Breaking The Spirit: the right to health
issue 179 - January 1988
Hit the Hospitals
The West is becoming more aware of the need for a healthy lifestyle: for prevention rather than cure. But its view of health care is still based on crisis management by highly trained professionals. Developing countries, meanwhile, cannot afford to supply high-technology medicine to more than a tiny élite.
More important than the level of health expenditure id the quality of that expenditure. Third World governments must aim to train a health worker in every village, no matter how remote. This worker will not have all the wonders of modern science at her disposal but she will have the knowledge to combat the major killer illnesses such as measles and diarrhoea. Governments that immunize children against basic diseases and promote breast feeding will save far more lives than any prestige hospital.
The biggest improvement in the rate of infant mortality between 1981 and 1985 occurred in Burkina Faso, a decline from 208 to 145 deaths per thousand births. This still leaves it with the ninth highest infant mortality rate in the world but the improvement is likely to continue: because of general policies geared towards helping the poor; and because of it's government's particular commitment to health. Over a million children were immunized in a single three week 'vaccination commando' campaign in 1984. Since then a 'commando' campaign on primary health care has ensured that every one of the county's 7,500 villages now has a health post.
Thailand is ruled by a strange amalgam of King, military and some degree of democracy. But its primary health care policies put many more radical governments to shame. Most countries pay lip-service to primary health care and can point to model projects. But Thailand is one of the few which has put the principles into practice nation-wide, training at least one health worker for every community. The Thais have made a special point of monitoring the growth of children to detect early signs of malnutrition. One and a half million children in 37,000 villages are now regularly weighed and the number of undernourished children has gone down from 51 per cent in 1979 to 29 per cent in 1984.
Algeria's health improved steadily after independence but then faltered about six years ago. By mid 1984 the Government had decided that the level of child deaths was unacceptable. A mass media campaign explaining how to combat diarrhoea was followed by a series of vaccination drives. It is also one of the few governments which has taken seriously the UN goal of supplying every village with clean water by 1990.
Votes for censure
The decline in life expectancy in South Africa - from 63 in 1981 to 55 in 1985 - is due partly to the fact that the black population is growing faster than the white but is subject to much worse social and economic conditions (see feature). Black people also have much less access to health care. The World Health Organization stipulates a minimum of two nurses per 1,000 people. In 1983 'African' people had 1.5 while whites had six.
Congo is the classic case of a country with the wrong priorities in health. The damaging effect of IMF - imposed spending cuts are outlined on page 15. But governments can still choose which programmes are to be cut most - in Algeria, for instance, spending was reduced in every department except health. The Congolese Government by contrast, not only made drastic cuts in health in 1986 but did so in the most damaging way possible: choosing to ravage it's primary-health-care programmes while devoting almost 90 per cent of the health budget to just one high-tech teaching hospital in the capital.
The Soviet Union claims that the collective human right to health is more important than the right to organize and express the opposition. And in the 1950s its own magnificent improvements in infant mortality and life expectancy were held up as proof of the superiority of their political system. But now life expectancy has actually fallen from 72 in 1981 to 70 in 1985 and infant mortality has risen from 28 per thousand in 1965 to 29 in 1985.
UNICEF State of the World's Children, 1983 to 1987; World Bank World development report, 1983 to 1987; Race Relations Survey 1984, SA Institute of Race Relations 1985; Informal consultations with experts in the field.
Article featuring one of the countries awarded a vote of censure under the Right to Health
Breaking the Spirit
South Africa's record for state terror is well-known. But it is
also guilty of another kind of violence: United Nations figures show
that its people's life expectancy fell by eight years between 1981 and 1985.
Chris van Wyk receives the news in his own black township.
Riverlea, where I live, is a 'coloured' township clustered around a huge yellow mine dump just outside Johannesburg. The dump tapers sadly skywards like a huge, depleted breast: having weaned white people into the brave new world of a modern industrialized economy, it is of no use to anyone now. Certainly none of the inhabitants of Riverlea, who live in its shadow, have ever laid claim to any of its gold.
Riverlea is one of the forgotten townships. Too small and too quiet to have become a household word across the globe like Soweto. But it is a suitable enough vantage point from which to view South Africa The NI tells me that South Africa has the world's sharpest decline in life expectancy in the last few years. This doesn't surprise me - it is the good news which surprises after all these years rather than the gloomy. The black population here is certainly growing faster than the white, which means that each year there are proportionately more people in poverty, more lives lost before their time.
Even the official figures prove this. My wife and I have just had our second child. As a 'coloured' baby, my son has a six-percent chance of dying in his first year of life. A few miles away - in the world of white suburbia, in the house my next-door neighbour goes to clean every day, a baby has less than a quarter that risk of death. While in an 'African' township such as Soweto the risk goes up to eight per cent.
Riverlea has always had its share of squalour, crime, unemployment and alcoholism - the natural consequences of apartheid. Unemployment is high. Every weekday morning the buses that take the more fortunate to work run the depressing gauntlet of unemployed people who hang listlessly around on the streets. Out of long habit these people rise early each morning. Perhaps this helps to keep them going, keeps them linked to a working class of which they were once a part.
Illegal shebeens and drug dealers have, as you might expect, prospered as unemployed people turn to them for solace. But alcohol and Mandrax don't come cheap. So there are more burglaries now, and muggings. But it is our own homes which are affected rather than those in the white areas which are protected by high-security devices. So the quality of township life is made still poorer as we are caught up in one of the downward spirals with which the poor the world over are so familiar.
Faced with such terrible inequalities, you might expect Riverlea to be a ferment of protest and political activism. It is not The only time it even approached such a state was in 1984, when my township probably saw more political activity than it had in all the rest of the 25 years of its existence. This was because in that year 'coloured' and 'Indian' people were finally offered the vote - though for our own separate parliaments rather than on the same electoral roll as whites. Apartheid was to be further institutionalized.
To Riverlea and all the other 'coloured' and 'Indian' communities, the Government brought its latest offering. And, like shepherds at the Nativity, the people of Riverlea gawked in awe at this swaddled new babe they were being asked to follow for their salvation. Along with other activists, I warned people that the new parliament was not the Messiah. How could it be when, among numerous other faults, it excluded the 'African' people who comprised 74 per cent of the population?
In the end most people did not vote. They were suspicious. Why was the Government suddenly asking them to get involved in politics? Politics! The very word that had for years been synonymous with police harassment, detention and treason.
From the podium black leaders - those few that have managed to stay out of prison - still decry apartheid's injustices with words like: 'We don't have to tell the people they are suffering. They know they are!' But when I look at Riverlea I sometimes wonder just how much truth there really is in this.
Too many of the people around me are broken in spirit by a system that has excluded and oppressed them all their lives.
I think of an elderly woman I know. Her pension is a pittance in itself, let alone in comparison with that of her white counterparts. Her gaunt features and sunken eyes are proof of an inadequate diet She lives in a ramshackle house without electricity, toilet or hot water. Yet she asked innocently 'But why shouldn't we vote? This Government has given the coloured people a little bit to be grateful for'.
I think too of the young unemployed artisan who told me: 'I deserve my lot. I was quite stupid at school. Whites are generally cleverer than coloureds or Africans anyway, so they deserve to have all these comforts. And them do the voting - they know what's best.'
You have heard about the brave resistance, the defiance, the boundless spirit of the black opposition. But it is as well to be aware of this other side of the coin: of spirits broken by bad health and poverty as much as by political oppression. I despair when people don't recognize the connection between their own deteriorating condition and the system. But perhaps l am asking too much. Perhaps I am asking the patients to diagnose their own rigor mortis.
Chris van Wyk is a poet and an editor at the South African publisher, Ravan Press.
1 Race Relations Survey 1984, South African Institute of Race Relations 1985.