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November 27, 2000

Lecture touches on South Africa's
socialized medicine experiment

By Eric Rangus

The noble failure of South Africa’s experiment with socialized medicine more than 50 years ago provided the basis of discussion in the latest installment of the Center for the Study of Health, Culture and Society’s History of Medicine Fall Speaker Series.

Shula Marks, professor of history in the School of Oriental and African Studies at the University of London, discussed “The International Context of South Africa’s Experiment in Social Medicine in the 1940s and 1950s” in front of a packed crowd in the School of Public Health’s Rollins Room,Nov. 20.

Marks framed her presentation around a 1997 paper she wrote for the American Journal of Public Health, “South Africa’s Early Experiment in Social Medicine: Its Pioneers and Politics.”

The lecture was co-sponsored by the Center for the Study of Health, Culture and Society in the School of Public Health, the Institute of African Studies and the history department. Marks said the conditions in South Africa that led to the experiment were just right for a progressive movement.

According to Marks, the period following World War II opened the door for a group of far-reaching doctors who wanted to expand the state’s role in improving the health of South Africa’s rural population.

As a harbinger of things to come, part of the reason this proposal gained a modicum of acceptance is because a healthy rural black population (the main benefactors of a socialized system) would help the country’s white population.

At the time, South Africa was experiencing economic troubles. With an economy based on mining, the health of its miners (almost exclusively blacks or poor whites) was paramount.

The group of progressive doctors and administrators hoped to fix the problem by creating a series of health centers run by the government and spread out among the countryside. The National Health Services Commission, created in 1942, would oversee the program.

“The commission planned to establish 400 centers serving 25,000 people each,” Marks said. “They would be staffed with six-to-eight doctors, nurses and health care workers.”

That goal was never reached. In all, Marks said, about 40 centers were established. However, they did accomplish progressive work. Health care workers conducted home visits, helped establish school feeding schemes, nursery schools, recreation clubs, gardening clubs and discussion groups.

Before the centers could accomplish anything more, though, politics got in the way. “After 1948, when the Afrikaner National Party came into power,” Marks said, “no more health centers were opened.”

The Afrikaners, who remained in power until Apartheid ended in 1994, did not support the program for reasons both racial and political (rabidly anti-Communist, they did not look fondly upon socialized medicine).

The health centers that had been established were turned over to local authorities, and ideas to address health problems of the rural poor were not revisited until the last decade.

“While primary health care based on health centers may be the foundation of a health service, it may not be enough without real economic redistribution,” Marks said.

Nevertheless, despite the program’s failure, many of the doctors involved spread their ideas to several other places such as Isreal, the United States and Southeast Asia.

Randy Packard, director of the Center for the Study of Health, Culture and Society, introduced Marks. “It’s safe to say,” he said, “she has been involved in the training of a whole generation of South African historians.”


Back to Emory Report Nov. 27, 2000