Page 54 - A Widening Idea of Health and Health Research - The South African Medical Research Council from Creation to COVID

On and over the Brink: The MRC, 1985–1994

For all the paradigm shift in the type of research conducted under the MRC banner,
which the work of CERSA and the National Trauma Programme represented, it would
be misleading to suggest that their conception of appropriate medical research was
dominant in these years. Of the MRC’s 28 external research units in 1991, only 5 had
what Yach considered ‘clear community health research objectives and application’.
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Certainly, campaigns for the compulsory iodization of salt and for drinking water
to be fluoridated were novel for their inclusiveness, while a few of the MRC’s new or
existing research units did focus specifically on health problems facing South Africa’s
black underclasses (e.g. perinatal mortality among ‘coloureds’, coronary risk factors
among urban Africans in the Cape Metropole (the so-called BRISK Study), and the
treatment of child diarrhoea in Khayelitsha), but the bulk of the new units were more
of the same. Thus, Tim Noakes’s MRC–UCT Bioenergetics of Exercise Research Unit
originated in a growing interest in the health of athletes (of whom a high percentage
were white) in the conditions produced by the ‘highly stressful environment of
modern-day man’ and in sports injuries. In the latter sphere one of its early successes
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was to have the rules of schoolboy rugby changed so as to reduce the risk of neck
injuries. For its part, the new Metabolic Research Group at Tygerberg Hospital took as
its first task investigating the nutritional status of jockeys, women dieters, the residents
of old age homes, and children with nephrotic syndrome. The other nine research
units or groups awarded MRC support status in these years fell into the clinical or
laboratory research category, in effect being narrow, niche projects in silos, ranging
from, for example, the exploration of respiratory peptides and phagocyte function to
molecular hepatology and immune dysfunction. An MRC staffer who provided several
of these units with technical know-how described them as engaging in ‘specialised,
blue-sky research … A lot of the work didn’t have direct, practical application.’ For
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his part, after completing a close assessment of the research then under way at the
MRC, a South African medical scientist active in the anti-apartheid movement abroad
was ‘appalled by the fact that [local] science had so little to do with what the country
needed’. It was still more ‘a scientific research institution [than] an institution
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focusing on the health of the people’, agreed a contemporary.
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Overcoming this lack of coherence in research was just one of the reasons for
the MRC readily embracing the philosophy of Essential National Health Research
(ENHR) in 1993. Only recently developed by an international non-governmental
commission for implementation by low- and middle-income countries and according
well with the policy of primary health care then gaining favour in the Department of
Health, the ENHR idea aimed to produce a situation in which health research was
better geared to addressing the health needs of entire populations more equitably,

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