Richard Feacham and Dean Jamison (eds), disease and mortality in Sub-Saharan Africa, Oxford, Oxford University Press for the World Bank, 1991, 356 pp., ISBN 0 19 520826 9 Price (UK) £40.00
✍ Scribed by Barry Munslow
- Publisher
- John Wiley and Sons
- Year
- 1992
- Tongue
- English
- Weight
- 145 KB
- Volume
- 7
- Category
- Article
- ISSN
- 0749-6753
No coin nor oath required. For personal study only.
✦ Synopsis
This study is published for the World Bank and as the title suggests, seeks to give a broad overview for Africa south of the Sahara. The picture presented is a mixed one with health gains for some countries and downward trends in others, but there is no systematic effort to apportion blame for the latter depressing fact. There is recognition of the serious economic crisis, however, and it is argued that new health plans must be made in the context of severe economic constrains, with an emphasis on costeffective programmes rather than increasing public spending on health services. Whilst the former is clearly necessary, this is still no substitute for increasing health expenditure. It is simply not good enough to countenance the slashing of public health expenditure in country after country adopting an IMFlWorld Bank structural adjustment programme. Sustainable development requires increasing, not decreasing expenditure in health and education. The burden of debt and engineering its repayment which is at the heart of structural adjustment is the biggest single reason for ill-health in Africa. Debt exacerbates poverty, hunger, environmental degradation and ill-health as attested to by a growing and persuasive literature (George, 1988; Cornia et al., 1987; UNICEF,1989). Writing off the debt alone will not improve the health situation, but it is the biggest single contribution that can be made to health care in the continent.
The book emphasises the paucity of existing health data, which is certainly true. However, Adetokunbo Lucas of the Harvard School of Public Health in his foreword to the book states that the absence of current, reliable information is perhaps the most serious handicap in developing and managing health services in the region. It is not. It is the budgetary constraints imposed under structural adjustment which elevates increasing exports above human resource capacity building. This is not to deny the importance of better information, nor is it to deny the immense work of scholarship that has gone into the many contributions to this major study. It is, however, important to place the problem of health within the wider development policy context. Whilst this was most decidedly not the terms of reference given by the Bank to the producers of this volume, it should certainly be the wider reference of its readers.
Part one of the volume deals with the patterns of mortality. The general conclusion is that, whilst there has been progress in reducing mortality since independence, Africa still has the highest levels of mortality and morbidity in the world. Africa shares its common diseases with the other continents of the developing world: diarrheal disease, acute respiratory infection, malnutrition and vaccine-preventable diseases in children. Tuberculosis and maternal death, both preventable if the necessary resources are available, contribute to an unacceptably high adult mortality rate. Poverty is the major cause of these common diseases, and eradicating poverty will do most to tackle them.
Part two looks at specific diseases and conditions. James Chin provides a valuable and insightful chapter on the epidemiology and projected mortality of AIDS. In the 1980s, AIDS in Africa was mainly an urban problem. Central Africa is the most severely affected region. Between 5 and 10 per cent of infants born in the urban areas are HIV positive, with few infections amongst the 5 to 15 year olds (note that the first drafts of the chapters for this book were prepared for a conference in 1987, and the volume appeared only in 1991). In 1989, up to 40% of the 3&34 year age group were found