BOOK REVIEW
THE POLITICS OF GENOCIDE, by C e d r i c De B e e r . Reviewed by Jacky Cock.
T h i s book makes a v a l u a b l e c o n t r i b u t i o n t o w a r d e x p o s i n g t h e r e l a t i o n s h i p between s o c i a l i n j u s t i c e a n d i l l h e a l t h i n S o u t h A f r i c a . The a u t h o r d e m o n s t r a t e s a c o n c e p t u a l c l a r i t y , a s o p h i s t i c a t e d g r a s p of h i s t o r i c a l p r o c e s s e s , and a m e t i c u l o u s u s e of e v i d e n c e . T h e s e q u a l i t i e s l i n k e d t o an e x t r e m e l y l u c i d s t y l e , make f o r c o m p e l l i n g
r e a d i n g .
The book r e v o l v e s around two c e n t r a l p r o p o s i t i o n s : t h e f i r s t i s t h a t n e i t h e r d i s e a s e p a t t e r n s n o r h e a l t h c a r e s e r v i c e s can be d i v o r c e d from t h e s o c i a l m a t r i x i n w h i c h t h e y a r e e m b e d d e d . T h i s p r o p o s i t i o n u n d e r p i n s t h e v a l i d i t y of a s o c i a l a n a l y s i s of h e a l t h .
The s e c o n d p r o p o s i t i o n , w h i c h f o l l o w s t h e f i r s t , i s t h a t t h e d i s t r i b u t i o n of d i s e a s e and t h e way w i t h w h i c h i t i s d e a l t , r e f l e c t s t h e m a j o r l i n e s of d i v i s i o n a n d i n e q u a l i t y i n s o c i e t y . The r e l a t i o n b e t w e e n i n e q u a l i t y a n d h e a l t h i s d r a m a t i c a l l y e v i d e n t i n S o u t h A f r i c a ,
The book d e m o n s t r a t e s t h e v a l i d i t y of t h e s e t w o p r o p o s i t i o n s t h r o u g h f i v e c a s e s t u d i e s .
C h a p t e r One p r o v i d e s a s o c i a l h i s t o r y of t u b e r c u l o s i s , w i t h w h i c h a t l e a s t t e n m i l l i o n S o u t h A f r i c a n s a r e i n f e c t e d . In t r a c i n g t h e a r r i v a l , s p r e a d and d i s t r i b u t i o n of t h i s d i s e a s e , De Beer shows a c l o s e c o n n e c t i o n b e t w e e n economic and p o l i t i c a l f a c t o r s and t h e d e v e l o p m e n t of TB a s a m a j o r p r o b l e m . He d e m o n s t r a t e s t h a t i t i s n o t
j u s t t h e p r e s e n c e of t h e TB b a c i l l u s w h i c h h a s c a u s e d t h e c u r r e n t e p i d e m i c :
" The c o n d i t i o n s for t h i s epidemic were created by the massive social upheavals which resulted from the development of large-scale
industry, beginning with the mines. These changes were accompanied by the development of the migrant labour system, the creation of the bantustans, and the destruction of the rural
subsistence economy.n
De Beer shows how that the spread of the disease is net random and haphazard, but affects the poor, the underfed, those who l i v e in overcrowded conditions and work at hard jobs. These are the people who hold the lowest p o s i t i o n s in the economy and do not have the p o l i t i c a l power to
improve t h e i r s i t u a t i o n .
The author points out that medical science by itself is unable to control the epidemic. Its cure requires the eradication of poverty, unemployment and social misery.
The l i m i t a t i o n s of medical solutions to health problems is one of the themes of De Beer's second case study, the Gluckman Commission of 1942 -
1944.
He shows t h a t the Commission was noteworthy in t h r e e r e s p e c t s : F i r s t l y , i t r e p o r t e d t h a t
throughout the country there was an unacceptable level of disease which could be a t t r i b u t e d to social and economic conditions.
•
Secc.idly, i t s t r o n g l y c r i t i c i s e d the h e a l t h services of the day as inadequate, unco-ordinated and misdirected.
Thirdly, i t produced a detailed blueprint for a National Health Service which might have made free health care available to a l l South Africans and which emphasised preventing sickness as well as curing i t .
De Beer demonstrates convincingly why none of the C o m m i s s i o n ' s major r e c o m m e n d a t i o n s were
implemented.
He argues that the Gluckman Commission was one of a number of commissions which represented the reformist response to the s o c i a l tensions of the 1940's.
Before 1948, c a p i t a l and t h e s t a t e proposed attempting to contain these tensions through reform aimed at undermining the growing militancy of the urban p r o l e t a r i a t . Improvements in medical services was only one way in which i t was hoped to s t a b i l i s e and control the working class.
However, the Nationalist party which came to power in 1948 was unwilling to engage in the massive mobilization of resources t h a t would have been necessary in order to implement the Commission's proposals. This unwillingness came out of the
nature of the South African s t a t e , based as i t was (and s t i l l is) on economic exploitation and racial oppression.
After 1948 s t a b i l i t y was maintained through increasing p o l i t i c a l repression and a tightening of the system of labour control. This involved an
increasing d i v i s i o n between african ' i n s i d e r s ' , l i v i n g in ' w h i t e ' urban a r e a s , and t h o s e 'outsiders' r e s t r i c t e d to the teeming rural slums termed the bantustans.
Focusing f i r s t on t h e h e a l t h 3f black urban workers, De Beer shows how dangerous i t is to be born into the black working c l a s s .
He documents the health hazards involved in work both through accidents and disease resulting from exposure to dust, noise and harmful substances in the workplace.
In the communities to which workers return, "life i s dangerous and often short". For example in Cape Town in 1981, the infant m o r t a l i t y r a t e for
whites was 9,4 deaths for every thousand l i v e births, and for africans 34,6 per thousand.
While such racial differences in infant mortality rates indicate how the burden of i l l health falls on the black working c l a s s , health services for blacks are t o t a l l y inadequate. This inadequacy has not been remedied by the 1977 Health Act and subsequent Health Plan, because the s t a t e (as in 1944) has not r e d i r e c t e d resources on the scale required. For instance, the 2% of the health budget spent on preventive health programs in 1977 had only risen to slightly more than 3% by 1982.
Tighter state control has cemented divisions among the a f r i c a n working c l a s s . The c o n s t r a i n t s trapping people in the homelands has been termed a p o l i c y of genocide. De Beer approaches t h i s al legation cautiously.
"Genocide i s a strong word. I t u s u a l l y d e s c r i b e s an attempt to destroy a large community of people, usually of one racial or religious group. No one i s driving around the bantustans machine-gunning people, or forcing them into gas chambers. The accuracy of the word depends, then, on being able to show that conditions in the bantustans are such that forcing people to l i v e there i s , in fact, sentencing a large number of them to death by
illness and starvation."
This is precisely what De Beer demonstrates with a disciplined avoidance of empty rhetoric, linked to
a s e n s i t i v i t y t o human experience t h a t makes moving reading.
The r e a l i t y i s t h a t the 54% of the a f r i c a n
l a
population living in the bantustans do not have access to means of decent survival, either through farming or jobs. The outcome is that hunger is widespread with as many as 50,000 children dying every year as a r e s u l t of getting too l i t t l e to eat. Among the survivors, malnutrition often
stunts physical and i n t e l l e c t u a l development so that a vicious c i r c l e of deprivations across generations is put into operation.
The lack of significant agricultural or industrial r e s o u r c e s in t h e b a n t u s t a n s behind such deprivation means that the prospects of a sound health care system are remote.
For instance, the entire KwaZulu health budget in 1982 was about R60 million, which is equivalent to the operating costs at the whites-only Johannes- burg hospital.
If money i s in short supply, so too are doctors and medical expertise. Only 3% of practising doctors are in the bantustans. Lebowa has one doctor for every 20,000 to 30,000 r e s i d e n t s , compared to one doctor for every 875 white South Africans. Those hospitals that do exist are short- staffed and overcrowded.
Apartheid allows people to describe South Africa's health services as good, while acknowledging the t o t a l breakdown in h e a l t h s e r v i c e s in the bantustans, because they are not viewed as part of South Africa.
DON'T KEEP IT TO YOURSELF -
PASS IT ON !
INFORMATION IS POWER
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De Beer concludes:
"Over two decades more than a million people, some at gunpoint, have been moved into the bantustans where there is little food and few
jobs. Family members are separated by influx control and migrant labour, and the social disruption this causes contributes to illness and death. Full statistics are not available, but thousands of people die each year as a direct result of these conditions. The
inadequate health services can do very little to alleviate this sickness, suffering and death. Genocide is perhaps an appropriate word
to describe these conditions."
In his final section De Beer argues persuasively for extending the strictly scientific, medical framework within which health issues are commonly viewed- This framework individualises Health
issues and results in a "victim-blaming" mode of thought.
r*If people get cholera it is because they do not use 'safe chlorinated water'. If children are malnourished it is beause their parents don't feed them properly."
The reality is that people are "condemned by political and economic factors to live in areas where healthy living is impossible".
In such areas the community medicine approach to health care is inadequate because it is structured on the assumption that "the poor must be taught to deal with the problems caused by their poverty", and "ignores the truth that poverty is itself a s y m p t o m of a h i s t o r y of d i s p o s s e s s i o n , exploitation and oppression". These conditions are
"as important as germs in causing disease and social justice is as powerful a medicine as any drug".
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De Beer suggests that health professionals are in a unique position to expose the link between disease and p o l i t i c s and contribute to a process of change.
While the t h r u s t of the book i s to dissolve the a r t i f i c i a l separation between health and p o l i t i c s , De Beer concludes by emphasising the link between the attainment of health and the building of a democratic society. He ends;
"As disease i s of social o r i g i n , i t can only be conquered when no section of the society is able to seek wealth, power or s t a t u s at the expense of any other section. There i s no more expressive and powerful demand than that health should be regarded as a fundamental p o l i t i c a l right."
The final quote indicates something of the nature and scale of the issues De Beer confronts in t h i s book.
For t h i s reason, while i t should be of special i n t e r e s t to health workers, his study has a much wider importance.
This study i s not simply an exposure of the devastating human consequences of the extreme inequalities in our society, but penetrates behind the level of appearance and 'common - sense' assumptions to i d e n t i f y the s t r u c t u r e s and processes which generate these i n e q u a l i t i e s . At
t h i s l e v e l i t i s one of the most i m p o r t a n t e x p l a n a t i o n s of the n a t u r e of South African society to appear in recent years.
