Health, population and social transitions in rural South Africa

It is now 13 years since the political liberation of South Africa – a rollercoaster period through which citizens of the ‘‘rainbow nation’’ have struggled to live up, individually and as a people, to the ideals articulated by visionaries that include Nobel laureates Nelson Mandela and Desmond Tutu. The country’s near-miraculous peaceful transition from apartheid rule to genuine democracy inspired the world community, providing a springboard for President Thabo Mbeki to launch continent-wide initiatives, pre-eminently the New Partnership for Africa’s Development (NEPAD). In parallel with such inspirational efforts has been the difficult, down-to-earth business of building a competent system of government and establishing a stable macro-economic and social environment responsive to the nation’s citizenry, especially the poor and vulnerable. The apartheid legacy of inadequate education and high unemployment, poverty and extreme inequality, and exaggerated emphasis on that which divides rather than unites people, is proving deeply embedded in the fabric of modern South Africa – more so perhaps than national leadership appreciated. In such circumstances, there is no substitute for informed leadership and astute decision-making that takes the longas well as short-term view. This in turn depends – as Adetokunbo Lucas put it – on generating the necessary ‘‘intelligence’’: information that is valid, responds to strategic priorities and captures change over time. While progress has been made – with the efforts of the Medical Research Council, Statistics South Africa, Human Sciences Research Council and key university-linked groups standing out – we submit that South Africa today faces a real ‘‘crisis of evidence’’. This is reflected in the limited availability of empirically-derived population-based data, weak investments to support their production, and limited public sector capacity to absorb, sift, interpret and respond to findings. The situation has been fuelled by the counter-scientific stance that, until recently, characterised government’s response to HIV/AIDS. This volume – comprising some 20 peer-reviewed articles and accompanying commentaries – is part of an effort to address this gap in information and understanding. Work demonstrates the unusual utility of health and demographic surveillance when characterising the dramatic transitions underway in South Africa today, and the exceptional R&D platform that such infrastructure can provide. The study site is part of a district barely 25 miles west of the southern Mozambique border, this rendering it part of north-eastern South Africa and integral to a cross-border region of rural Southern Africa – thereby amplifying the relevance and applicability of data and findings.