The Blackwell Companion to Medical Sociology

21
Health and Health Care in South
Africa Against an African
Background
H. C. J. van Rensburg and Charles Ngwena
Basic to medical sociology, or the sociology of health and health care, is the
premise that the health of populations is profoundly influenced and determined
by society, in particular by the social, cultural, political, and economic contexts.
In similar vein, health care systems closely reflect the broader societal environments
in which they nestle. The opposite also holds: societies are in significant
ways influenced by health and disease in their populations.
This chapter sets out to describe and explain the nature and development of
health and health care in South Africa. It does so against the background of
health and health care on the African continent. In particular, we focus on the
main features, trends, and deformations of health and health care in Africa, as
well as the underpinninghistorical forces. When it comes to South Africa, our
focus is mainly on the current transformation of the health system, against the
backdrop of inequalities, disparities and distortions entrenched in the South
African health system over three and a half centuries of exposure to colonialism
and apartheid. In particular we assess the current reforms of, and constraints on,
the health sector. We also glance at some of the main features of morbidity and
mortality in South Africa, as well as at the dauntingchallenges these pose to the
health system and the current reform process.
Historical istorical Forces orces Shaping haping Health ealth and Health ealth Care are in
Africa frica
The Main Historical Shapers ofAfrican Health Care
Some of the earliest evidence of medical practice comes from Africa. Ancient
Egyptians were known, over 5,000 years ago, for their advanced knowledge of
medicine. Imhotep (3,000 BC), the ``historical father of medicine,'' instructed