Randall M. Packard

Epidemiologists, social scientists, and the structure of medical research on aids in Africa

The development of medical research on AIDS in Africa resembles earlier efforts to understand the epidemiology of TB and syphilis in Africa. In all three cases early research focused on why these diseases exhibited different epidemiological patterns in Africa than in the west. Early explanations of these differences focused on the peculiarities of African behavior, while largely excluding from vision a range of environmental factors. These parallels provide a framework for examining how western ideas about AIDS in Africa developed, the role of social scientists in the formation of these ideas, and how these initial perceptions shaped the subsequent development of AIDS research, encouraging a premature narrowing of research questions. The paper warns that, as in the histories of TB and syphilis research, this early closure may generate inadequate and inappropriate responses to the African AIDS epidemic and limit our understanding of the disease.

Industrial production, health and disease in Sub-Saharan Africa

Industrial development in Africa has carried with it significant health costs. These costs are normally defined rather narrowly by those concerned about occupational or industrial health and safety and refer only to the health consequences of worker exposure to specific hazardous processes, materials or environmental conditions associated with the workplace. A more comprehensive measurement of industrial health costs, however, must also include an assessment of the impact which industrial development and the creation of an industrial workforce has on ecological relationships, environmental conditions and patterns of sickness and health in the areas surrounding industrial centers. Traditional definitions of occupational health also tend to focus attention on the immediate causal linkages which exist between the development of particular industrial processes and specific health hazards. Yet any attempt to fully understand the causes of industrial health problems in Africa must look beyond these immediate causal linkages and examine the wider political and economic forces which determine the shape of industrial development and the extent to which the health costs of this development are borne by industrial workers and their families, as well as by people who may not be directly or even indirectly connected to industrial development, but may, nonetheless, be exposed to its health risks. The paper surveys the direct and indirect health costs of mining, large scale agriculture, and manufacturing in Africa and examines the economic and political interests which have determined the distribution of these costs.

Agricultural development, migrant labor and the resurgence of malaria in Swaziland.

Much of the research on the recent resurgence of malaria in Third World areas has focused on the problem of vector resistance arising out of the widespread use of pesticides in conjunction with the development of large-scale agricultural projects. Evidence from southern Africa, and particularly from Swaziland, where a resurgence of malaria has occurred in the absence of pesticide-resistant strains of Anopheles mosquitoes, suggests that changes in agroecosystems, labor utilization and settlement patterns, which are also associated with large-scale agricultural development, may play an equally important role in the resurgence of malaria. Renewed efforts to control malaria must, therefore, take account of the social and economic, as well as the biological determinants of this disease.

Maize, Cattle and Mosquitoes: the Political Economy of Malaria Epidemics in Colonial Swaziland

Malaria was a major health problem in Swaziland during the colonial period. Prior to the commencement of vector control measures in the late 19405 annual outbreaks of malaria occurred during the summer and autumn months from December to May. These seasonal epidemics incapacitated large numbers of Swazis as well as a few Europeans. During most years the epidemic was limited to the lower regions of the country and was marked by relatively few deaths. In other years, however, the annual epidemic spread throughout the country and was accompanied by a high rate of mortality especially among young children. Colonial medical opinion ascribed these major epidemics to abnormally heavy rainfall and increased vector breeding. Yet they were also a product of long-term trends in the Swaziland political economy – the semi-proletarianization of Swazi herdsmen/cultivators and the subordination of Swazi economic interests to those of South African and local European capital - which produced a state of nutritional vulnerability among many Swazi families. This, vulnerability in combination with short-term economic crises, such as the worldwide depression of the early 19305, and drought, gave rise to famine conditions which greatly increased the severity of subsequent outbreaks of malaria, as seen in the histories of the major epidemics of 1932 and 1946.

Tuberculosis and the development of industrial health policies on the Witwatersrand, 1902–1932

The development of the gold mining industry along the Witwatersrand at the end of the nineteenth century had a dramatic impact on patterns of sickness and health within southern Africa. The high health costs associated with gold mining and related industries along the Rand were passed on directly to the black workers and to the families of those workers who chose to settle along the Rand at the turn of the century, through the provision of wages which failed to cover the cost of food and housing, and the creation of working conditions which were marked by long hours and a near absence of concern for sanitation or safety measures. Indirectly, the health costs of production on the Rand were passed on to the black workers kinsmen and neighbours who remained in the rural areas from which black labour was drawn. The combination of taxes and measures, such as the 1913 Land Act, designed to free labour by undermining rural productivity, impoverished reserve areas and reduced the disease resistance of rural dwellers. At the same time, diseases contracted by black workers while on the Rand, found an ideal breeding ground in the reserves when the infected workers returned home. 1 The health costs of industrialization among blacks did not go unnoticed among white health authorities and employers of labour along the Rand, if only because they threatened both the security of labour supplies and the health of white workers and their families. There was little consensus, however, about either the causes of black ill-health or about the best way to deal with the problem. The debate over the causes of black ill-health, in fact, dominated discussions of public health within the urban areas of South Africa through the 1940s. While the debate involved the discussion of a number of black health problems, it centred increasingly on the problem of tuberculosis, which became the major cause of black