Page 79 - 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

to increase control over, and to improve, their health’, with ‘achieving equity in health’
a priority. Disregarding those MRC scientists who questioned the validity of her field
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as ‘science’ – she dismissed them as ‘doubting and hostile Thomases’ – Reddy and
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her staff devoted themselves in the first instance to creating ‘the theoretical struts that
support the practice of health promotion’ by conducting surveys of, for instance,
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smoking in schools, sexual behaviour among high-school learners, and the amount of
physical activity they undertook. This data – gathered most fully in three Youth Risk
Behaviour Surveys between 2002 and 2011– they then fed into intervention planning
in a bid to foster behaviour change, which, Reddy believed, was ‘often at the core
of improving health’. For this to happen, however, Yach’s ‘right combination’, so
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skilfully cultivated by CERSA, had to be present – which Reddy found many a time
was not the case.
Similar in intent, but starting from a more clinical and epidemiological angle, the
Chronic Diseases of Lifestyle Research Unit also began as a division within CERSA
before maturing into a full MRC research unit in 2001. Under the single-minded
biochemist-turned-medical doctor and epidemiologist Krisela Steyn, it focused on
the surveillance of chronic ailments like cardiovascular disease and diabetes, which
shared similar risk factors such as hypertension, smoking, high salt and cholesterol
levels, obesity and lack of exercise. As Steyn herself soon recognized, these were but
manifestations of a country undergoing transition from diseases of poverty to diseases
of lifestyle. ‘There was a general perception that non-communicable diseases were
diseases of affluence,’ she pointed out, ‘which is arrant nonsense. When we started
looking at the risk factors in populations other than white, it quickly became very clear
that risk factors were rising rapidly in poorer communities in South Africa.’ These
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the unit sought to counter through upstream interventions at the level of policy-
makers and manufacturers and midstream through the education of primary school
learners, as in its Health Kick Project against diabetes, which sought to kickstart
prevention by publicizing the need for healthy eating and physical activity among
pre-teenagers. Despite these initiatives, and despite its key role in unravelling the
intertwined nature of chronic diseases of lifestyle in the country and its compilation of
a community nutrition textbook for South Africa, after Steyn’s retirement its overlap
with other units saw it merged with them into the Non-communicable Diseases
Research Unit in 2013.
A third public health-oriented focus among the new research units set up in this
period, health systems, also had its origin as a division within CERSA in 1993. Within
the context of the transformation of South Africa and its health system, a bird’s-eye
overview of this system and how its constituent parts did (or did not) relate to one

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