Health disparities between racial groups in South Africa: a decomposition analysis

Abstract

This article explores the sources of self-rated health status inequalities among South Africans. We propose a decomposition of observed health disparities between racial groups using a procedure based on an extended version of Oaxaca-Blinder decomposition methods which addresses explicitly the specificities associated with the analysis of subjective measures. This method allows for a decompositions of differences in self-rated health status between races and isolates what may be due to observed socioeconomic inequality between racial groups, i.e. an "indirect racial effect" (Whites and Africans with different socio-economical characteristics have different health), from what could be due to unexplained racial differences, i.e. a "direct racial effect" (Whites and Africans with similar socio-economical characteristics have different health). Unsurprisingly, we find a strong indirect racial effect in favor of Whites. However, our analysis tends to show that the issue of direct racial discrimination on health is more complex and closely linked with that of economical inequality and discrimination. Our results thus stress the necessity not only to open access for Africans to the more sophisticated sector of health care but also to provide them with the economical opportunity to use it.