November 27, 2000
Lecture touches on South
socialized medicine experiment
By Eric Rangus email@example.com
The noble failure of South Africas 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 Societys
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 Africas Experiment in Social Medicine in the 1940s
and 1950s in front of a packed crowd in the School of Public Healths
Rollins Room,Nov. 20.
Marks framed her presentation around a 1997 paper she wrote for the American
Journal of Public Health, South Africas 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 states
role in improving the health of South Africas 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 countrys
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,
Nevertheless, despite the programs 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. Its safe to say, he said, she has been involved in the training of a whole generation of South African historians.