Intended for healthcare professionals

Education And Debate

Personal paper Africa in the 21st century: can despair be turned to hope?

BMJ 1997; 315 doi: (Published 29 November 1997) Cite this as: BMJ 1997;315:1444
  1. Dorothy E Logie (, general practitionera,
  2. Solomon R Benatar, professor of medicineb
  1. a Medical Action for Global Security, London N19 4DJ
  2. b University of Cape Town, 7925 Cape Town, South Africa
  1. Correspondence to: Dr Logie
  • Accepted 22 September 1997


The free flow of trade and money around the world has brought economic growth for the fortunate in the largest and strongest economies but has also created widening gaps in wealth and health between, and within, countries. These polarising forces have intensified in the past decade, creating a hundred million poor within the rich “core” in addition to the 1.3 billion people in the “periphery” who exist on $1 a day or less.1


Sub-Saharan Africa is the most dramatic loser. Here poverty is at its most stark and marginalisation from the global economy most pronounced. The continent contains 33 of the world's 50 poorest countries. Improvements in health, education, and living standards have reversed in the past two decades, and standards continue to fall. By the end of the decade, two thirds of Africans will live in “absolute poverty.”2 More than half still lack safe water and 70% are without proper sanitation; 40 million children are not in primary school. Infant mortality is 55% higher than in the rest of the world's low income, developing countries, and average life expectancy, at 51 years, is 11 years less.3 Malaria and tuberculosis are increasing, and in parts of central, southern, and eastern Africa 30-40% of pregnant women are now HIV positive.2

Summary points

Two thirds of people living in sub-Saharan Africa are desperately poor

Health and education standards continue to deteriorate

More money is spent on debt servicing than on health and education

Within Africa, corruption, wars, and lack of commitment to health (especially women's health) have contributed towards the appalling health indices

The role of the industrialised countries in destabilising Africa needs to be openly debated

Poverty causes ill health, but ill health also imposes immense economic costs on individuals, their families, and society. African productivity could increase by …

View Full Text

Log in

Log in through your institution


* For online subscription