By Thabo Mbeki

ANC Today 5 April 2002

April is our Health Month. This gives all of us the important possibility to make a contribution to improving the health of the disadvantaged. It also gives us the chance to understand our health challenges better.

This is especially important given the very unfortunate reality that some in our society and elsewhere in the world, seem very determined to impose the view on all of us, that the only health matters that should concern especially the black people are HIV/AIDS, HIV, and complex anti-retroviral drugs, including nevirapine.

We still await the results of the work being done by a number of government agencies to give us as accurate a picture as possible of the causes of death in our country, which up-to-date information we do not have. This report will help us to improve our planning with regard to the interventions we need to make to move closer to the achievement of the goal of health for all.

We will have to ensure that the information contained in the report reaches as many of our people as possible. This is necessary because the matter of the health of all our people is of critical concern and importance to our movement and country. To respond correctly, we have to be informed by the real health situation of our people.

The majority of our people are poor. Necessarily, therefore, our policies are focussed on the issue of the alleviation and eradication of poverty. We are implementing many programmes aimed at ensuring that we lift the burden of poverty that weighs heavily on the shoulders of our people.

We are working continuously to develop and expand our economy. Among other things, this should help to reduce the levels of unemployment and therefore increase the number of people who earn a means of livelihood. The larger economy also enables us to generate the resources necessary to fight poverty.

In a few years, we have restructured our budget expenditure to ensure that more public resources are directed towards the poor. Because of this, it has been possible to allocate more resources to such areas as pensions and other welfare payments, water and sanitation, health services and infrastructure, nutrition, housing and electricity.

Our Integrated Rural Development and Urban Renewal Programmes have selected those geographic areas in our country that have the highest concentration of poverty and therefore the social ills that result from this poverty.

Some of these social ills are the diseases of poverty to which millions of people in our country are prone. It is for this reason that, as we discuss our Health Month, we have mentioned the centrality for us of the objective of poverty alleviation and eradication.

There is a determined and aggressive attempt to hide the truth about the direct and immediate relationship between poverty and health. Huge resources are devoted to the accomplishment of this objective. There is virtually no discussion in our country about the diseases of poverty that regularly claim the lives of hundreds of thousands of our people.

Some individuals, engaged in politics and public health, have achieved and seek to obtain public prominence, on the basis of leading an extremely harmful and unacceptable campaign to deny our people all information and knowledge about the incidence of diseases of poverty in our country. We are told that we must accept the harm these persons cause, and their insult of an entire people, as the very essence of free democratic expression.

Despite the propaganda offensive, the reality is that the predominant feature of illnesses that cause disease and death among the black people in our country is poverty. This poverty impacts on health in a variety of ways, all of which are well known and recognised throughout in the world.

This impact ranges from poor nutrition, unavailability of clean water and proper sanitation, unhygienic environmental conditions, unaffordability of drugs and medicines, inadequate or unavailable health services and infrastructure, low levels of education, the effect of rapid urbanisation, to social breakdown within communities.

The truth is that poverty causes illness and death. The truth is also that ill-health causes poverty. As we work during Health Month to address issues of health, including AIDS, we must understand these fundamental truths, as a necessary condition for the success of the sustained campaign we must wage to ensure the continuous improvement of the health of our people.

The Director-General of the WHO, Dr Gro Harlem Brundtland, spoke at a meeting in Washington D.C. on October 27, 1999. Inter alia, she said:

"The 20th century has brought about dramatic improvements in health, but the unfinished agenda is there before us: more than a billion human beings have been left behind in the health revolution. The burden of disease and disability on the poor remains unbearable in many parts of the world both in terms of suffering and the economic strain it leads to.

"Today, respiratory diseases, diarrhoea and perinatal conditions remain the main contributors to the overall global burden of disease and to mortality among children, against a backdrop of chronic malnutrition. But at the same time, and in the same countries of the developing world, we face the mounting burden of heart diseases, cancer, diabetes, accidents and mental health conditions, against a backdrop of ageing and new risk factors of which tobacco is the most prominent. The epidemic of tobacco use will make it the single largest cause of disability and premature death in the coming twenty years.

"We recognise that poverty is multi-dimensional by nature and has several causes, including poor health, and several cures, including health status improvement. WHO has to build and strengthen knowledge about the links between poverty and health. In all areas, we need to work with like-minded partners committed to poverty reduction."

In a speech entitled 'Health and Poverty Eradication', a senior health official, Dr O. Walker, attached to the WHO Regional Office for Africa, told a UN General Assembly Working Group in New York on May 18, 2000, that:

"Given that poverty remains a major contributor to ill-health and premature death in the African Region, the anti-poverty advocacy role of the health sector must be greatly enhanced."

Bangladesh, in Asia, is also a poor country. It understands and approaches the issue of diseases of poverty with great seriousness. A report datelined: Dhaka, Bangladesh 24 May 2001, states:

"Forty prominent experts meeting in Dhaka today have called for health services in Bangladesh to refocus on the needs of the poor. The meeting, which involved leading thinkers from the government, private sector, research institutions, NGOs and the media, highlighted the destruction caused by the seven health conditions most responsible for deaths among poor people. These conditions, named the 'diseases of poverty', include tuberculosis, malaria, childhood diseases (respiratory infections, diarrhoeal diseases, measles), maternal and perinatal conditions and HIV/AIDS.

" 'The diseases of poverty are responsible for more than half of the deaths in this country,' said Prof. Abul Barkat, after presenting a paper to the meeting. 'This burden is almost entirely borne by the poor. What's particularly unjust about this situation is that all of these diseases are easily preventable.' "

For its part, the U.S. University of Virginia says:

"Diseases of poverty demand the attention and co-operation of the entire world community. Our common humanity requires that our resources be directed at preserving and enhancing life wherever it is endangered, and poverty increases the frequency and severity of disease. Moreover, our common humanity is biological as well as ethical, and diseases of the poor can and do become diseases of the rich. In a shrinking world, to seek health behind barricades is not only selfish, it is bad science. Building on existing strengths locally and internationally, the Centre for Global Health will be dedicated to alleviating diseases of poverty.

"Thus, our focus is on understanding and ameliorating of the costs of diseases of poverty. Effectively addressing the growing health threats from the diseases of poverty may well be the greatest imperative and challenge to our survival as a civilization respectful of human dignity."

Dr O. Walker also pointed to what needs to be done, to which we must respond, to reinforce what we are doing already. He said:

"Health needs to be promoted in the home, community and the workplace with emphasis on the following:

  • ensuring a positive political and legal environment
  • promoting community empowerment
  • ensuring access to gainful employment
  • guaranteeing healthy working conditions
  • enhancing environmental health and safety
  • guaranteeing access to safe water and sanitation
  • guaranteeing access to formal and non formal education
  • ensuring access to safe food
  • promoting healthy life style
  • guaranteeing safe and affordable housing
  • establishing and/or strengthening social protection systems."

Because of the pursuit of particular agendas, regardless of the health challenges facing the majority of our people, who happen to be black, in our country there is a studied and sustained attempt to hide the truth about diseases of poverty.

If we allow these agendas and falsehoods to form the basis of our health policies and programmes, we will condemn ourselves to the further and criminal deterioration of the health condition of the majority of our people. We cannot and will not follow this disastrous route. We are both the victims and fully understand the legacy of centuries-old and current racism on our society and ourselves.

We will not be intimidated, terrorised, bludgeoned, manipulated, stampeded, or in any other way forced to adopt policies and programmes inimical to the health of our people. That we are poor and black does not mean that we cannot think for ourselves and determine what is good for us. Neither does it mean that we are available to be bought, whatever the price.

Health Month must help us to form and strengthen the partnerships of which the WHO DG spoke, based on commitment to poverty reduction, the improvement of the health of the poor and human dignity.