Africa: a continent for the third millennium

BMJ 2001; 322 doi: (Published 06 January 2001) Cite this as: BMJ 2001;322:a

Africa stalks this BMJ. And so it should in an issue which for pedants is the first of the third millennium. Africa has a greater concentration of poverty and health problems than any other continent, and the health inequality between those in rich and poor countries must be the world's number one health issue.

A W Logie, a retired Scottish physician, describes his return to Zambia, where he became infected with HIV (p 59). His disease is held in check by expensive treatments that are simply not available to most of the 25 million people (of a worldwide total of 33 million) in sub-Saharan Africa who are infected with HIV. More teachers are dying every day than are being replaced, and the disease is having major socioeconomic effects across the continent.

Interestingly the local newspaper of the richest people in the world, the Wall Street Journal, has involved itself in this major health issue. Gavin Yamey tells how the newspaper has identified baby milk manufacturers as “heroes poised to save African children from certain death” (p 57). They are willing to donate tons of baby milk formula so that mothers can avoid breastfeeding and infecting their babies with HIV. Yet Unicef is blocking the donation, leading the US media, who have picked up the story on a grand scale, to accuse it of “killing the children it's supposed to protect.” The problem is that only 5% of African women know their HIV status, and giving baby milk to every mother could cause a public health disaster. Yamey concludes that you can make great copy every time by taking one very complicated public health issue, adding a large dose of scientifically dubious rhetoric, and diluting out the complexities.

Africa is also the setting for a new novel by thriller writer John le Carré (p 55). Left high and dry by the end of the cold war he has turned his attention to the wickedness of multinational corporations—in this case a drug company testing a new drug unethically in Africa. Andrew Herxheimer says that le Carré “is subtle in his handling of the many issues about drugs in poor countries” and “it is not an anti-industry novel.” Rhona MacDonald describes websites where you can learn more about the ethics of research in the developing world (p 58).

F J Cooke and A Holmes describe on the letters pages a successful project that offers email health support to some of the remotest areas in Africa (p 51). “In many cases,” they write, “it is easier to email the overseas training programme doctor in the United Kingdom than contact the local doctor.” The internet will change everything, including, as an editorial discusses (p 1), the BMJ.