September 11, 2019
Like many public health practitioners, I first got to know David Sanders through his book, ‘The Struggle for Health’. I read it in 1991, six years after it was published. I still have that book, and it sits in my current office.
At the time, I was a junior doctor in England, not knowing that I would end up working in South Africa and eventually meet David.
When I read the book, I was already steeped in political economy and activism. I had spent six months at the University of Sussex in the School of African and Asian Studies (with half-baked plans to give up medicine); and had been involved in land rights struggles in Indonesia; and in a global health charity called Medact that worked on the underlying determinants of global health.
David’s book was a joy to read. Here was a doctor showing the link between medicine and the politics of under-development; and demonstrating how doctors and other health workers could (and should) combine their clinical skills, professional mandate and social power to treat both disease as well as the causes of disease. It helped me decide to stay in medicine, and a year later I was doctoring in a rural district hospital in northern Kwazulu in South Africa.
If I remember correctly, I met David in 1995, a year after South Africa’s first democratic elections. By then I had already met David’s wife, Sue Fawcus, an obstetrician and maternal health expert who taught me on the University of Cape Town’s M-Phil programme on Maternal and Child Health that had been set up by Marian Jacobs.
Over the next seven years, I worked with and learnt from David on a wide range of health policies, projects and programmes in South Africa, but also internationally. And when I returned to the UK in 2002, I got very involved in the Peoples Health Movement (which David had helped establish), and was therefore constantly in touch with David.
The last time I saw him in person was in London last year (2018) when he generously made time to speak to the global public health unit at Queen Mary University London. I wanted my global health colleagues to hear from David – not just about his work, but also about himself and his personal journey through medicine and public health.
I wish I had recorded his account of life as a medical student in Harare and as a junior doctor in London, and his early experiences of bridging the schisms between medicine, public health and politics. Typically, he also felt it important to describe the celebrations that marked the independence of Zimbabwe from colonial rule and his glee at finding himself downstream from Bob Marley and his crew, who were imbibing in certain herbs known for their mellowing properties.
And the last time I was in touch with David was only a few weeks before he died because I wanted to see how my department could access some of the teaching materials that he and others had developed at the School of Public Health (SoPH) at the University of the Western Cape. There is so much about the teaching and learning at SoPH that is important to health in Africa, and the fact that David’s legacy and efforts at SoPH are in such good hands is also a testament to his ability to attract such good colleagues.
It is now very, very weird to think of David no longer being around – especially given how active, vital and involved he was with so many things. For many people, he was so valued because he gave voice to so much that is important. There is a need to fill the gap that he has left behind, so it’s worth describing what made him so unique.
One of his major attributes was the combination of deep intellect and an ability to communicate effectively. He was brilliant at explaining the links between disease, illness and political economy. He was a superb exponent of the principles and logic of Alma Ata; and the breadth and depth of his knowledge and expertise across each of the three levels of UNICEF’s conceptual framework on child mortality and malnutrition was pretty unique.
He was able to describe and explain the many long and complex causal pathways of disease and illness in a way that was clear and compelling. The Struggle for Health and Questioning the Solution (which he wrote with David Werner) were masterpieces. They are both highly analytical and complex books – combining science with passion and polemic – and written to be accessible to as many people as possible. He was unapologetically political, and I have a particularly fond memory of him explaining why the distinction between social democracy and democratic socialism was important to public health.
This is connected to a second attribute of David’s: his commitment to education. He always seemed more concerned with teaching and empowering ordinary health workers than with publishing in peer-reviewed journals or engaging in theoretical and academic discussions. He saw teaching as an essential and important part of being an academic. Today, as universities bend to the demands of private financing, markets and defective university ranking systems, David’s commitment to an academic ethos that truly serves society and the public interest (and in particular, the needs of the people of Africa) is something that will be missed.
A third attribute of David was his non-elitism and ability to get on so well with ‘ordinary folk’. He was very much a man of the people. He certainly dressed like one. You could see this in the way he was willing to rough it out, whether it was sharing a room in a low cost hostel in Geneva so that he could represent the Peoples Health Movement at the World Health Assembly, or sleeping in a cold and damp rondavaal in the Transkei to conduct research on household food security. Today, as distance and disconnect with liberal elites are used to fuel the rise of populist authoritarianism across the world, highlighting David’s commitment to the building of bridges between academics and professionals on the one hand, and civil society and the general public on the other, is not just of sentimental value, but also of practical importance.
Indeed, a fourth attribute of David’s public health approach was his insistence that real public health involved mobilising communities – not ‘saving lives’ through top-down programmes that would deliver healthcare to passive recipients. This attention to bottom-up social mobilisation was informed by the knowledge that politics shapes the distribution of power and health in society, and is fundamental to addressing global problems of poverty and premature mortality. He devoted huge amounts of time and energy to the values and principles of the Peoples Health Movement; but also supported other social movements such as the Treatment Action Campaign. And he also made the valiant effort of standing for election as a candidate for the African National Congress in local elections for this reason.
Furthermore, he did all this with humour and wit – the fifth and final attribute to highlight. No doubt, this was part of David’s popularity. But it was also an important part of how he got things done; and inspired so many others to also get things done. Although he was also famous for his complaining and whingeing, this was always conducted with charm and good nature. A mutual colleague of ours wrote this to me when she heard of David’s death: I just heard that David Sanders has passed away. It took my breath away. I haven’t been in touch with him for years but he was a great person with a true heart for social justice. And also a bit of a curmudgeon!!, which also made him endearing. Sad. But he lived a full life and left an amazing impact in Zim, SA and more generally.
However, David would also be the first to acknowledge that ‘no man is an island’. And in paying tribute to David, it’s necessary to also pay tribute to all those who supported him and helped sustain his work and impact. These would include: a) his colleagues in South Africa, especially in the School of Public Health at the University of the Western Cape; b) his friends and comrades in the Peoples Health Movement, many of whom display the very same attributes listed above; and c) his family, and in particular Sue who deserves a big slice of all the complements and plaudits that have been directed at David.
Thanks for the inspiration and memories, David.
September 11, 2019