detroit stores. Some stores claim to be serving a “black clientèle,” but  Gordon Alexander, who lives on the East side, says its just an excuse for stocking bad quality goods. This is a perfect example of racial privilege compounding income disparities when it comes to healthy food options in Detroit.

Our world of abundance needs to be able to serve everyone. There should be no reason that low-income communities struggle to purchase fresh produce or healthier foods. We can’t allow fast-food chains to make profits in the “marketplace of the poor” and add to the health disparities of minority communities. If anything, we should be able to find a way to offer healthy food to all citizens of our country regardless of race, income level, or location.

Featured on Americans for Informed Democracy Blog where I’m contributing as a Global Health Analyst.

the coming revolution in african health care

 

african power fist Pictures, Images and Photos

Before you have anything else, you have your health. Hopefully if you have nothing else, at least you have your health. Unfortunately, for millions across the African continent this is not an absolute fact. Even more unfortunate is the fact that many Africans have no ability to change their health status. They are trapped in a system that is driven by Western market based, profit driven health care systems. As the failures of Western development practices come to light, alternatives to what has been are becoming increasingly visible. These alternatives will form a revolution in African health care delivery. This revolution will be fueled by health care delivery models that will give local communities agency in the provision of their own health care. Community-based models involving cooperative financing, proven para-professional training, new information technology, and social enterprise for the social good will drive the revolution in African health care. People will be able to determine for themselves, their level of health.

What does “Health” mean anyway?
This is a question often left to remain ambiguous. For the purposes of my writing I will provide a comprehensive view of “health” and all that is entailed in sustaining and maintaining health. “Health” in all instances will refer directly to the “basic needs” of a person in regards to health care.

Healing, like health, is obviously rooted in the social and cultural order. […] To define dangerous behavior, and to define evil, is to define some causes of illness. As the definition of evil changes, so does the interpretation of illness. To understand change in healing, we must understand what it is that leads people to alter the definition of dangerous social behavior. It can easily be accepted that health and healing in Africa are shaped by broad social forces.

As Feierman and Janzen state, health (and healing for that matter) are directly linked to social forces. If a comprehensive understanding of health is to be understood, it must be studied in the context of politics, economics, and other societal structures.

Health is defined by the World Health Organization (WHO) as, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The WHO and many other international organizations recognize that this broad and encompassing definition of health. Where this definition becomes ambiguous is what qualifiers meet, “a state of complete physical, mental, and social well-being.” In 1978 the WHO made primary health care its number one objective with the Declaration of Alma Ata. However, even this statement had no clear definition of health or its qualifiers.

Feierman and Janzen provide a more clear definition of the qualifiers of health in the preface to their volume: The Social Basis of Health and Healing in Africa,

[…] it [health] is maintained by a cushion of adequate nutrition, social support, water supply, housing, sanitation, and continued collective defense against contagious and degenerative disease. Such a view is necessary if we are to understand those contexts in today’s Africa where health levels deteriorate, and where they improve.

These authors provide a complete set of qualifiers, or “basic needs,” of health that can be researched further to understand where political, economic, and social structures interfere with sustaining and maintaining health and where health care is inadequate.

Health care should thus be understood as the system and structure that works to provide the above defined “basic needs” to each individual. Often this role falls to governments, but sometimes is taken up by communities and organizations when government’s fail to provide these basic needs.

This blog series will cover four key areas identified that will fuel this revolution in African health care: cooperative financing, para-professional training, information technology, and social enterprise. SCOUT BANANA works to tackle social medicine (social, economic, structures) while enabling others to provide medical services. Be sure to follow closely to learn more!

Written for the SCOUT BANANA blog.

Why There is No Doctor: the Impact of HIV/AIDS on the Post-Apartheid Health Care System of South Africa

Empty waiting room at Clinic 2 in Zonkizizwe, the doctor was not in (photo credit: Alex B. Hill, 2008)

This research was the culmination of my three month long internship at Vumundzuku-bya Vana “Our Children’s Future,” a center in Zonkizizwe, Katlehong, South Africa (Gauteng Province) for children and youth affected by HIV/AIDS. During my time there I developed an HIV Peer Educators curriculum and taught HIV/AIDS information sessions to the youth. The piece that I am most proud of was the planning and organizing of a area-wide HIV Testing Day where over 80 people were tested in a settlement where there was a very high testing stigma.

What I noticed during my time in Zonkizizwe was the lack Doctors (at government clinics, private clinics, etc.) as well as the lack of a working health system in an informal settlement not far from Johannesburg and Germiston. The research focuses on how and why apartheid and HIV/AIDS impact South Africa’s current post-apartheid health system.

Related blog posts:

Implications for Foreign Aid Across the Continent: The Shifting Africa Policies of China and the USA

China’s growing influence in Africa has been a topic that I have followed for a long time starting in 2006 when I recognized the increase in economic investment by China is various African countries. Since then I have been following China’s development investments and arms deals as well as the USA’s increase in “anti-terrorism” training with African militaries, notably in the Sahel region, via AFRICOM. This research paper was completed as part of a senior level Capstone course on the historical relationship between China and the USA, specific to international relations and policy.

Related blog posts:

why there is no doctor: the impact of hiv/aids in the post-apartheid health care system of south africa

This is a series of posts based on the lengthy research paper that I completed as part of my “field experience” requirement for my International Relations major at James Madison College, as well as my Global Area Studies: Africa major and International Development specialization through the College of Social Science at Michigan State University. I was supported by the Young People For internship program as well as my friends and family. My field experience was completed as a three month long internship at Vumundzuku-bya Vana ‘Our Children’s Future’ (VVOCF) in the peri-urban settlement of Zonkizizwe, just south of Johannesburg. My tasks as an intern were to conduct health classes, run the HIV/AIDS Peer Educator courses, help with day-to-day programming, as well as assist in the nonprofit development and paperwork. The highlight of my work was organizing an HIV Testing Day with the clinics for the whole community. In all 80 people were tested in an area where stigma around HIV/AIDS and testing is very high. Please feel free to send comments and recommendations to help improve my work. Thanks!

Index:
i. Why are there No Doctors?
Academic Paper:
1. Introduction to an Epidemic
2. The Health System via Apartheid
3. Cleaning Black Spots of off a White Land?
4. High-Risk Migration Patterns
5. Scapegoating “tropical workers”
6. HIV/AIDS in South Africa
7. Denial is the First Step
8. What happened to Reconstruction and Development?
9. Post-Apartheid Health: the Burden Continues to get Heavier
10. Harsh Realities in Zonkizizwe (part 1)
11. Harsh Realities in Zonkizizwe (part 2)
12. Conclusion & Works Cited
13. Appendix A: Timeline of Health Care and HIV/AIDS in South Africa

why there is no doctor: conclusion & works cited (12)

The sea of gravestones near Zonkizizwe was almost unimaginable. I would not have believed it myself if I had not seen it firsthand. This scene conveys the real implications and impacts of HIV/AIDS on a health care system and a country that has been stripped, divided, and neglected by apartheid.

While I often asked why there is no doctor, I was able to track down a traditional medicinal doctor who seemed to see no patients as well as the private clinic doctor who did not seem to care about providing real health care to the residents of Zonke. Writing has been done on where there is no doctor and what to do when there is no doctor, but the number one question in South Africa is why there is no doctor. This question is answered through history: apartheid, oppression, denial, and failure to recognize a crisis. The reality of apartheid health policies continuing to affect Black populations and responses to HIV/AIDS can be seen firsthand in the Zonkizizwe informal settlement.

Health was a weapon of apartheid and it worked. Denying medical access and training to the Black majority has kept the population in submission even 16 years after the end of apartheid. The critical period of 1993-2000 saw the new democratic government with its hands tied behind its back. There was no way that the health care system could be so dramatically scaled-up to meet the human and social needs of the HIV/AIDS crisis. As Seedat stated in Crippling a Nation, 1984, “Health in South Africa is inseparable from the economic, political and social structure of the apartheid state.” The health and HIV/AIDS realities that can be seen Zonkizizwe are direct result of apartheid’s legacy. HIV/AIDS in South Africa is not a direct result of apartheid policies, but the impact of HIV/AIDS and the health care system of South Africa is still inseparable from its apartheid past.

Works Cited
Beinart, William. “Labour Migrancy and Rural Production: Pondoland c.1900-1950.” In
Black Villagers in an Industrial Society, edited by Philip Mayer, pp. 81-108. Cape Town: Oxford University Press. 1980.

Boseley, Sarah. “Mbeki Aids denial ‘caused 300,000 deaths.” Guardian News UK. 26 November 2008. .

Chirwa, Wiseman Chijere. “Aliens and AIDS in Southern Africa: The Malawi-South Africa Debate.” The Royal African Society. African Affairs 97:53-79, 1998.

E. O. Nightingale, K. Hannibal, H. J. Geiger, L. Hartmann, R. Lawrence and J. Spurlock. “Apartheid Medicine. Health and Human Rights in South Africa.” Committee on Health and Human Rights, Institute of Medicine, National Academy of Sciences. Vol. 264 No. 16, October 24, 1990.

‘Forced removals in South Africa 1977-1978’, paper prepared by IDAF for the United Nations Centre Against Apartheid, No. 44/78, Oct. 1978, p.9.

“HIV and other STDs. Chapter 3, Part 1” Population Reports. Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health. Volume XXIV, Number 3. November, 1996.
http://www.infoforhealth.org/pr/J45/j45chap3_1.shtml.

“HIV & AIDS in South Africa: The history of AIDS in South Africa.” Avert.
http://www.avert.org/aidssouthafrica.htm.

J Yawitch, Betterment. “The myth of homeland agriculture” SAIRR: Johannesburg, 1981, p.86.

Kon, Zeida R. and Nuha Lackan. “Ethnic Disparities in Access to Care in Post-Apartheid South Africa.” American Journal of Public Health. December 2008, Vol. 98, No. 12.

Lodge, Tom. “The RDP: Delivery and Performance” in “Politics in South Africa: From Mandela to Mbeki”, David Philip:Cape Town & Oxford, 2003.

Lurie, Mark N., Brian G Williams, Khangelani Zuma, David Mkaya-Mwamburi, Geoff P Garnett, Michael D Sweat, Joel Gittelsohn, Salim SAbdool Karim. AIDS:17 October 2003 – Volume 17 – Issue 15 – pp 2245-2252.

Packard, Randall. White Plague, Black Labor: Tuberculosis and the political economy of health and disease in South Africa. University of California Press, 1989.

Palitsza, Kristin. “A Burden that Will Only Become Heavier.” Inter Press Service News Agency. May 28, 2006. http://www.ipsnews.net/africa/nota.asp?idnews=33396.

Posel, Dorrit. “Have migration patterns in post-apartheid South Africa changed?” 4-7 June 2003.
http://74.125.95.132/search?q=cache:4Oor9pRwaTkJ:pum.princeton.edu/pumconferenc e/papers/1-Posel.pdf+the+economic+of+apartheid,+labor+migrations&cd=1&hl=en&ct=clnk&gl=us&client=firefox-a.

Seedat, Aziza. Crippling a Nation: Health in Apartheid South Africa. International Defence Aid Fund for Southern Africa, London, April 1984.

“The Demographic Impact of HIV/AIDS in South Africa – National and Provincial Indicators for 2006” Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa. November 2006.

“The uprooting of millions, forced removals.” For their Triumphs’ and Tears. ANC, 1983.
http://www.anc.org.za/books/triumphs_part1.html#3back1.

UNAIDS 2006 Report on the Global AIDS Epidemic, Chapter 4: The impact of AIDS on people and societies
http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2006/default.asp.

UNAIDS 2008 Report on the Global AIDS Epidemic. http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/.

Appendix A