Page 115 - A Widening Idea of Health and Health Research - The South African Medical Research Council from Creation to COVID

A Widening Idea of Health: The SAMRC from Creation to Covid

Ratele’s departure in 2021 saw his particular focus lose priority in the joint unit.
All five of the new public health-orientated research units were thus responses to
pressing problems either in the operation of South Africa’s developing health system,
particularly in its basic clean water infrastructure, or in its social dysfunctionality.
None, however, was able to do more than blunt the problems they sought to address.
Of the 21 new research units without a strong public health basis, 11 focused on
diseases or conditions reflecting a country in the midst of an epidemiological transition.
Thus they included research units devoted not only to communicable diseases like TB,
HIV/AIDS and pulmonary diseases in children, but also to the rising tide of lifestyle
diseases like hypertension, cardiovascular disease, cancer and diabetes.
Given the still racialized nature of pathologies in South Africa, some of the new
units quite explicitly focused on diseases or conditions found especially among
particular, vulnerable groups in the population. For example, the Wound Healing and
Keloid Scarring Research Unit at UCT aimed to improve treatment of ‘neglected
common clinical problems that predominantly affect patients of African ancestry’ and
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‘neglected African hair and skin disorders’. For its part, the Cardiometabolic Research
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Unit sought to characterize the burden of these diseases among ‘coloureds’ and to
discover the epigenetics of diabetes in Africans, while in 2015 the Non-Communicable
Diseases Research Unit extended the Cardiovascular Risk in Black South Africans
(CRIBSA) Study to allow comparisons to be made of cardiovascular risk among urban
Africans then and in 1990, when the BRISK Study had been conducted. Already
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back in 2005 Dr Tony Mbewu had called for a systematic investigation into the ‘raging
epidemic of cardiovascular disease in the country … I think the country has been so
focussed on HIV/AIDS, and rightly so, but cardiovascular disease is almost as severe.
Twenty years ago this was a disease largely affecting white men; today it is common
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among Africans.’
At the other end of the epidemiological transition spectrum, in the area of
communicable diseases, because of its wide prevalence and severity (as Mbewu had
observed) HIV continued to attract intensive study by and funding of yet further
research units, for instance the HIV–TB Pathogenesis and Treatment Research Unit
set up in 2015 in KwaZulu-Natal, the epicentre of the country’s HIV epidemic, and
the intramural AIDS and TB Research Unit, with its dominant focus on HIV/AIDS.
In 2020 it began to trial social impact bonds to financially incentivize HIV prevention
and the avoidance of unintended pregnancies by adolescent girls and young women.
As the African majority of the population constituted the bulk of those infected with
HIV – as with all communicable diseases in South Africa then – this made them the
particular target of the MRC’s post-revitalization concentration on the top ten killers
in the country.

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