Issues in the political economy of health in Southern Africa.

Abstract

Over the past few years there have been major political developments in southern Africa. In the Republic of South Africa, the National Party's short-lived reformist strategy designed to buy off black discontent and to restructure apartheid in order to meet the changing demands of the economy has simply further fuelled black aspirations for their legitimate share of political and economic power. While some of the reforms may change the character of apartheid, South Africa's rulers have shown themselves to be as determined as ever to maintain white domination and their economic and political control of the sub-continent. They are neither willing nor able to engage in negotiations over genuine power-sharing, as the failure of the Commonwealth Eminent Persons Mission and the declaration of a fresh State of Emergency in the Republic on the 12th July 1986 have dramatically illustrated. Commonwealth hopes for a peaceful settlement were brought to an abrupt end by South Africa's military assault on the states of Zimbabwe, Zambia and Botswana. The Republic's onslaught against its neighbours reveals the intrinsic connection between apartheid and the well-being of people in the surrounding states. In the countries of the sub-continent and in South Africa itself these political and economic developments have had their repercussions in the health sphere. Violence and preventable diseases have taken an increasing toll, yet fewer resources are available for dealing with them as military preparations swallow up vast sums of money. In our report to the WHO conference on health and apartheid held in Brazzaville in 1981, we talked of the hidden violence in South Africa: the decimation of the black population by preventable diseases of infancy; the systematic destruction of family life and human health under the migrant labour system; the inadequate protection of workers' lives and safety; the deep insecurity and violence of township life; and the humiliation and degradation forced upon the majority of the population as second class citizens. 1 All these forms of violence have continued unchanged, deepened if anything by the current civil war. Despite the talk of reform, and limited changes in legislation, the racial discrepancies in the incidence of the diseases of poverty and deprivation such as tuberculosis, malnutrition and associated infections have if anything become starker. Although the South African state adopted as rhetoric many of the recommendations of the WHO Alma Ata conference on primary health care,