Thank you for the invitation to your Department’s Lecture Series to share my thoughts on some of the most pressing matters in our country, our continent, and our world. Your Department serves the most vulnerable people in the world at their most vulnerable:
- Women whose bodies carry so much, compounded by the reality that women do not often take care of themselves first. They are not only last in other people’s considerations, but in their own considerations as well – Mma gwana o swara thipa ka bogaleng ‘mothers would grab a knife blade to protect their children’.
Women in childbirth are at their most vulnerable, but they keep giving, including the gift of life itself to their offspring.
Children are also a vulnerable segment in any society, but more so in societies like ours that are topping the scales in terms of inequality and inequity. They too are at their most vulnerable under your care: pre-natal; intra-natal and immediate post-natal.
In our unequal society, women bear the brunt of poverty, low pay, gender-based violence, and single parenting (more than 50% of children are brought up by single mothers). Women are truly the most vulnerable and deserving of VVIP care from your profession and society as a whole.
You are a critical element in the Health Care and Healing profession. You care for the most vulnerable yet anchoring pillars of our families, communities, and society as a whole. I continue to think of myself as a healer – a wounded healer. Above all other careers, health care and the healing profession remain critical elements and passions of my life journey. Ours is a sacred profession. Our work of healing bodies and enabling the birth of new life is nothing short of being handmaidens of the gods.
I chose to speak to you on Wellbeing for All for a Healthy Planet in response to the planetary emergencies presenting as dramatic climate change, inequities and inequalities that ferment conflicts and wars. Humanity must work together to emerge from these emergencies or perish together.
In this talk, I would like to touch on the following points:
Why is Wellbeing for All a Common Good for Humanity?
What are the measures of Wellbeing for All?
What is the connection between Wellbeing for All and a Healthy Planet?
How can We Achieve this golden goal?
Why is Wellbeing for All a Common Good for Humanity?
Africa, the cradle of humanity and the first human civilisation, has a responsibility to re-embrace the wisdom of our ancestors that: to be human is to be interconnected and interdependent within the web of life. As Africans, we have this rich heritage of Ubuntu to reclaim to guide us back to the essence of what it means to be human. Claiming this Ubuntu heritage to guide our personal, professional, and political lives would enable us to appreciate that our wellbeing is inextricably linked to the wellbeing of other human beings and of the planet itself.
Public health principles teach us that no individual, family, or community can enjoy wellbeing in an environment that does not ensure that all are protected from diseases that can ultimately spread to the rest of us, including life threatening ones. The COVID pandemic was a great reminder of the importance of human connectedness and interconnectedness and the principles of sound public health. Isolation and loss of physical human contact and intimate relationships made many people more vulnerable and less resilient to COVID-19 infections and serious diseases.
There is still no scientific explanation for the lower than expected morbidity and mortality from COVID-19 in Africa. But it is clear that expectations by the medical and scientific establishment that Africa would be littered with corpses from the COVID pandemic did not eventuate. Why? No one knows for sure. But what we do know for sure is that the poorest communities in Africa leaned over their fences, and crossed footpaths to seek out vulnerable people, especially the elderly and those living alone to ensure that their basic needs were taken care of.
The idea of Wellbeing for All being a Common Good was drilled into us growing up in rural villages. Concern for the wellbeing of others is embedded in the greetings of villagers: ‘Sanibonani! Ninjani?’ Notice the plural – ‘We are seeing You, How are You?’ The plurality is an indicator of the inextricable link between people over time and space. As an individual, you are the embodiment of your family, your clan - those alive, departed and yet to be born. You carry multiple generations in your being from the ancients to the yet to be born.
Indigenous culture and belief systems do not see time as linear but as a cycle of life. Interestingly, quantum physics has now come to the same conclusions that our ancients always knew all along - that everything is connected to everything else, and that the process of observation itself changes what is being observed. How extraordinary! Yet our beliefs and behaviours are not necessarily changing for the better. Many of us have yet to embrace this interconnectedness and interdependence within the web of life. Why?
I believe that modernity defined by dominant Western culture, has blinded us from seeing ourselves as a relational species that can only survive through mutual support and collaboration. The dominant Western culture focuses on competition rather than on collaboration.
Dr Julian Able, a UK Midlands-based palliative doctor, characterises this culture as a “Victorian Nightmare” resulting from a misreading of Darwin’s scientific observations of the evolutionary process. What Darwin observed was the survival of species that lived in symbiosis, not the popular distorted notion of “survival of the fittest” that suited the competitive colonial narrative justifying their extractive socio-economic system.
Dr Able calls upon all human beings to adopt “survival of the kindest” as the way to promote a culture of Compassion, Care and Support, to enhance wellbeing of all. He has demonstrated that compassionate palliative care enables people with terminal illnesses to live longer dignified lives, and some to unexpectedly recover. He is championing Compassion training for all his staff, the families of his patients, and the communities and cities where he practices. The results are so spectacular that the NHS is adopting Compassion in Health care to enhance the quality of care! This is a call to return to Ubuntu as the loadstar in our personal, professional and political lives.
What Are the Measures of Wellbeing?
Modern medical science has traditionally taught us that good health is the absence of ill health. During my health care training in the 1960s-1970s the focus was on the physical body. Mental health got little attention in our education and training at the undergraduate level. Those people who struggled with mental health challenges only got attention when their mental conditions disrupted the ‘normal life’ for others. Internal suffering of people received little attention unless it became a public concern through abnormal behaviour of those who suffer that ‘disturbs the peace.’
Silent sufferers from depression in most cases suffer alone even today. Their silence is often an embarrassment to others, until the suffering person either takes drastic actions, including suicide, or removes themselves to live outside of the non-supportive society as recluses. Our own society has confined the majority of poor people including, the more than 50% unemployed young people, to reclusive lives of crime, substance abuse and suffering.
We need to establish new measurements of wellbeing beyond medical-biological physical ones. This requires us to appreciate that humans are not just their physical bodies, but members of a species that is inherently relational. We are at our best as human beings when we are living in supportive relationships. The affirmation of our ‘being’ as humans is only possible in relationships.
Our world has increasingly incentivised us to care more about ‘having’ than about ‘being’. The consumer society with planned obsolescence built into every product, and where success is measured by ‘having more’ whatever the cost, has led to the current planetary emergencies. Just look around us. We are increasingly drowning in our own generated waste produced by extracting scarce inputs from ecosystems that sustain life as we know it. The damage to sensitive ecosystems is generating the planetary emergencies that are unfolding: climate change with droughts and floods, including in Dubai – imagine a desert in flood! Yet we continue to destroy forests, consume food and drink beyond our needs, produce emissions, and extract water beyond the sustainability of watersheds and underwater resources.
As health professionals, you need to add your voices to the discussions about going beyond GDP as a measure of progress. Traditionally GDP is used to measure the value of goods and services. GDP growth is seen as a measure of success that benefits humanity directly or indirectly through the so-called trickle-down from rich to poor. This approach has been challenged by many progressive people from Robert Kennedy to the Club of Rome in its seminal 1972 Report – The Limits to Growth. Yet its use continues:
GDP not only measures goods that benefit humanity but includes the value of arms and many poisonous chemicals that kill and damage our ecosystems.
GDP is also inadequate as a measure of progress given the dominance of financial assets - real or virtual - that is not backed by any products or services of substance. For example, the global balance sheet tripled between 2000 to 2020 from $440 trillion or 13.2 times GDP to $1540 trillion! What does this mean to you and me? The world lives in a fool’s paradise from financial crisis to crisis!
We need to explore how to measure true wellbeing at the personal, family, community and country levels. Gross National Well-being/Wellness (GNW)or Gross National Happiness (GNH) are being increasingly used to measure socio-economic development as more credible measurement frameworks. Bhutan has over the last decade or so been using GNH measures, which are a complex combination of a person’s physical, mental, emotional and social health factors in society. Wellbeing is strongly linked to happiness and life satisfaction. Imagine what our country could be like if all our endeavours were directed at ensuring happiness and life satisfaction for all!
Inputs into such an outcome would be economic policies that are aimed at generating enough resources to ensure spatial reconfiguration of our cities, towns, and rural areas to provide sustainable dignified human settlements. Such settlements would have high quality essential social, and physical infrastructure such as water& sanitation; roads and reliable public transport; education and training facilities with totally transformed curriculum and teaching and learning approaches that liberate the inner genius within each person to be able to contribute their very best to society.
A transformed health system in such a reimagined South Africa would have a properly conceptualised National Health Insurance System, with a Strategic Plan with short, medium and long term resources goals and objectives. A carefully conceptualised monitoring and evaluation system would be put in place to effect course corrections whenever needed to meet desired goals.
Imagine what a fabulous place our country could be? Building on strong institutions such as Groote Schuur and other academic, provincial, and primary care facilities peopled by only the best trained health professionals with adequate financing to meet the needs of all citizens to achieve Wellbeing for All! For that dream to come true we need leadership with the will to appoint a professional, competent, ethical public service! That is in the hands of each one of us in this room as we prepare for our national and provincial elections!
Wellbeing for All and Healthy Planet?
Indigenous communities all over the world have held on to the wisdom of the ancients that has enabled them to be the best custodians of essential sensitive ecosystems. Indigenous people comprise 6% of the world's population yet are effective stewards of their lands that contain 80% of the world’s biodiversity. They do so by harnessing their ancient knowledge systems including: traditional healing plants and herbs; life giving food systems; protecting biodiversity; and safeguarding conservation and wildlife. They ensure the continuation of forests as carbon sinks - 24% of the world’s carbon is stored in tropical forests and biomass.
Without these ecosystem services by indigenous people, our wellbeing as a global community cannot be safeguarded. But what about the home front here in our own country? South Africa has dismally failed to transform itself over the last 30 years to create socio-economic conditions conducive to wellbeing for all. This is the greatest disgrace for our country. Despite boasting of a Constitution that guarantees human rights and wellbeing for all, the lived reality of the majority of our fellow citizens belies the lofty ideals in that Constitution. Poor people are poorer now more than ever before with little hope for a better future. They live in appallingly humiliating conditions surrounded by sewage, lack of safe drinking water and reliable access to electricity, and lack of safe affordable public transport. Wellbeing for All is a distant dream in our country, unless we the citizens, stand up and use the power of our vote to elect leaders accountable to us and future generations.
How Do We Achieve Wellbeing for All?
A few weeks ago, I listened to 94-year-old Dolores Huerta, a USA Civil Rights leader and activist, at the 35th Bioneers Conference in San Francisco with Civil Society Organisations, Academics, Indigenous leaders, young people, and business leaders. She was amazingly vigorous despite her age, and clear that we have the power to change systems of injustice and to liberate ourselves from unaccountable leaders.
She got us to chant: “We have the Power! The Power is in Our Hands! It is People’s Power! Yes, We Can!!”
Are we clear that Yes We Can?
Mamphela Ramphele
Chair of Tutu IPTRUST & GCC
26/4/2024