Struggles for Control: The Social Roots of Health and Healing in Modern Africa

Abstract

This paper is a general interpretation of the social determinants of health and health care in Africa over the past century. The evolution of health cannot be separated from the broader story of social change. The political and economic forces which shaped the continent's history also established the framework within which patterns of diagnosis and treatment, health and disease, emerged. The implication of this is that healers of all kinds—whether doctors or “traditional healers”—have been less influential than we commonly think in shaping states of health or in healing the sick. This position opens up a range of difficult problems which are addressed in the following pages. What is the exact nature of the link between the broad political-economic forces and the distribution of health or disease? Which of these forces have driven therapeutics along its historical path, and by what means? What role do healers actually play? The body of the paper is divided into three main sections. The first explores the micro-sociology of changing treatment of illness. In most African communities several kinds of healers work side by side: physicians or medical assistants, specialists in sorcery or spirit possession, Christian or Muslim religious healers, and others. Multiple authorities co-exist, and therefore no one healer decides the cause or cure of illnesses in a way which others accept as beyond challenge. But treatment cannot exist without coordination. Someone must decide on a course of action when lives are threatened.

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