Health and disease in southern Africa: a comparative and vulnerability perspective

Using a vulnerability and comparative perspective, this paper examines the status of health in southern Africa highlighting the disease complex and so me of the factors for the deteriorating health conditions. It is argued tha t aggregate social and health care indicators for the region such as life e xpectancy and infant mortality rates often mask regional variations and int ra-country inequalities. Furthermore, the optimistic projections of a decad e ago about dramatic increases in life expectancy and declines in infant mo rtality rates seem to have been completely out of line given the current an d anticipated devastating effects of the HIV/AIDS pandemic in southern Afri ca. The central argument is that countries experiencing political and/or ec onomic instability have been more vulnerable to the spread of diseases such HIV/AIDS and the collapse of their health care systems. Similarly, vulnera ble social groups such-as commercial sex workers and women have been hit ha rdest by the deteriorating health care conditions and the spread of HIV/AID S. The paper offers a detailed discussion of several interrelated themes wh ich, through the lense of vulnerability theory, examine the deteriorating h ealth care conditions, disease and mortality, the AIDS/HIV situation and th e role of structural adjustment in the provision of health care. The paper concludes by noting that the key to a more equitable and healthy future see ms to lie squarely with increased levels of gender empowerment. (C) 2000 El sevier Science Ltd. All rights reserved.