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The health and health system of South Africa: historical ...

Vol 374 September 5, 2009 817 health in South Africa 1 The health and health system of South Africa: historical roots of current public health challengesHoosen Coovadia, Rachel Jewkes, Peter Barron, David Sanders, Diane McIntyreThe roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country s history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system , the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa s troubled past, and all have inexorably aff ected health and health services.

racial attributes of any kind).1 After 15 years, South Africa is still grappling with the legacy of apartheid and the challenges of transforming institutions and promoting equity in development. South Africa has four concurrent epidemics, a health profi le found only in the Southern African

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