Abstract

I examine racial differences in child stunting in mid-1990s South Africa and Brazil, two multiracial societies with different histories of legal support for racial discrimination. Using data from nationally representative household samples linked to community-level measures, the analysis shows that racial inequality in the distribution of socioeconomic resources across households and communities explains much of the racial difference in stunting in both countries. Even after these factors are controlled, however, the results indicate that in South Africa, nonwhite children are still at greater risk of growth faltering than are white children. The nature of socioeconomic and racial differences in children’s growth is examined, and major determinants are discussed. These findings suggest that although state-sanctioned racism may help to explain the greater racial inequality in stunting in South Africa than in Brazil, the eradication of a disadvantage for nonwhites will depend on changes in the same fundamental socioeconomic inequalities that characterize both nations.

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References

Andersson, N., & Marks, S. (
1988
).
Apartheid and Health in the 1980s
.
Social Science and Medicine
,
27
,
667
81
. 10.1016/0277-9536(87)90327-3
Barrera, A. (
1990
).
The Role of Maternal Schooling and Its Interaction With Public Health Programs in Child Health Production
.
Journal of Development Economics
,
32
,
69
91
. 10.1016/0304-3878(90)90052-D
Becker, G. (
1981
).
A Treatise on the Family
.
Cambridge, MA
:
Harvard University Press
.
Behrman, J.R., & Wolf, B.L. (
1987
).
Women’s Schooling and Children’s Health: Are the Effects Robust With Adult Sibling Control for the Woman’s Childhood Background?
.
Journal of Health Economics
,
6
,
239
54
. 10.1016/0167-6296(87)90011-7
Preliminary Results: 1996 DHS Survey of Brazil
. (
1996
).
Columbia, MD
:
Macro International
.
South Africa—Demographic and Health Survey. Preliminary Report
. (
1998
).
Calverton, MD
:
Macro International
.
Boerma, J.T. (
1996
).
Child Survival in Developing Countries: Can Demographic and Health Surveys Help to Understand the Determinants?
.
Amsterdam
:
Royal Tropical Institute
.
Bollen, K.A., Glanville, J.L., & Stecklov, G. (
2001
).
Socioeconomic Status and Class in Studies of Fertility and Health in Developing Countries
.
Annual Review of Sociology
,
27
,
153
85
. 10.1146/annurev.soc.27.1.153
Botha, J.L., & Bradshaw, D. (
1985
).
African Vital Statistics—A Black Hole?
.
South African Medical Journal
,
67
,
977
81
.
Buss, P., & Gadelha, P. (
1996
).
Health Care Systems in Transition: Brazil Part I: An Outline of Brazil’s Health Care System Reforms
.
Journal of Public Health Medicine
,
18
,
289
95
.
Chaning-Pearce, S.M., & Solomon, L. (
1986
).
A Longitudinal Study of Height and Weight in Black and White Johannesburg Children
.
South African Medical Journal
,
70
,
743
46
.
Christopher, A.J. (
1994
).
The Atlas of Apartheid
.
New York
:
Routledge
.
DATASUS. 1996. Informaes de Saude. Available on-line at http://tabnet.datasus.gov.br/tabnet/ tabnet.htm
DaVanzo, J., & Gertler, P. (
1991
).
Household Production of Health: A Micro-economic Perspective on Health Transitions
. In Cleland, J., & Hill, A.G. (Eds.),
The Health Transition: Methods and Measures
(pp.
85
101
).
Canberra
:
Australian National University Press
.
Degler, C.N. (
1971
).
Neither Black nor White: Slavery and Race Relations in Brazil and the United States
.
Madison
:
University of Wisconsin Press
.
Filmer, D., & Pritchett, L.H. (
2001
).
Estimating Wealth Effects Without Expenditure Data—or Tears: An Application to Educational Enrollments in States of India
.
Demography
,
38
,
115
32
.
Frank, R. (
2001
).
The Misuse of Biology in Demographic Research on Racial/Ethnic Differences: A Reply to van den Oord and Rowe
.
Demography
,
38
,
563
68
. 10.1353/dem.2001.0034
Glei, D., & Goldman, N. (
2000
).
Understanding Ethnic Variation in Pregnancy-Related Behaviors, Health Care and Birth Outcomes in Rural Guatemala
.
Ethnicity and Health
,
5
,
5
22
. 10.1080/13557850050007301
Habicht, J-P., Martorell, R., Yarbrough, C., Malina, R., & Klein, R.E. (
1974
).
Height and Weight Standards for Pre-school Children: How Relevant Are Ethnic Differences in Growth Potential?
.
Lancet
,
1
,
611
15
. 10.1016/S0140-6736(74)92663-4
Hasenbalg, C.A. (
1985
).
Race and Socioeconomic Inequalities in Brazil
. In Fontaine, P.M. (Ed.),
Race, Class, and Power in Brazil
.
Los Angeles
:
UCLA Center for Afro-American Studies
.
Horton, S. (
1986
).
Child Nutrition and Family Size in the Philippines
.
Journal of Development Economics
,
23
,
161
76
. 10.1016/0304-3878(86)90086-6
Jinabhai, C.C., Coovadia, H.M., & Abdool-Karim, S.S. (
1986
).
Socio-medical Indicators of Health in South Africa
.
International Journal of Health Services
,
16
,
163
76
. 10.2190/JTNM-2D1H-8TK8-63DV
Kaufman, C.E. (
1998
).
Contraceptive Use in South Africa Under Apartheid
.
Demography
,
35
,
421
34
. 10.2307/3004011
Krieger, N., Rowley, D.L., Herman, A.A., Avery, B., & Phillips, M.T. (
1993
).
Racism, Sexism, and Social Class: Implications for Studies of Health, Disease, and Well-being
.
American Journal of Preventive Medicine
,
9
,
82
122
.
Lam, D. 1999. “Generating Extreme Inequality: Schooling, Earnings, and Intergenerational Transmission of Human Capital in South Africa and Brazil.” Unpublished manuscript, Department of Economics and Population Studies Center, University of Michigan.
LaVeist, T. (
1996
).
Why We Should Continue to Study Race … But Do a Better Job: An Essay on Race, Racism, and Health
.
Ethnicity and Health
,
6
,
21
29
.
Liang, K.-Y., & Zeger, S.L. (
1986
).
Longitudinal Data Analysis Using Generalized Linear Models
.
Biometrika
,
73
,
13
22
. 10.1093/biomet/73.1.13
Lillie-Blanton, M., Parsons, P.E., Gayle, H., & Dievler, A. (
1996
).
Racial Differences in Health: Not Just Black and White, but Shades of Gray
.
Annual Review of Public Health
,
17
,
411
48
.
Lovell, P.A., & Wood, C.H. (
1998
).
Skin Color, Racial Identity, and Life Chances in Brazil
.
Latin American Perspectives
,
25
,
90
110
. 10.1177/0094582X9802500305
Madise, N.J., Matthews, Z., & Margetts, B. (
1999
).
Heterogeneity of Child Nutritional Status Between Households: A Comparison of Six Sub-Saharan African Countries
.
Population Studies
,
53
,
331
43
. 10.1080/00324720308092
Martorell, R., & Habicht, J.-P. (
1986
).
Growth in Early Childhood in Developing Countries
. In Falkner, F., & Tanner, J.M. (Eds.),
Human Growth: A Comprehensive Treatise: Volume 3
(pp.
241
62
).
New York
:
Plenum Press
.
Mendez, M.A., & Adair, L.S. (
1999
).
Severity and Timing of Stunting in the First Two Years of Life Affect Performance on Cognitive Tests in Late Childhood
.
Journal of Nutrition
,
129
,
1555
62
.
Monteiro, C.A., Benicio, M.H. D’A., & Gouveia, N.C. (
1994
).
Secular Growth Trends in Brazil Over Three Decades
.
Annals of Human Biology
,
21
,
381
90
. 10.1080/03014469400003372
Monteiro, C.A., Benicio, M.H. D’A., Iunes, R., Gouveia, N.C., Taddei, J.A.A.C., & Cardoso, M.A.A. (
1992
).
Nutritional Status of Brazilian Children: Trends From 1975 to 1989
.
Bulletin of the World Health Organization
,
70
,
657
66
.
Mosley, W.H. and L.C. Chen. 1984. “An Analytical Framework for the Study of Child Survival in Developing Countries.” In Child Survival: Strategies for Research, edited by W.H. Mosley and L.C. Chen. Population and Development Review 10(Suppl.):5–45.
The Health Care System in South Africa. Financing Health Care With Particular Reference to Medicines, Volume 19
. (
1996
).
Basle
:
Pharmaceutical partners; London: National Economic Research Associates
.
Pan American Health Organization. 2001. “Brazil: Basic Country Health Profiles.” Available online at http://www.paho.org/english/SHA/prflbra.htm
Pebley, A.R., & Goldman, N. (
1995
).
Social Inequality and Children’s Growth in Guatemala
.
Health Transition Review
,
5
,
1
20
. 10.5172/hesr.1995.5.1.1
Pelletier, D.L. (
1991
).
Relationships Between Child Anthropometry and Mortality in Developing Countries: Implications for Policy, Programs, and Future Research.” Monograph 12
.
Ithaca, NY
:
Food and Nutrition Policy Program, Cornell University
.
Pelletier, D.L. (
1998
).
Malnutrition, Morbidity, and Child Mortality in Developing Countries
Too Young to Die: Genes or Gender?
(pp.
109
32
).
New York
:
United Nations
.
Pelletier, D.L., Frongillo, E., & Habicht, J-P. (
1993
).
Epidemiological Evidence for a Potentiating Effect of Malnutrition on Child Mortality
.
American Journal of Public Health
,
83
,
1130
33
. 10.2105/AJPH.83.8.1130
Reichmann, R. (
1999
).
Race in Contemporary Brazil: From Indifference to Inequality
.
University Park
:
University of Pennsylvania Press
.
Rosenzweig, M.R., & Schultz, T.P. (
1982
).
Child Mortality and Fertility in Columbia: Individual and Community Effects
.
Health Policy and Education
,
2
,
305
48
. 10.1016/0165-2281(82)90015-7
Silva, N. (
1985
).
Updating the Cost of Not Being White in Brazil
. In Fontaine, P.M. (Ed.),
Race, Class, and Power in Brazil
.
Los Angeles
:
UCLA Center for Afro-American Studies
.
Silva, N. (
1999
).
Racial Differences in Income: Brazil, 1988
. In Reichmann, R. (Ed.),
Race in Contemporary Brazil: From Indifference to Inequality
(pp.
68
82
).
University Park
:
Pennsylvania State University Press
.
Siqwala-Ndulo, N.W. 1993. Rural African Family Structure in the Transkei, South Africa. Unpublished doctoral dissertation, University of California at Los Angeles.
South Africans Rich and Poor: Baseline Household Statistics
. (
1994
).
Cape Town, South Africa
:
University of Cape Town
.
Stata User’s Guide. Stata Statistical Software: Release 6.0
. (
1999
).
College Station, TX
:
Stata Corporation
.
Strauss, J. (
1990
).
Households, Communities and Preschool Child Nutrition Outcomes: Evidence From Rural Côte d’Ivoire
.
Economic Development and Cultural Change
,
38
,
231
61
. 10.1086/451791
Sullivan, K.M., & Gorstein, J. (
1999
).
ANTHRO: Software for Calculating Anthropometry
.
Atlanta
:
Centers for Disease Control and Prevention; Geneva: World Health Organization
.
Telles, E.E. (
1992
).
Residential Segregation by Skin Color in Brazil
.
American Sociological Review
,
57
,
186
97
. 10.2307/2096204
Telles, E.E., & Lim, N. (
1998
).
Does It Matter Who Answers the Race Question? Racial Classification and Income Inequality in Brazil
.
Demography
,
35
,
465
74
. 10.2307/3004014
Thomas, D., Strauss, J., & Henriques, M.-H. (
1990
).
Child Survival, Height for Age, and Household Characteristics in Brazil
.
Journal of Development Economics
,
33
,
197
234
. 10.1016/0304-3878(90)90022-4
Thomas, D., Strauss, J., & Henriques, M.-H. (
1991
).
How Does Mother’s Education Affect Child Height?
.
Journal of Human Resources
,
26
,
183
211
. 10.2307/145920
Treiman, D.J., McKeever, M., & Fodor, E. (
1996
).
Racial Differences in Occupational Status and Income in South Africa, 1980 and 1991
.
Demography
,
33
,
111
32
. 10.2307/2061717
van den Oord, E.J.C.G., & Rowe, D.C. (
2001
).
A Step in Another Direction: Looking for Maternal Genetic and Environmental Effects on Racial Differences in Birth Weight
.
Demography
,
38
,
573
76
. 10.1353/dem.2001.0040
Waterlow, J., Buzina, R., Keller, W., Lane, J., Nichaman, M., & Tanner, J. (
1977
).
The Presentation and Use of Height and Weight Data for Comparing the Nutritional Status of Groups of Children Under the Age of Ten Years.
.
Bulletin of the World Health Organization
,
55
,
489
98
.
Williams, D.R. (
1995
).
Racism and Health: A Research Agenda
.
Ethnicity and Disease
,
6
,
1
6
.
Williams, D.R., & Collins, C. (
1995
).
U.S. Socioeconomic and Racial Differences in Health: Patterns and Explanations
.
Annual Review of Sociology
,
21
,
349
86
. 10.1146/annurev.so.21.080195.002025
Wood, C.H., & Carvalho, J.A.M.D. (
1988
).
The Demography of Inequality in Brazil
.
New York
:
Cambridge University Press
.
Wood, C.H., & Lovell, P. (
1992
).
Racial Inequality and Child Mortality in Brazil
.
Social Forces
,
70
,
703
24
. 10.2307/2579750
Zenger, E. (
1993
).
Siblings’ Neonatal Mortality Risks and Birth Spacing in Bangladesh
.
Demography
,
30
,
477
72
. 10.2307/2061652
Zuberi, T. (
2001
).
One Step Back in Understanding Racial Differences in Birth Weight
.
Demography
,
38
,
569
72
. 10.1353/dem.2001.0041