Health in South Africa 1 The health and health system of South Africa: historical roots of current public health challenges
Health in South Africa 1 The health and health system of South Africa: historical roots of current public health challenges
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DOI：
10.1016/s0140-6736(09)60951-x
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发表时间：
2009-09-05
期刊：
影响因子：
168.9
通讯作者：
McIntyre, Diane
中科院分区：
文献类型：
--
作者：
Coovadia, Hoosen;Jewkes, Rachel;McIntyre, Diane
南非卫生系统功能失调以及传染病和非传染性疾病流行的冲突的根源可以在该国历史时期的政策中找到，从殖民征服、种族隔离剥夺到后种族隔离时期。种族和性别歧视、移民劳工制度、家庭生活的破坏、巨大的收入不平等和极端暴力都是南非过去的麻烦的一部分，并且都不可避免地影响了健康和保健服务。 1994年种族隔离结束后，卫生系统面临巨大挑战，其中许多挑战仍然存在。尽管社会补助大幅增加，但促进增长而不是再分配的宏观经济政策导致了种族间经济差距的持续存在。公共卫生体系已转变为一体化、综合性的国家服务体系，但领导和管理的失败以及管理薄弱导致往往良好的政策未能得到充分实施。初级卫生保健的关键方面尚未到位，卫生部门面临严重的人力资源危机。艾滋病毒的流行加剧并加速了这些挑战。如果南非要改善健康状况并实现千年发展目标，新政府就需要解决所有这些因素。
The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. in 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.