Inputs of social scientists are critical

Why should epidemiological studies include social aspects of diseases?
Public health requires an interdisciplinary approach. So, at the hsrc we study all factors that cause disease and what prevents people from accessing health care. For example, in my area of interest, hiv and poverty, we found that not only do the poor have less access to health services, they also lack information on the availability of these services. So, even when services are free and available, the poor do not always benefit from them. Besides, some ill people require not just medical care but also social support. This is where sociologists, psychologists, and professionals from other disciplines have to step in. Inputs of social scientists are critical to make public health programmes sensitive to the requirements of their actual targets.

Does epidemiological research really address social issues, today?
Biomedical models dominate epidemiology. So social issues often don't get the recognition they deserve. But the situation is changing. There are epidemiologists today who talk of how social conditions make some people more vulnerable to certain diseases.

Sometimes health imperatives can militate against environmental concerns. For example, dichloro diphenyl trichlorethane (DDT), used to control malaria, causes pollution.
In such cases, we have to perform a balancing act. We know ddt is harmful, but then so is malaria. Banning ddt could be catastrophic to economies of poor countries, which already have difficulty managing programmes using this cheaper insecticide. Using the more expensive alternatives might be out of their reach. So, we have to ascertain the competing risks. Some of them can be managed. The South African experience shows that if used judiciously, ddt is quite cost effective.

Do you think there is an interest group that's working against epidemiology addressing social issues?
I am not aware of any such group but there are always situational constraints. For example, while many in South Africa know that social issues hold the key to preventing diseases, our ministry of health has little time to think of such an approach. The current burden of disease and increasing numbers of sick people keeps it terribly preoccupied.

Can what you say be ascribed to lack of staff or lack of political will?
Elected leaders tend to support programmes that promise short-term benefits. Long-term health goals, though much more important, are harder to get into their agenda. Moreover, some such targets, including aspects of the un's Millennium Development Goals are quite vague. Let's not forget that policy makers prefer to see measurable impacts rather than general, sometimes imperceptible, improvements.

What are the main areas of epidemiological research in South Africa?
We have covered almost all relevant fields. In recent years, our research agenda has had a stronger focus on health problems of the poor, for example issues related to water and sanitation. So diarrhoeal diseases, which afflict large sections of the population and are largely preventable, receive more attention than, say, cancer, which is both harder to prevent and affects relatively few in comparison. However, the health transition (transition from a predominance of infectious disease to lifestyle-related diseases) means that non-communicable diseases are becoming important.

The HSRC was formed during the apartheid period. Was there any change of focus after the apartheid regime was dismantled?
It's a very delicate question. But 15 years back, the hsrc did some research, which was irrelevant for the broader community, for example, documenting the genealogy of white communities in South Africa. Since the early 1990s, the hsrc started reorienting it's research, and in 2001 underwent a radical restructuring. It now strives to do policy-relevant, user-driven and public sector-oriented research.

Did HSRC ever work on eugenics?
No, that was never a field of research, as far as I know. Anyway, I was not with the hsrc then. For the last five years, we have radically realigned with programmes related to democracy and governance, gender, education and training, urban and rural economic development, and social aspects of health. Currently, social scientists outnumber epidemiologists in the hsrc. South Africa has a long history in development of public health. Some well-known public health professionals are South Africans. Some of them left the country during the apartheid period. But they continued to address the public health issues related to black people.

Was there any problem for such professionals during the apartheid period?
There were some problems, but since ours was a mass movement, several issues were highlighted. Things are easier now, but the health department still retains some of its earlier biases.