African Studies: Health 285
those on the political economy of health peaked in the late
1980s as economic structural adjustment policies were
applied, and HIV/AIDS papers mostly appeared in the 1990s,
with no clear trend during the decade.
The Future
The immediate future is not reassuring. In contrast to the rest of
the world, the regional life expectancy is stalled at under 50 years.
Most sub-Saharan African countries are unable to do more than
maintain their present public health systems. The impact of such
systems depends on their level of use, which is largely determined
by the population’s ability to pay, and by their level of education,
which raises the priority given to successful treatment and the skill
with which it is administered. The fee-for-service principle is
limiting the expansion of use of both the health and education
systems. On the other hand, the likelihood of accessing the health
system is probably increasing with the transition from subsistence
to market agriculture. Fertility decline has now begun in a range of
African countries. Smaller families will mean fewer women dying
from maternal causes, and probably greater concentration on the
education and health of children.
It is now likely that no country in mainland sub-Saharan
Africa will, by the year 2000, have attained any of the three criteria
established by the World Health Organization to certify the
attainment of the 1978 Alma Ata Declaration of’Good Health for
All’ by the year 2000: a life expectancy of at least 60 years, and
a survival level of 95% of births to 1 year of age and 93% to 5 years
of age. Indeed, most of East and Southern Africa will probably by
that date be slipping further away from these criteria.
Editor’s Note
The Ebola virus, rampant HIV infections, the emergence of
multiply drug-resistant strains of tuberculosis, along with the
traditional African morbidities (malaria, lung infections, diar-
rheal diseases, tetanus, meningitis, elephantiasis, leprosy,
helminthiasis, and the panoply of STDs) has kept the health of
the African population on the minds of health researchers
around the world. Indeed, it is not unfair to say that African
morbidity and mortality is its own subsection of the public
health discipline. So the recent literature on African health and
disease is vast (Giles-Vernick and Webb, 2013; Jamison et al.,
2006; Crane, 2013; Cooper et al., 2013; Fassin, 2007; Amzat
and Razum, 2014; Webb, 2014).
See also: AIDS: Acquired Immune-Deficiency Syndrome; Health
Politics and Policy; Health: Anthropological Aspects; Mortality
and the HIV/AIDS Epidemic.
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