The loss from premature deaths of economically active manpower in the various populations of the RSA. Part I. Leading causes of death: health strategies for reducing mortality.

Age-adjusted mortality rates (MRs) per 100 000 for the leading causes of death were calculated for 1970 for Asians, Coloureds and Blacks and compared with the MRs of Whites for the economically active age-group of 15 - 64 years. Marked differences in mortality patterns were shown by this comparison. At the one extreme were the Whites in whom the five leading causes of death in rank order were ischaemic heart disease, motor vehicle accidents, cerebrovascular accidents (CVA), cancer of the digestive system and bronchitis and associated respiratory diseases--a mortality pattern which is characteristic of a developed Western community. At the other extreme were the Blacks in whom the five leading causes of death in rank order were "ill-defined" diseases, the pneumonias, tuberculosis, CVA and homicide and unspecified violence -- a mortality pattern commonly seen in less developed communities. Reducing mortality in the various populations will not come about by spending more money on hospital-bases curative medicine but by greater emphasis on health promotion and disease prevention. Quite different health strategies are needed to reduce mortality in the Whites and Asians on the one hand, and the Coloureds and Blacks on the other. The health strategies required for Whites and Asians involve behavioural changes in lifestyles, whereas for Coloureds and Blacks they involve elementary public health measures such as clean water, proper sanitation, better housing improved nutrition and health education.