December 15, 2012
Final Research Project: A Comparison of Health in South Africa and the U.S.
Part I: WHO Global Health Observatory Health Statistics
Prevalence: Death Due to Cancer (Ages 30-70)1
Gross Per Capita Income
Education: Net Primary School Enrollment %
Healthcare Quality: % of GDP Used for Healthcare
17.8% - ages 15-49 (2009)
89% (male), 91% (female) (2009)
0.6% - ages 15-49 (2009)
95% (male); 96% (female) (2010)
A comparison of these statistics indicates that South Africa experiences a higher prevalence of both HIV, an infectious, “preventable” virus, and cancer, a chronic, unpreventable illness, than the United States. Moreover, these health indicators are indirectly related to both countries’ overall socioeconomic conditions and access to healthcare. The U.S. has over four times greater average per capita income, more children enrolled in primary school, and dedicates over twice as much of the GDP to healthcare. This is an important reflection of how larger social forces and structural barriers play a significant role in a population’s health. What is also notable is that the prevalence of HIV in South Africa is nearly thirty times that of the United States, but the mortality due to cancer is only slightly higher. This reaffirms Phelan and Link’s Fundamental Cause Theory that low socioeconomic status is the underlying cause for poor health outcomes in preventable diseases because it leads to consistent low access to health resources and a healthy lifestyle2. For unpreventable diseases, such as cancer, socioeconomic status is not a good indicator of prevalence because access to health resources plays little to no role in determining whether or not a person develops the illness.
What questions should we ask about these statistics?
What is the relative rather than absolute wealth of these countries in terms of buying power? This is important because, while the countries may have significantly different per capita income, the costs of, and therefore access to, their health resources (and resources in general) may differ significantly as well.
While not as wealthy as the U.S., South Africa is a fairly wealthy nation compared to most other African nations. What non-SES-related distal causes, such as stigma or policy responses, could cause structural barriers that might help to account for South Africa’s extremely high prevalence of HIV? This is important especially for HIV, where fear and stigma surrounding the disease and those affected has had a direct impact on prevention and treatment and leads to personal decisions of individuals and proximate causes of infection.3
What kind of healthcare system and healthcare insurance system does South Africa have? This is important in order to determine whether the amount of GDP that goes to healthcare is in addition to private insurance that citizens pay for, or if this statistic includes a state-directed, single-payer system and therefore reflects the total amount spent on healthcare in South Africa.
Part II: Pharmaceutical Companies and Social Movement Organizations Video: “The Treatment Action Campaign – The SING Campaign”
Can be found at: http://www.youtube.com/watch?v=tMgmaKhH038
Because of the unusually heavy burden of HIV and AIDS that South Africa carries, it is the recipient of a large amount of global support. It receives donations from both the United States’ PEPFAR, which between 2004 and 2011 had given $3,233,700,000 in bilateral funding for HIV/AIDS. and the Global Fund, which together are the two largest sources of international financial support to fight HIV and AIDS4. One international non-governmental AIDS organization involved in South Africa is OxFam, which is formed of NGO’s from seventeen different countries and based in Oxford, England, advocates for the fulfillment of human rights and empowerment of impoverished populations, educates on safe sex practices, and provides condoms5. Another is the International Community of Women Living with HIV/AIDS, based in Buenos Aires, which fosters an international community of support for women infected with HIV, an extremely important component in AIDS response in a place where lack of personal agency for women can facilitate HIV transmission6. The Kaiser Family Foundation out of Washington serves as both an international HIV/AIDS donor and developed the Program for Health and Development in South Africa to improve the overall healthcare infrastructure of the country over the next twenty years7. Even some pharmaceutical companies have aided South Africa in its fight against AIDS, including American company GlaxoSmithKline, who provided Aspen, a South African pharmaceutical company, with a voluntary license to produce several of their ART drugs at no cost, enabling South Africa to produce these drugs at a much lower price8.
What questions should we ask about South Africa in relation to the rest of the world?
How did the thought collective of South Africa at the start of their AIDS epidemic, specifically the thought style perpetuated by then-President Mbeki and the South African government which rejected the Western explanation for AIDS, contribute to making the South African epidemic so much larger than most other countries?910
In what ways did Apartheid create structural barriers for black South Africans for accessing healthcare, and how does having it in their recent past influence differences in health outcomes between races that exist in South Africa today?11
How did the Treatment Action Campaign’s lawsuit victory against the South African Minister of Health to provide mother-to-child-transmission prevention inform, empower, and inspire other countries’ HIV/AIDS social movement organizations and activist groups? How did it help to shift the global perspective on providing antiretroviral treatment, and what specific elements of the TAC could be applied to other SMOs to make them more effective?12
“AIDS, Drug Prices, and the Rest of the World.” Avert. Accessed December 12, 2012. http://www.avert.org/generic.htm.
Ehrlich, Rodney I., Landon Myer and Ezra S. Susser. “Social Epidemiology in South Africa.” Epidemiologic Review 34 (2004): 112-123.
Epstein, Helen. “A President, A Crisis, a Tragedy.” In The Invisible Cure. 105-126. United States: Picador, 2008.
Fleck, Ludwik. “Epistemological Conclusions from the Established History of a Concept.” In Genesis and Development of Scientific Fact. 38-43 Chicago: University of Chicago, 1979.
“Global Health Observatory Data Repository.” World Health Organization. Accessed December 12, 2012. http://apps.who.int/gho/data/#.
Link, Bruce G., and Jo Phelan. “Social Conditions as Fundamental Causes of Disease.” Journal of Health and Social Behavior 35 (1995): 80-94.
“OxFam in South Africa.” Oxfam. Accessed December 12, 2012. http://www.oxfam.org.uk/what-we-do/countries-we-work-in/south-africa.
“Partnership to Fight HIV/AIDS in South Africa.” The United States President’s Emergency Plan for AIDS Relief. Accessed December 13, 2012. http://www.pepfar.gov/countries/southafrica/index.htm.
“South Africa: The Treatment Action Campaign Fights Government Inertia With Budget Advocacy and Litigation.” International Budget Partnership. Accessed December 12, 2012. http://internationalbudget.org/wp-content/uploads/LP-case-study-TAC-summary.pdf.
“South Africa.” The Kaiser Family Foundation. Accessed December 13, 2012. http://www.kff.org/southafrica/.
“Speaking Freely, Being Strong: HIV social movements, communication and inclusive social change – a case study in Namibia and South Africa.” Panos London. London: Panos London, 2006.
1 To clarify: this mortality rate is looking at a 100,000 person population and the percentage reflects the number of these people who died in a year from cancer and thus is not all people who died; the percentage is not out of total deaths, but of the entire cohort
2 Link, Bruce G., and Jo Phelan, “Social Conditions as Fundamental Causes of Disease,” Journal of Health and Social Behavior 35 (1995): 80-94.
4 “Partnership to Fight HIV/AIDS in South Africa,” The United States President’s Emergency Plan for AIDS Relief, accessed December 13, 2012, http://www.pepfar.gov/countries/southafrica/index.htm.
5 “OxFam in South Africa,” Oxfam, accessed December 12, 2012, http://www.oxfam.org.uk/what-we-do/countries-we-work-in/south-africa.
6 “Speaking Freely, Being Strong: HIV social movements, communication and inclusive social change – a case study in Namibia and South Africa,” Panos London, (London: Panos London, 2006), 5.
12 “South Africa: The Treatment Action Campaign Fights Government Inertia With Budget Advocacy and Litigation,” International Budget Partnership, accessed December 12, 2012, http://internationalbudget.org/wp-content/uploads/LP-case-study-TAC-summary.pdf.