Special Hearings — Health Sector Hearings — 1997-06-18

DR PRETORIUS: Madam Chairperson, Commissioners, Ladies and Gentlemen.  True to my personality I would not comment on the fact that we are addressing a Commission only consisting of women. (General laughter)
 It is for the Department of Health and for me, as a public servant who served in those dispensations, an historic and important opportunity to make this submission today.  This presentation is a short overview of the full submission already submitted to the TRC.  And in the light of what has been said today I am pretty sure that we will have to make a subsequent submission dealing with the issues that have not been dealt with sufficiently in the initial one so that we can provide a comprehensive response.
 Before I start I would like to clarify my terminology that I will be using.  When I use the term "Department of Health", unless I specific otherwise, I refer to all health departments during the previous 30 to 40 years at the national and provincial level.  This will also include the health departments of the then independent and self-governing states and thus also by implication the various departments responsible for the budgeting and governance of the various homeland structures, such as the Department of Foreign Affairs and the Department of Development, Cooperation or whatever name was used during the various phases of its history.  And the departments of health of the Tricameral system. I am, however, not speaking on behalf of the political functionaries who were the final decision and policy-makers.  
 The Department of Health was not a passive functionary only carrying out political orders. It was responsible for drafting and the practical implementation of the policies of the State, and that fragmented system of the past with provinces being quite autonomous and the various homeland governments being also autonomous this created the formula which allowed different interpretations of present policy in various areas.
 This period was marked by legislated racial discrimination, segregation and oppression, which not only affected the organisation of health services, but also the health of the people.
 Although the full consequences of the policy of apartheid were never anticipated nor acknowledged during the time when it was developed it is well researched and well documented.  In this submission I will briefly outline how the department acted as part of the apartheid apparatus leading to ill-health of millions and the unnecessary death of many South Africans.
 It is the responsibility of every person working in the health department today to ensure that never again will we allow practices and policies to be developed and implemented that will ignore or abuse the health and human rights of our people as it was in the case in the period under review.
 The health status of the population is a measure of more than just health services, poverty, employment, access to water, sanitation facilities and other socio-economic conditions are major determinants of health status in the country.  However, it is worth looking at the health status during the period under review as it reflects important patterns of health and health care which can be considered as violations of human rights.  Quite a number of speakers during the past two days have referred to various aspects of it.
 Through the period 1960 to 1994 the health situation in South Africa reveals two distinct patterns of disease and health status for Blacks and for Whites respectively.  Differences between the mainly Black rural areas and the urban areas are also stark.  White South Africans have had the infant mortality and life expectancy rate similar to countries in the developed world.  The figures for Blacks were similar to the underdeveloped world.  For the period 1965 to 1970 the life expectancy for African males was 51 and for females 60 years.  For Whites during that period the figures were 65 and 72 years respectively.  During 1985 the figures for African males was 55 and 61 compared to the 68 and 76 years respectively for Whites.  The life expectancy of the Indian and Coloured people fell between the White and the African figures.
 The following figures of estimates of infant mortality rate by population group and in rural areas in South Africa speaks for itself.  The IMF for South Africa during 1981 to 1985, excluding the TBVC countries was 94 to 124 for Africans, 51,9 for Coloureds, 17,9 for Indians and 12,3 for Whites. In the urban areas the situation was that the IMF for Africans was 38,6; for Coloureds 25,9; for Indians 17,1 and Whites 12,3.  While in the rural areas the figures for the African population was 100 to 135; for Coloureds 66; Indians 19,8 and for Whites 12,3.
 High incidence of kwashiorkor and marasmus have been extensively documented and clearly link the policies of the day to such - such as the Homeland system and the migrant labour system.  It was estimated in 1989 that there were 2,3 million people in South Africa, including the TBVC countries, who could be considered to be in need of nutritional assistance.  Of these 87% were African and 2% were White. Active nutrition support programmes, however, only started in the latter part of 1992. 
 The disease patterns reflected major differences between the White and Black South Africans during that period.  Amongst Africans and Coloureds diseases such as tuberculosis, pneumonia, enteritis ...(intervention)

MS MKHIZE: Dr Pretorius can I just ask you to put a mike close to your mouth, some people can't hear.  Thank you.