MAVERICK CITIZEN

A world of respect pours out for ‘public health legend’ David Sanders

By Anso Thom 1 September 2019

Dr David Sanders. Photo: Twitter/PHMglobal

The sudden and unexpected death of public health activist and teacher Professor David Sanders has left the health community in South Africa and beyond saddened, but determined to make sure that they continue his work. Sanders died while on holiday in Wales.

I was a wet-behind-the-ears health journalist, fresh out of completing a short stint on the health beat at a daily newspaper, when Health-e sent me on my first story. It was a long trip involving flights and cars and bumpy roads.

I recall walking into a ward where a baby was hanging from a makeshift sling, a scale measuring his weight. A bearded man with a sling bag over his shoulder and a file in his hand gave me a steely look and growled something which I assumed was “follow me”. That was my first introduction to David Sanders.

It was 1999 and there would be many chance meetings, visits to the then prefab buildings at the University of the Western Cape where I bumped into many of today’s top health researchers and leaders, back then learners under Sanders’ tutelage and steely eye. David was not one for small talk; when he gave you his time, which was often, it was to teach you, to guide you and in my case, make me a better health journalist. He taught me about inequities in the health system, why community healthworkers mattered and that a child in the middle of Cape Town could be as malnourished as a child in the rural Eastern Cape.

For more than 40 years, Sanders was active in policy development, research, advocacy, lobbying, and teaching, to promote primary healthcare, health equity, and health as a human right, both nationally (Zimbabwe, South Africa) and internationally. Sanders was a paediatric specialist with postgraduate qualifications in Public Health. His work combined scientific quality with social activism for communities whose health is compromised by injustice and inequality.

On returning to independent Zimbabwe from exile he assisted the new government to develop and implement new health policy. At the University of Zimbabwe Medical School in the 1980s he revolutionised paediatric teaching by introducing the first rural attachment for medical students.

In 1993 Sanders was appointed a founding director of the new Public Health Programme (later renamed School of Public Health – SOPH) at the University of the Western Cape. He built the SOPH into a large, nationally and internationally acknowledged postgraduate teaching and research unit, and contributed to health and education policy development at both national and provincial levels.

His ability to work across policy and community levels is demonstrated by his work in the Eastern Cape, where his team, through research and training, has assisted staff in several hospitals to restructure their work practices, thus reducing child deaths from malnutrition. Sanders’ influence as head of the SOPH at UWC over a 16-year period produced research that has informed key equity-oriented policies and trained many public health graduates in this approach. Under his visionary leadership the SOPH established itself as a significant and pioneering initiative with national and continental influence.

His first book, The Struggle for Health, published in 1985 and reprinted many times, was extremely influential in popularising debate on the social determinants of health, health system development and the politics of health. His longstanding advocacy activity included his founding, in 2000, and now assisting co-ordination of, the Peoples Health Movement, a health civil society network present in more than 70 countries.

Good friend and colleague Dr Louis Reynolds shared the story behind this picture he took at the International People’s Health Movement People’s Health University in Kisumu, Kenya. “This pic is one of a series I was forced to take. It started with David (in red shirt) and the 2 people next to him, then some saw it being taken and came to join in, then more and more came — everyone wanted to be in the photo with him. I had to step further and further back to fit everyone in. David was loved by everyone he taught.”

Sanders published three books, almost 50 chapters, and more than 100 peer-reviewed articles, and secured many competitive, large research grants. Sanders was a ‘B’ rated researcher with the National Research Foundation. His research leadership was recognised by his appointment in 2010 as Emeritus Professor, selection by the London School of Hygiene and Tropical Medicine for the prestigious Heath Clark Visiting Lectureship in 2005 and appointment there as Honorary Professor, and Adjunct Professor at the University of Bergen.

In 2012 Sanders was awarded by the Council of the University of Cape Town the degree of Doctor of Science (Medicine) honoris causa in recognition of his pioneering work in shaping the thinking around the implementation of the World Health Organisation’s model of primary healthcare with its emphasis on equity and health as a right, and for (his) contribution to child health research, teaching, training and policy advocacy’.

The health world is poorer without David Sanders, the tributes too many to publish, and they continue to pour in on social media, in emails and in WhatsApp messages. He will be missed for the sparkle in his eye, his teaching, his crazy, enthusiastic dance moves, his messy office, his fondness of chewing gum, his long Powerpoints, his dashes to the airport and his love for people.

Below is a selection of those that reached us before this story went to bed. A small way to pay tribute to one of the health world’s truly Maverick Citizens.

Statement from the family

David Sanders, Emeritus Professor University Western Cape. life-long activist for social justice in health,  husband to Sue, and father of Ben, Lisa and Oscar, passed away suddenly on August 30th while in UK. We will miss his passion, strong convictions, energy, humour, uncompromising commitment to making this a better world, and his unshakeable love. Memorial to be announced in due course, when family return from UK. His family request that, in lieu of flowers, please send donations to People’s Health Movement South Africa, First National Bank, Mowbray (200209), 622 437 98 107, SWIFT/ABA code: FIRNZAJJ

Dr Zweli Mkhize, Minister of Health

The Ministry of Health has learned with shock and disbelief about the news of the passing on Prof David Sanders. The Minister of Health Dr Zweli Mkhize said, “David lived most his life for Public Health. We mourn the passing of Prof David Sanders, a champion of economic and social justice and a pioneer of public health, notably the importance of primary healthcare. He emphasised the importance of involving communities, being accountable to communities and the role of community health workers in promoting health and preventing disease.

Prof Sanders was a fierce critic of the impact of neoliberalism on the health of people. He was not only an accomplished researcher, academic and mentor to many but also a leader of social movements, including the Peoples’ Health Movement.

It is not surprising that in his latest publication in the Lancet entitled From primary health care to universal health coverage—one step forward and two steps back, he and his colleagues warn against the “risk of further medicalisation and commercialisation of health care under the UHC model”. This is good advice for South Africa as we design and implement national health insurance.

David was a true internationalist and worked tirelessly, even after his retirement from his School of Public Health at the University of the Western Cape. As we mourn David’s passing we also celebrate his life and his passion for the health of the poor throughout the world.

On behalf of government and the National Department of Health, I wish to express our sincere condolences to his wife Prof Sue Fawcus, his children and his friends and colleagues,” said Dr Zweli Mkhize.

May his soul rest in peace.”

Anele Yawa, Treatment Action Campaign General Secretary

The death of Comrade David Sanders left me and other activists working on the field of health shocked. We worked with Comrade David in organising the first People’s Health Assembly in 2016 at UWC, an assembly which was attended by health professionals, researchers, lawyers, health activists and community healthcare workers.

I also worked with Comrade David in 2017/18 when doing analysis on an NHI Pilot project as well as the NHI Bill in 2018 which afforded us an opportunity to make a meaningful submission. Comrade David was not only an academic but he was a true activist. Comrade David’s contribution will be dearly missed as we are soldiering ahead trying to fix the broken health care system of our country.

Hamba kahle Comrade David Sanders.”

Mark Heywood, activist and Editor of Maverick Citizen

For as long as I can remember, David Sanders was there as a voice for equity and equality in health. Sometimes things have to be repeated and repeated and repeated if nobody will hear, and David never tired of repeating that health rights could not be achieved without tackling the inequalities that determine poor health.

One of the things he really fought consistently for was a cadre of trained and properly supported community healthworkers. If the Department of Health really wants to honour his memory they should sort out and formalise the CHW programme then name a CHW training college in his honour. It’s hard to imagine a world without David’s presence and voice. Hamba kahle Mkhonto.”

Dr Mickey Chopra, World Bank

I first met David when he took time out from establishing the School of Public Health at UWC to visit our community health programme in Hlabisa, KwaZulu-Natal. Our first distinguished visitor didn’t seek us out to lecture us on the insights from his seminal first book, The Struggle for Health, or from his many years of establishing primary healthcare systems in Zimbabwe, but to listen and learn.

His brilliant insights and cutting critiques of the global economic system were not just based upon a bedrock of intellectual study but informed by his constant concern and efforts to seek out and learn from those who were living and working in the frontlines.

But his was not just an intellectual contribution. Whether the thousands who attended the summer and winter schools at UWC or the hundreds who completed the innovative mixed learning masters courses or many more who fought alongside him: Generations of activists and workers now stand on his (stooped) shoulders.”

Professor Helen Schneider, School of Public Health, University of the Western Cape

In a truly extraordinary career spanning five decades, David combined a sharp intellect with charisma, fearlessness and an unflagging commitment to economic, social and health justice. David Sanders will forever remain a public health legend in South Africa and globally.”

Professor Uta Lehmann, School of Public Health, University of the Western Cape

David has been a truly larger-than-life presence in the local and international public health arena. How much he shaped the thinking of colleagues and friends in academia as well as health activists around the world is evident from the tributes and messages that have been pouring in since yesterday.

I worked closely with David for 26 years, and while he never was, never wanted to be an easy colleague, he has without any doubt been my most important mentor, teacher and colleague; and I, like so many others around the world, will miss his persistent and often inconvenient, often exhorting voice hugely, which insisted that ‘health is political’.”

Dr Louis Reynolds, close friend and colleague

David loved his family. He was a good friend. He was kind, intelligent, generous, humorous, inquisitive, passionate, frank and honest. He brooked no-nonsense. He was rigorous, incisive, and creative. He could get to the hub of complicated matters quickly. He disdained bullshit and could see clearly through it no matter how thick and smelly it was. He confronted power but did not seek to have it. He was never self-seeking.

He loved fishing, football, walking, children, 1950s, ‘60s and ‘70s music, good movies and books, parties and being sociable. Otherwise, he never seemed to be not at work, no matter where he was and what was going on around him.

The world is a poorer place without David. We, those who knew him, will be poorer and emptier; some of us for the rest of our lives. We will miss him. But the struggle for Health for All will continue.”

Bridget Lloyd, People’s Health Movement

The first time I got to work directly with David was in the lead-up to the 2002 World Summit on Sustainable Development, where we worked together on an alternative health declaration and worked via telephone, until 1am.

Little did I know we would spend the next 17 years working closely together, in changing roles; he has without a doubt been my greatest mentor, guide, teacher and inspiration in public health, activism and social justice. He has also been a close friend and was always there when needed, always concerned about those around him and making time for personal relationships.

David worked tirelessly to share his unique and eloquent thinking, to challenge economic and social injustice and influence policies and work towards a more equitable world. His wealth of knowledge was huge and he imparted if at every opportunity, whether at high-level meetings, a community setting or in one on one conversation.

He often brought humour into his conversations, often repeating and embellishing a story every time it was told. But when things needed to be challenged he did so directly, with all the facts at hand, and he was respected and heard, even by those who didn’t want to hear. David shared his life and thinking with so many; we all need to now honour him by continuing the struggle for health and social justice. Hamba Kahle David, go well my comrade.”

Professor Robbie van Niekerk, University of Witwatersrand, friend and former colleague

Few toiled as assiduously and with as much passionate commitment as Dave Sanders on carefully understanding with the purpose of radically transforming South Africa’s monstrously unequal health care system.

The excellent School of Public Health he was instrumental in establishing at UWC started off as a mere collection of prefabs in the early 1990s. It must be said, Dave Sanders rejected handsome offers of recruitment from Wits and UCT to join their staff in favour of a commitment to building a world-class centre of public health at UWC, a historically black university. This stands as a legacy to his endeavours.

Of the many memories that stand out of this time when I was fortunate to be mentored by him as a young black policy researcher, based down a parallel corridor at the Education Policy Unit in those prefabs, was one meeting with him in his office to discuss an article on a national health campaign. Walking into his tiny office packed to the gills and onto the floor with books and papers and folders, I was struck by how utterly exhausted Dave looked and yet how calmly focused he was and excited at the prospect of a national health campaign in South Africa on the Cuban model.

In those halcyon days of the early 1990s, all seemed politically possible, even feasible. Dave looked like he had just come off a long plane journey, I thought. He had in fact just landed an hour before off a long-haul flight from Australia and had driven straight to his office from the airport.

No pausing for something as mundane and wasting of precious time as freshening up for Dave. There was always urgent work to be done, work he was always willing to lead from the front. This illustration exemplified him, the rule rather than the exception in his selfless commitment, at least as I experienced it.

Another characteristic was his patience and enthusiasm for mentoring young black scholars like myself, occasionally unsparingly so, when he felt the quality of the work was wanting. There was no shred of condescension in interactions with him though. It’s because he cared very deeply that he held others to account to the same incredibly gruelling standards he held himself to. More respect one cannot ask.

A large part of my own academic career and the possibilities of health policy contributing to fundamental social change was directly inspired by his scholarship and example and for this and the comradeship and warm friendship in those formative and intense years of the 1990s, in particular, I will be eternally grateful.

Reconnecting with Dave many years later to work together on overlapping interests on the NHI, his concern over the political and financially corrupt route our country had drifted into was apparent to me, yet he still held a consistent position since the time I knew him from the 1990s. This position was that the healthcare system could not be transformed without simultaneously transforming the underlying inequalities characterising South Africa’s obscene model of rampant capitalism evidenced in the private healthcare system and its ethically corrupt values among other, values which had spilt into the public healthcare system and which actively reproduced the health inequalities evidenced in our damaging social determinants of health.

It was his hope that a transformative ‘Peoples NHI’ underpinned by the health needs of the impoverished masses, not the elite, could address this. In an era now that many are claiming the status of struggle stalwarts while paradoxically still fully enjoying all the selective fruits of a still fundamentally unequal society they had originally fought against, Dave Sanders remained consistent in his egalitarian values and principles through all these years of our post-apartheid democracy, a humane socialist and stalwart of the impoverished many, not the elite few. We have been robbed of a fine, ethical scholar and activist and a ‘mensch’ who was committed to the fundamental transformation of SA at a time when we most need such commitment. He will be very sorely missed.”

Professor Lucy Gilson, Health Economics Unit, University of Cape Town

In memory of David, I would say remember the struggle for health!”

Tinashe Njanji, People’s Health Movement South Africa

David has been a stalwart of the struggle for health and social justice for all here in South Africa and globally, making personal sacrifices throughout his life to do what he believes in. He has been my mentor and friend, and just so hard to believe that his larger-than-life presence is no more. I know everyone will be feeling the same sense of loss.”

Professor Vera Scott, Programme Director, Tekano Health Equity SA, University of the Western Cape

David Sanders was an inspiration and a mentor to many healthworkers. I met David in 1998 when I was a young, but already burnt-out doctor wrestling with how to do meaningful work in the then-fledgeling district health system in South Africa.

He gave a lecture which literally changed how I saw my work and understood my identity and role as a healthworker. He challenged us to look beyond a biomedical model of health, and recognise the political economy driving the increasing burden of disease. For the first time, I understood that young children die of diarrhoeal disease, not because of germs, but because of the lack of adequate water and sanitation which gives rise to circumstances that allow germs to be transmitted.

I began to see the extent to which ill-health is socially engineered. David was a gifted teacher. He took complex concepts and conveyed, in eloquently simple ways, the liberating essence of the idea and its practical implication for change. This was one of his greatest skills as a revolutionary, and he combined it with a deep love for social good.

David was a world leader who understood the importance of global influences on the health of local communities. He understood the power of multinational companies dictating nutritional policies and tariffs, but also the power of a mother choosing to breast-feed her baby, and the power of a community mobilising to access their right to land.

He understood that the struggle for health lies beyond what the health sector could achieve and so he used his medical knowledge to build bridges to work with other sectors. He understood that for the struggle to be successful, it needed to liberate, and to be led by, those who are most marginalised society. He was as comfortable speaking with community healthworkers in a small clinic as he was addressing powerful decision-makers on the international stage. He was selfless in his passion for change, and mentored and challenged generations of activists.

Conversations were often edgy and awkward when David entered a room, because he understood the power that each one of us has to bring about change, wherever we are positioned in society, at whatever level. He wasn’t looking to reinforce comfortable circles of agreement, but to challenge all of us to engage with the uncomfortable politics of ill-health, and to take action, now, with the urgency needed to promote social justice and health equity for all.”

A tributes page has been created for David Sanders on the People’s Health Movement website, it can be accessed here. MC

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