South Africa Case Study

The example of South African Prime Minister of Health Dr. Zuma’s struggle to gain control over tobacco demonstrates a critical point when addressing public health issues:  the need for a multi-sectorial approach.  Perhaps far too often social problems are analogized into medical issues.  The role of the World Health Organization in defining such issues in a medical vision of the disease-vector-host paradigm can unfortunately de-emphasize the importance of the social and political environment.  This point is best illustrated by the strategic decision of the tobacco corporations to offer fair wages to employees during apartheid, promoting usage amongst lower income groups.  In addition, there was significant variances in access to quality care between different racial groups. These groups were also the most likely to generate health issues from tobacco use due to unequally distributed health education and access to health clinics and care.  One might consider the thought that the real issue was not tobacco but instead unequal access to care and also unequal health education.  The case study mentioned HIV prevalence rates increasing from .7% to 14.2% in just six years.  Tobacco regulation is not going to change those statistics!  Furthermore, the most significant cause of lung disease was said to be TB with a quarter of cases relating back to HIV/AIDS.  It appears that without acquitting tobacco from its role in degrading health in South Africa, nations also need to step back, take a broader look, and reframe the scope of the issue.  If a nations focus is too narrowly centered on a topic, it makes it difficult to distinguish the forest among the tress.

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