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EDITORIALS: Daniel J Ncayiyana Africa can solve its own health problems BMJ 2002; 324: 688-689 [Full text]

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Not economic growth but education...

johannes borgstein   (22 March 2002)

Total agreement

Ms. Judy Rosner   (24 March 2002)

Can Africa really solve its own health problems?

Solomon R Benatar, Observatory, 7925, South Africa   (27 March 2002)

Less globalisation, more real assistance

Bosede B Afolabi   (28 March 2002)

Not economic growth but education... 22 March 2002
johannes borgstein University Hospital Rotterdam Send response to journal: Re: Not economic growth but education...	Congratulations on a provocative editorial though I found it a curious mixture of sensible comments and sweeping statements. Of course any country in the world can and solve it's own health problems with “with sufficient will, commitment, and vision”.that is a tautology The first paragaph indicates the ancient and heterogeneous origins of Africa, while the second sweeps them all together and considers “Africa” in much the same way as the old colonial administrations used to do, when they arbitrarily divided up the continent in the 19th century, .or the Pope who drew a line across South America for the Spanish and the Portuguese in the 16 the century. For better or for worse, Africa is now made up of a collection of very varied and diverse countries which must each seek the best solution they can. There will certainly not one solution for Africa as a whole; for any of the problems. The WHO may have done more to upset the ecological balance in Africa than any other single cause, with such absurd statements as “health for all by the year 2000” which was their slogan not 20 years ago, when it we quite clear to all of us then working in Africa that there would not even be food for all by the year 2000. Now that they are entirely out of their depth due to the AIDS problem they blame everything on poverty. Poverty and even health are meaningless terms if you do not have enough to eat, so the first priority is not to lift people out of poverty, but to find a balance between population growth and food production, if possible before lack of food re-establishes some sort of balance the hard way, as was seen in the Sudan and Ethiopia. DDT is harmful to everyone and is not a weapon against malaria but an insecticide that insects eventually become immune to long before mammals. Advocating its widespread use may have short term benefits but is a long term global disaster. Globalisation really means globalised commerce and that is the real villain here. Ultimately it is not in anyone’s interest, for its only motive is profit and it will destroy everything in its path to obtain a short term economic gain for a small minority who will hardly be able to enjoy it amidst the resulting poverty and violence. Finally I am a little surprised that Dr Ncayiyana leaves education till last and then considers mainly university education and research. With an adequate lower education alone many of the worlds health problems can be solved at practically no extra cost, and if it is not possible to educate all, perhaps you should concentrate you educational efforts on women – then the next generation will have a head start, and will probably be less numerous.
Total agreement 24 March 2002
Ms. Judy Rosner, science writer/editor PArkinson's Disease Foundation Send response to journal: Re: Total agreement	The author is correct that leaders must be found who will work with African peoples to pull themselves out of poverty. I am hopeful that some of these as yet unknown persons will arise so that these countries can stop blaming Americans for their problems and simply accept help when requested. When Requested!
Can Africa really solve its own health problems? 27 March 2002
Solomon R Benatar, Professor of Medicine University of Cape Town,, Observatory, 7925, South Africa Send response to journal: Re: Can Africa really solve its own health problems?	Prof Ncayiyana's editorial makes many interesting and valid points. He is to be commended for advocating greater responsibility by Africans for resolving the devastating problems faced by our continent. However, it should be noted that the views expressed by David Dollar have been contested by others who have been critical of the World Bank's view that the solution to poverty lies in 'buying into the global economic movement.' While some countries have indeed benefited from doing so, such trends are being reversed and sub-Saharan Africa which has not benefited, suffers greatly (1-3) Prof Ncayiyana concedes Africa's legacy of exploitative colonial occupation and the undisputed fact that Africans themselves must also bear responsibility for lack of development on the continent. However, he fails to address the patronage of despotic leaders by powerful nations that has allowed many to remain in control for so long. He also neglects to mention the neo-colonial forces that co-opted African leaders into powerful exploitative global economic processes leading to vast unpayable debt for the African continent, and massive ongoing extraction of human and material resources from this once rich continent (4-6). Sub-Saharan Africa houses 10% of the world's population, lives on less than 1% of the global economy and bears the burden of 70% or more of the HIV/AIDS burden, and an enormous burden of tuberculosis, malaria, malnutrition and preventable diseases. This reflects deprivation suffered over many generations. The escalating extent of extreme poverty in Africa makes it extremely unlikely that it can solve its own health and development problems. Clearly ongoing exploitation must be avoided. At the very least, ongoing extraction of resources needs to be halted. New approaches to development will also need to be operationalised 7), and greater accountability of African governments encouraged and achieved. The Report of the Commission on Macroeconomics and Health (8), new concepts of development (6), provision of debt relief and new commitments to Foreign Aid (8-10) are good news for Africa. These imaginative endeavours are as essential as those of Africans (11) to put their own house in order if the root causes of Africa' problems are to be effectively addressed. It must also be conceded that a narrow biomedical approach to HIV/AIDS is impractical for sub-Saharan Africa. However, denial of the link between HIV infection and AIDS, failure to emphasise that HIV infection is predominantly spread through sexual activity, and unwillingness to make good use of proven medical advances during a devastating pandemic must surely rank amongst the gravest of many irresponsible errors made by politicians. Africa does indeed have great potential for solving its own problems, but to do so effectively and rapidly will require a much deeper understanding of the systemic nature of the problems affecting the continent. Privileged elites locally and abroad need to understand both their intimate implication in Africa's plight and their long-term self- interest in providing relevant and effective development support. References 1. Momberg D. Silencing Joseph Stiglitz. http://www.salon.com/news/feature/2000/05/02/stiglitz (accessed 27 March 2002) 2. Butler C. Inequality, global change and the sustainability of civilisation. Global Change and Human Health. 2000; 1 (2) 156-71. 3. Watkins K. Making globalisation work for the poor. International Monetary Fund Journal 2002, 39: 4. Davidson B. The black man's burden. James Curry, London. 1992. 5. Sandbrook R. Closing the circle: democratisation and development in Africa. Zed Books London 2000. 6. Lancaster C. Aid to Africa: so much to do so little done. University of Chicago Press, Chicago 1999. 7. Rist G. The history of development: from western origins to global faith. Zed Books London, 1997. 8. Macroeconomics and Health: investing in health for economic development. Report of the Commission on Macroeconomics and Health. WHO, Geneva, 2001. 9. Kassalow J S. Why health is important to US foreign policy. Council on Foreign Relations & Milbank Memorial Fund. New York, 2001. 10. McSmith A. Major backs Brown call for 'Marshall Plan.' The Daily Telegraph 27 March 2002. 11. New Partnerships for Africa's Development. http://www.dfa.gov.za/events/nepad.pdf (accessed 27 March 2002)
Less globalisation, more real assistance 28 March 2002
Bosede B Afolabi, Lecturer II Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, PMB 12003, Lagos Send response to journal: Re: Less globalisation, more real assistance	The only part of this editorial I agree with is the last sentence which talks about a critical mass of African researchers. Starting from the second paragraph where, with one sweeping statement 'Granted, Africa's legacy of particularly exploitative colonial occupation by European powers is partly to blame', the author pushes aside centuries of slavery,colonialism, oppression and neocolonialism, it becomes apparent that the author does not quite understand the psychological and sociological implications of the effects of Western domination on the situation of most African countries. With his exposition of World Bank capitalist ideologies and his quotation of obvious statements by a British minister, his ideological bent gets clearer. It is without doubt that Africa must pull herself out of her political and economic doldrums. Our 'leaders' have squandered our resources and oppressed us over the years, with or without the tacit support of Western countries, and lack the political will to improve the health system. We have to make a significant effort and try to reorient our people after decades of militarisation and non-accountable governments. However,in some instances, it must be done with the help of well meaning developed countries and organisations by making available unequivocally useful assistance like EDUCATION which is self sustaining and ever progressive, as opposed to handouts time and time again, which always dry up eventually or are diverted. Kudos to the BMJ in this regard, the good thay have done by making their journal and articles freely available to all is immeasurable. I wish more Western organisations would try to HELP 'Africa' more in this sort of way instead of their ultimately hurtful 'globalising and free market policying, privatisation' kind of way.