Racial Health Disparities in the Colonial Period
Colonial scientists and doctors used theorized that Tutsis and Hutus were genetically distinct. In a 1963 Belgian paper, the author claims that differential residential distribution of the two groups (the Hutus in the Savannah, and the Tutsi in places with good grazing lands for their cattle) led to a divergence in the gene pool (Hiernaux, 1963: 576). The study also noticed that there were variations in health outcomes within the Hutu group between those who lived in high and low altitudes – these health outcomes included nutritional intake and vulnerability to malaria (Ibid., 577).
Disparities in Child Mortality between Hutu and Tutsi (Brockerhoff, 2000)
Whether or not these claims are true, there is evidence that colonialism led to racial health disparities in modern Rwanda.
Brockerhoff and Hewett found that child mortality among Tutsis was significantly lower than that of Hutus. The unadjusted odds of child mortality for Tutsis was 24% lower than that of Hutus for children in their first year of life; for children under two and five, the odds were around 20%.
The authors included two sets of covariates to try to explain what accounts for this difference. One set of variables included economic factors that indicate access to resources: the presence of electricity or piped water at home, and the occupational status of the head (man) of the household. The second set of variables included what they call more “social” indicators, such as the education level of the mother, whether the family had migrated in the last 5 years, whether the family lived in the largest city, and whether the mother sought important antenatal services.
All economic variables had a significant effect on the odds of child mortality. The mother’s level of education was not a significant contributor, while not having migrated in the last 5 years and living in the largest city contributed to significantly lower rates.
The effect of race on child mortality was significantly reduced when economic variables were accounted for. This suggests that racial disparities in child mortality are largely due to disparities in access to resources. Access to quality healthcare is highly dependent on access to economic resources; the more money you have, the more you are likely to be able to afford better services (i.e. giving birth in hospitals, instead of with traditional birth attendants). Having migrated in the last 5 years, and living in the largest city, were also significant factors in explaining racial disparities in child mortality.
It makes sense why these are significant explainers of racial health disparities in Rwanda. Tutsis were an economically privileged group in Rwanda, largely due to the legacy of a colonial structure that placed Tutsis as administrators above Hutus. Thus, Tutsis are probably more likely to have lived around large cities and have privileged jobs.