Doctors should help improve the social conditions that affect the health of poor people, writes Prof Jimmy Volmink, Dean of the Faculty of Medicine and Health Sciences at Stellenbosch University, in an opinion article published in Business Day on Thursday (1 October 2015).
- Read the complete article below or click here to read the article as published.
Doctors champions of the poor
Despite improvements in medical treatment and the on-going production of excellent doctors and specialists in South Africa, we have yet to achieve the health gains hoped for.
We still see far too much unnecessary suffering, debilitation and death from preventable or treatable illness. Our mothers are still dying in childbirth and our children continue to succumb to measles, gastroenteritis and malnutrition. HIV/AIDS continues to ravage our young women and the demons of violence and homicide too often snuff out the lives of our men in the prime of their youth. Alarmingly, all this is happening as the rising tsunamis of diabetes, stroke and mental illness are breaking on our shores.
Why is this? Why does a country that spends so much on health care and produces so many superb health practitioners still experience such poor health? What does it say about our society and our health care system? Do we have the right strategy for dealing with our problems? What are we missing?
While these questions can evoke complex and nuanced responses, one issue frequently overlooked in our academic and public debates about health and health care is poverty.
Allow me to share with you some startling figures. In February this year, Statistics South Africa reported that 54% of the South African population (27 million people) were living in poverty (defined as having an income of less than R779 per month). Of these people, 11 million were living in extreme/abject poverty, that is, with an income of R335 month or less.
Let's take a moment to absorb this information. Let's consider what it means in terms of human suffering and lost potential. How is it possible for a relatively rich country, like South Africa, to have half of its population trapped in poverty and 1 in 4 of its inhabitants going hungry? Statistically, this can only arise in a context where the gap between rich and poor is spectacularly large.
What we often seem to forget is that poverty and inequality are flip sides of the same coin. Both need to be addressed if we are to make progress in improving health and wellness in our country. These issues should be the concern of every health professional because as health practitioners we ought to be in the business of improving health, not just treating disease. We should not forget that it is peoples' lived experience, rather than the pills and procedures we offer them that matters most for health.
Given that social and economic factors are undoubtedly the most important drivers of health and disease, we will only improve the health of our nation if we urgently address the basic problems of access to housing, sanitation, food, safe water, education and employment opportunities. We need to keep in mind that these social and economic factors also influence the quality of healthcare we receive. Sadly, our public health system is often little more than a vehicle for delivering poor services to poor people. There is indeed a wide gulf between the health services enjoyed by the "haves" and the "have nots" in our beautiful land.
So, how can health professionals help address these challenges?
I suppose, we could respond by taking the view that these problems are not for us, but for government, to solve. Unfortunately, by adopting this mindset we would simply restrict ourselves to the act of dishing out chemical cures while averting our gaze from the social conditions at the root of the patient's condition. We will miss the important connection between patients' living conditions and their health status, a connection they hope healthcare providers will acknowledge and show some solidarity.
A second way we might respond is to engage in victim blaming. Here we would adopt the view that the patient is to blame for his or her problem. We could also succumb to 'learned helplessness'. We might care deeply about the upstream factors impacting our patients' health and want to do more, but may feel so overwhelmed by the magnitude of the challenge that we give up before even starting. And so it becomes easier to ignore the elephant in the examination room than acknowledging it and trying to do something about it.
Fortunately, the current divide between clinical medicine and public health is not inevitable. And in this regard, health professionals can play a key role. Since doctors are accorded more intimate exposure to human suffering caused by destructive social, economic and political forces in society, they are well placed to address root causes of their patients' health problems and have often done so with great impact over the years.
Furthermore, given that health is the legitimate business of health professionals they can be considered the authentic champions of health as a right which is enshrined in the Universal Declaration of Human Rights and also embodied in the South African Bill of Rights. Yet 21 years after the birth of our democracy, we seem further from realising this right than ever. Undoubtedly, it will take a combined effort from all role players to fix the problem, but health professionals can play an important part.
Finally, doctors are held in high regard in society. As such their voice, whether individually or collectively, is more likely to be heard, than that of others. Doctors must not neglect to use their formidable social capital in the struggle for health and equality in South Africa. By serving as advocates for the poor, we will make South Africa better for everyone, including ourselves and our children.
*Prof Jimmy Volmink is the Dean of the Faculty of Medicine and Health Sciences at Stellenbosch University. This is an abridged version of a recent address at the Admission Ceremony of the South African Colleges of Medicine.
