Violence and Transformation in South Africa
Updated: Jul 16, 2019
Exploring the issues of violence and transformation through the South African health system
Before beginning to delve into the myriad issues surrounding violence and transformation in South Africa, it might first be wise to define some terms as they will be used and discussed here. The World Health Organisation (WHO, 2014) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.” This definition is broad enough to classify a wide range of historical events in South Africa as institutionalised violence, mainly racialised violence, that sought the oppression and subjugation of non-whites in the country. Violence is not a new phenomenon in the socio-historical South African context. It was deeply embedded in an institutionalised apartheid, which perpetuated the destructive prejudice the country is still fighting today. Transformation refers primarily to deconstructing and re-creating the prevailing collective relations embedded in higher education, as well as within the broader social relations in the economy and society. Our particular historical narrative has had an effect on the way South Africans perceive and react to violence. This perspective, in turn, affects the health and well-being of our population, not least through its effect on the health and social institutions in the country. Since the end of apartheid in 1994, efforts have been made to make far reaching structural changes to the country. The following reflection will show that our shared history has critically determined our understanding of violence, affected its determinants and produced the racialised and gendered ideas of violence still present in our society. The backdrop for this discussion will be the transformation (or lack thereof) in the country’s higher education system, the #feesmustfall movement and how these phenomena affect the health systems in the country and ultimately the health and well-being of South Africans.
Contextualising the Need for Transformation in South Africa
Badat (2009) points out that any meaningful discussion of transformation must be understood in a specific context, the past being the only material from which the present is formed. Higher education has been shaped by a wide range of factors in South Africa. Colonialism and apartheid, with all their implied discrimination and resultant economic and political inequality have marginalised or advantaged different people based on race classification. In the first decade of South African democracy, there was severe inequalities in the participation of different race groups in tertiary institutions. While African and Coloured participation rates hovered around 10%, whites participate in higher education at a rate of 70%, with the Indian population meeting in the middle at 40%. At work, in 1994, four out of five professional staff were white and only one third were women. Additionally, women were disproportionately represented in the lower ranks of academic or professional staff. (Council on Higher Education, 2004). Further inequality was also created by apartheid planning that delegated different institutions for different race groups, seeking to exacerbate the existing differentiation between races and serve the apartheid social order.
De Vos (2016) relates the violence prevalent in South African society with its colonial past and the subjugation of its indigenous population. De Vos (2016) also emphasises that state violence during apartheid was used to maintain power and notes that the resiliency of patriarchy is its ability to use violence as a means of domination over women. This violent history, however, does not justify its prominent place in South African society, rather it is necessary for us to powerfully denounce it and move towards a more peaceful and united society, partly facilitated by meaningful transformation. The #feesmustfall campaign played a role in raising questions about transformation as well as violence. It forced governments and universities to address how they allocated their funding. It also caused us to question the culture of violence in South Africa. For example, during the #feesmustfall movement, student protesters – who injured police and journalists with rocks at the Union buildings in 2015 – and police both used violence in certain instances. De Vos (2016) maintains that the violent “institutional culture within the police service has not been effectively transformed since the end of apartheid”, commenting in part on the violence inflicted by police on protesting students.
Apart from the tangible exclusion of race groups from universities, Badat (2009) illustrates the existence of subtler divisive factors which have influenced existing ideology. The apartheid regime attempted to influence the thinking of the population in line with its values and goals. As a result, the pre-1994 government attempted to monopolise knowledge production, meaning literature, academic discourse, research and even recreational media was controlled and influenced by the “racist, patriarchal and authoritarian apartheid social order, and the socio‐economic and political priorities of the apartheid separate development programme” (Badat, 2009). Sadly, and despite some significant effort by civil society and the government to reform this state of affairs, South Africa remains a highly unequal society. Wealth and opportunity are widely disparate even in 2017, and race as well as gender are still significant factors in the arrangement of this inequality.
Badat (2009) notes that the ambitious attempt by the new democratic government to transform education in a context of i) Redistribution, ii) Political equality and iii) Economic transformation and development. The attempt to pursue all three of these outcomes simultaneously has proved very challenging. Another challenge to transforming higher education lies in the now predominant view that development means economic growth. As a result, public investment in tertiary education is often justified only in terms of economic benefits and costs. This thinking tends to ignore the added social benefits of transformation and its impact on issues such as violence and societal values. Tertiary institutions are, of course, huge drivers of social change and this consideration might persuade governments to invest more heavily in their creation and expansion.
The health system in South Africa has also been affected by historical injustices. There are large racial differences in the social determinants of health, and there is major need for a transformation of the South African health system to enable equitable, affordable and effective health coverage, especially for societies most vulnerable members. Additionally, there is still a high level of interpersonal violence and a high rate of accident occurrences. Maternal, neonatal and child health also desperately need to be improved in South Africa, with the HIV epidemic and poor health system increasing child mortality since 1990. It seems that the great burden of disease caused by violence and injury in South Africa is largely attributable to societal determinants. Disturbingly, there has not been a significant reduction in gender based violence in recent decades. The need for transformation in South Africa’s health system is evident and urgent, though it must be noted that there have been large efforts by the post-apartheid government to equalise healthcare and provide it to previously disenfranchised people (Mayasi, et al., 2012).
What to Do? Moving forward with Transformation in South Africa
It is no surprise that South Africa has an observable culture of violence, given its history. Nor is it surprising that the health systems set up by a racist and discriminatory government pre-1994 has left the majority of the population with poor health care, being constructed so as to serve the minority white population. In short, South Africa has a turbulent past that certainly affects its current circumstances. That being said, the evidence points to limited, slow transformation after democracy. The democratic government has done little to equalise South African society beyond political equality. Social determinants of health, like wealth, are still highly unequal and thus lead to the inequality of health outcomes among different race groups in the country. This is simply unacceptable. The violent culture in South Africa, particularly the gendered violence, is clear in numerous studies, including a prominent study by Dunkle, et al. (2004). There remains a quadruple disease burden in South Africa, including poverty-related epidemics (HIV/AIDS and TB), maternal and child mortality, non-communicable diseases and violence related deaths (Mayasi, et al., 2012). These burdens overwhelm a less-than-perfect health system in South Africa and must be dealt with.