Public health in South Africa 1975–89: reflections on a momentous past

I t is an honour for me to reflect on a momentous period in the evolution of South Africa’s Public Health. In 1979, Wits University appointed its first full-time Chair of Community Health to a post, which had been approved four years earlier. The delay in filling the post was a product of bureaucratic challenge and uncertainty around the job description of the incumbent. The bureaucratic challenge centred on the post being a tri-partite appointment, with the successful candidate answerable to the National Department of Health, the Provincial Department of Hospital Services, and the University of the Witwatersrand. A further complication was that most public health activities took place under the auspices of the Johannesburg Municipality which was not a part of the tri-partite arrangement but which had a strong presence on the selection committee. There was much confusion back then as to what constituted community health, or public health, as it had been previously named and is now renamed. The shortlisted candidates for the chair were a paediatrician with strong primary health care (PHC) credentials and a physician with a background in health service management and epidemiology. The physician was a hot-blooded 30-something year-old revolutionary recently returned from Oxford University and the powerful influence of Sir Richard Doll, a committed socialist with alleged links to communism! It is unclear why a conservative selection committee gambled on the latter. What follows are some reflections of that now retired revolutionary.