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Choices for a healthy society in East and Southern Africa

by Rene Loewenson – December 17, 2012

Photo: A. Zulu, Lusaka District Health Management Board

Photo: A. Zulu, Lusaka District Health Management Board

There is a lot of talk about crisis these days. It can hide the reality of winners and losers from current global processes and the fact that having a healthy society is a matter of choice.

EQUINET’s 2012 Regional Equity Watch report (part I and part II) highlights how economies have grown in most of the 16 countries of East and Southern Africa, from Cape Town to Kampala, but that in many, so too have social, economic and health inequalities, leaving large parts of the population without the basic food, water, shelter, employment and income needed for health.

 Globalization and growing health inequalities

Countries in the region are integrating into a global economy that draws more resources than it returns. Unequal benefits from the global economy are associated with massive differences in health, such as 49-fold differences in child mortality between children in Mozambique and Switzerland or 57-fold differences between high and low-income countries in maternal mortality. The International Covenant on Economic and Social Rights commits states to ensuring the highest standard of health, and the 2000 Millennium declaration makes it a shared global responsibility. Such profound inequalities in health signal that we are far from achieving these commitments.


The fact is there are policies and interventions in health systems, agriculture, safe water and sanitation, employment, and urbanization that have closed health gaps. The 2012 Regional Equity Watch describes some of these measures within East and Southern Africa. For example, investments in local biodiversity, in smallholder food production, especially for women farmers, have reduced inequalities in nutrition. Many countries have successfully implemented measures to encourage girls to enrol and stay in primary education, a key contributor to health. In South Africa, there have been civil society pressures, including through constitutional claims, to ensure schools provide safe environments and resources for quality education. There are examples of activities that reduce urban poverty and health risks by enhancing employment, improving living conditions and investing in participatory planning, particularly in unplanned urban settlements. There are initiatives that have supported community management or public provision of safe water, and protected access to affordable minimum levels of water.

There are also some promising practices in overcoming geographical and social differentials in access to health care through investments at primary care and community levels, including through community health workers, community outreach, social organization and participation, moving away from fee payments at point of care and integrating specific programs within comprehensive primary care services. There have been initiatives to reduce markups and put public health above patent protections that have widened access to medicines.

These and other practices underway repeatedly point to the possible. So in a crisis of injustice, why are we not making more progress in implementing the possible?

Dr Rene Loewenson is Director of the Training and Research Support Centre (TARSC) and EQUINET Cluster lead for Equity Watch, Zimbabwe. You can download the 2012 Regional Equity Watch in two parts at and or order from EQUINET.