Holistic approach to disease of inequality

2011-06-18 14:02

The National Planning Commission (NPC) launched its diagnostic overview last week in Parliament.

This overview contained two aspects: elements of a vision statement and a diagnosis of the challenges we as a nation face together.

Two strategic ­objectives – eliminating poverty and reducing social inequality – along with nine challenges, were identified.

These nine challenges are:

»? Poor education;

» ?Unemployment;

» High disease rates;

» Crumbling infrastructure;

» Divided communities;

» Resource-intensive economy;

» Public-service performance;

» Corruption; and

» Spatial patterns that marginalise the poor.

On the face of it, these challenges may appear obvious and indeed are obvious. Metaphorically, each represents a form of “disease” in our nation. They are obstacles to eliminating ­poverty and reducing social inequality.

So, why was it necessary to appoint the NPC to tell South Africans that which is seemingly so obvious?

The answers are found in the following: the NPC’s appointment by the president, an ­understanding and interpretation of the word “diagnosis”, and the evidence-based comparative and integrative approach taken by the NPC.

In inaugurating the NPC last year, President Jacob Zuma stated: “The mandate of the commission is to take a broad, cross-cutting, independent and critical view of SA to help define the South Africa we seek to achieve in 20 years time and to map out a path to achieve those objectives.”

This is precisely what the NPC has done. When a diagnosis is obvious, it often denotes:

» ?Unambiguous evidence of a disease;

» A disease that is so well established and whose signs and symptoms are pervasive and are easy to characterise;

» That the patient has been, or is, in denial or some form of it or the patient may lack insight into the problem or the severity of the problem;

» The patient obviously needs treatment; and

» The disease is a common one and known to most people.

However, regarding all of the above, a long-term plan needs to be designed and agreed on by the ­nation to prevent, cure, counsel, alleviate or control irreversible deterioration.

Evidence-based analysis
The basis of any diagnosis is evidence, which the NPC sought and provided through analysing data, research articles, consulting experts and scholars, commissioning more research, and doing comparative analysis of literature and research done in other countries.

Using these, the NPC discussed and debated the challenges that affect all South Africans. While recognising there are many other challenges, the NPC prioritised nine.

So what’s new? A few things:

» According Planning Minister Trevor Manuel during his parliamentary speech last week, the mandate given to the NPC is without precedent anywhere in the world;

» The NPC’s diagnosis and diagnostic overview provides an evidence-based analysis, eschewing anecdotal stories based on subjective opinions. It comes out of rigorous testing;

» The NPC’s clustering of strategic objectives and challenges provides an integrated analysis that moves us beyond sectoral silos;

» The NPC is an independent structure that makes independent analyses and assessments not wedded to political parties and sectoral vested interests;

» The NPC is planning for a better, more inclusive country that most of us current members may just live long enough to experience;

» The voice of the youth is so essential and ­critical in these engagements and is integral and palpable in the diagnostic overview;

» The NPC’s identified and prioritised strategic objectives and challenges are interlinked and interconnected by an integrative ­approach;

» Because the challenges and obstacles are so intertwined, the sum effect of their impact on our society is profound and, if left unattended, would be irreversible;

» Because they are so closely linked and interconnected, the impact of deterioration of one on the others has a snowball effect, and can be insidious and imperceptible; and

» The NPC is of the firm belief that none of these are insurmountable or insoluble.

Holism and independence
When the education minister speaks on ­educational matters, he or she often says less about health, about the economy or how poor education perpetuates inequality and leads to divided communities and poverty.

Similarly, when the health minister speaks, he or she refers less to the link between health and education, health and the economy, health and inequality, health and spatial ­distribution, health and poverty, health and ­infrastructure, and health and corruption.

Here is the obvious: healthy people are easier to teach and they learn better, healthy people are economically engaged, and healthy people participate and engage better with their ­environments.

The NPC moves away from the silo approach by seeing the challenges of individuals, ­community and society holistically.

Health affects education, the economy, innovation and creativity, nation building, services, infrastructure and corruption.

In a similar way, education or corruption affects health.

While it is easy to illustrate this by drawing straight lines, life does not operate linearly.

It’s more mosaic, amoeboid and constantly interactive in multidimensional and multi-hierarchical ways. People imagine their futures in ­holistic frameworks and not as isolated silos.

It is the independence – the almost conflict-freeness combined with the holistic and integrated approach or the helicopter- or eagle-view approach with laser-like focus, zooming sharply onto the strategic objectives and ­challenges – that is new in the NPC’s diagnostic overview.

What is new is not that the challenges in ­isolation are obvious but that these as a cluster and in their interconnectedness are real, need fixing and can be overcome by our collective effort.

» Makgoba is vice-chancellor and principal of the University of KwaZulu-Natal, a Fellow of the Royal ­College of Physicians (London), a foreign associate member of the Institute of Medicine of the USA Academies of Science, and a member of the NPC

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