The public health philosophy of the earliest Medical Officers of Health is as relevant today as it was in the middle of the last century. The social, economic and environmental conditions, together with the historical and cultural background of a community are all worthy of study when assessing health care needs. This paper describes the high-density peri-urban black communities in Natal and KwaZulu that surround the City of Durban, South Africa, and outlines an 'alternative health strategy' that has been developed to meet their specific needs.