Page 78 - A Widening Idea of Health and Health Research - The South African Medical Research Council from Creation to COVID

Positively into the New South Africa: The MRC, 1995–2012

2008, a special liquor Act for the Western Cape was under discussion, it was suggested
that the MRC be given a dedicated place on the statutory committee to be set up to
monitor the effects of alcohol on communities.
At home too, research by the Alcohol and Drug Abuse Research Unit (ADARU)
– the importance of its research gained it full unit status in 2005 – made clear the
nexus between alcohol, drugs and HIV transmission and progression, prompting it
to propose practical strategies to reduce the chances of sex workers being infected.
Despite its catchy slogan, ‘ART [antiretroviral therapy] and alcohol do not mix’, it is
hard to know if they had much effect. As the MRC itself recognized, ‘It is difficult to
directly link the MRC’s intervention [on HIV/AIDS] to the number of lives saved.’
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Apparently more efficacious was the work of another division within the ADARU
which in 2008 began surveying the experience of substance abuse patients to establish
the capability of the health system to provide them with adequate treatment and to
discover how far they were satisfied with it. Using a standard Service Quality Measure,
which the researchers devised along lines pioneered in the US, they compiled a
uniform South African Addiction Treatment Service Assessment, which gradually
began to inform the making of policy, facility planning and treatment delivery locally.
To date, partly funded by the Department of Social Development, it has been rolled
out in three provinces.
Where there is even firmer evidence of successful interventions by the unit is in its
continuing the anti-tobacco campaign started by CERSA – in fact, ‘tobacco’ was added
to its title in 2014. Between 1992 and 2010 the percentage of adults in South Africa
who smoked fell from 33 per cent to 24 per cent and the per capita adult consumption
of cigarettes from 76 to 40 packs per annum, in no small measure due to the empirical
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evidence put before the Government by the unit. This helped to persuade it to
tighten anti-tobacco restrictions even further through three Tobacco Product Control
Amendment Acts, to raise the tax and excise duty on cigarettes, and to include in the
national school curriculum information about the addictive nature of nicotine. As the
CERSA veteran of the anti-tobacco campaign, Derek Yach, recognized, ‘You need the
right combination of science, evidence and politics to succeed. If you have one without
the other, you don’t see action.’ 97
Taking a leaf out of Yach’s book – she was, after all, a protégé of his who matured
very quickly – in 1995 the US-trained health behaviourist Priscilla Reddy persuaded
the MRC to create an internal research unit or office in health promotion, a new field
within public health deemed especially appropriate for a country marked by enormous
health disparities within its diverse population. Citing the Ottawa Charter for Health
Promotion (1986), Reddy defined health promotion as ‘the process of enabling people

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