Socio-medical indicators of health in South Africa

Abstract

Socio-medical indicators developed by WHO for monitoring progress towards Health-for-All have been adapted to reveal, clearly and objectively, the devastating impact of state planning based on an outmoded immoral and unscientific philosophy of race superiority in South Africa on the health of the disenfranchised majority within the context of social and economic discrimination; Health policy indicators confirm that the government is committed to three options (Bantustans, A New Constitution, and A Health Services Facilities Plan) all of which are inconsistent with the attainment of Health-for-All; Social and economic indicators reveal gross disparities between African, Coloured, Indian, and White living and working conditions; Provision of health care indicators show the overwhelming dominance of high technology curative medical care consuming about 97 percent of the health budget with only minor shifts towards community-based comprehensive care; and Health status indicators illustrate the close nexus between privilege, dispossession and disease with Whites falling prey to health problems related to affluence and lifestyle, while Africans, Coloureds, and Indians suffer from disease due to poverty. All four categories of the indicator system reveal discrepancies which exist between Black and White, rich and poor, urban and rural. To achieve the social goal of Health-for-All requires a greater measure of political commitment from the state. We conclude that it is debatable whether a system which maintains race discrimination and exploitation can in fact be adapted to provide Health-for-All.

PIP: This report evaluates the effects of race discrimination on the health status of South Africa using a socio-medical indicator system derived by WHO. The indicator system consists of 4 categories: health policy indicators, social and economic indicators related to health, indicators of provision of health care, and health status indicators. Political commitment is essential for the attainment of health for the population; the government of South Africa is committed to 3 different options influencing health, all described in detail. Budget allocation is an objective measure of commitment; 3.2% of the GNP was spent on health in 1981, and only 2.2% of the total health budget is devoted to preventive medicine. Absence of democratic structures for all to express needs and demands results in racially biased allocation and distribution of health services. Social and economic indicators relating to health include rate of population increase, gross national product, income distribution, work conditions, literacy rates, housing needs, and food availability. Indicators of basic health status include nutritional status, child mortality rates (15.6/1000 for Africans, 1.1 for whites) and life expectancy at birth (for black males 45.0 yrs and for black females 47.3, for white males 65.5 and white females 71.9). In order to achieve health for all, action is needed at the political level to eliminate apartheid, and at policy and decision making levels, to improve living and health conditions.