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<p class="MsoNormal" style="text-align:center;margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria" align="center"><b><span style="font-family:Times">David Sanders, pioneer of Health for All – as
remembered by David Werner<span></span></span></b></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">When
David Sanders died suddenly of a heart attack on August 30, 2019, it was a
great loss. But his many friends and colleagues around the world can take heart
that his passing did not leave a vacuum. To the contrary, David left a legion
of fellow travelers around the world who, thanks to him, are today more
strongly committed, better prepared, and have a greater sense of solidarity to
continue the uphill struggle for health. After his passing, the huge outpouring
of appreciation for his exemplary contribution worldwide makes it clear that
his contagious spirit, boundless energy, and unflinching honesty in the face of
power lives on in the vast spectrum of people – from community health workers
to international movement organizers – who had the good fortune to know him. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">Indeed,
so many fine tributes have already been circulated in praise of David Sanders
that it seems there is little more to add. Therefore, I will focus on my own
personal interaction with him,<span> </span>which
began over 40 years ago.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">I
first met David in the late 1970s in London, where he was working for Oxfam. At
that time, David was in exile from his homeland in Rhodesia, where he’d been a strong
proponent for that country’s independence from Great Britain’s colonial rule.
As a pediatrician in that land, David had an early exposure to the devastating
impact that entrenched inequalities of power had on the wellness of the
subservient population. Thus, in the pursuit of health and social justice, he’d
become an avid activist in the grassroots movement for Rhodesia’s independence.
Faced with threats to his life, he went into exile to the UK, where he
continued his advocacy for Rhodesia’s independence.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">On
one of my trips to London during that time, to present a paper on “Health Care
and Human Dignity”, David Sanders invited me to his circle at Oxfam. He’d used
my books <i>Where There Is No Doctor </i>and <i>Helping Heath Workers Learn</i></span><i><span style="font-size:10pt;font-family:Times"> </span></i><span style="font-family:Times">in his community health
promotion in Rhodesia, and in our Hesperian newsletters he’d read about Project
Piaxtla, the villager-run health program in western Mexico I’d helped start. He
told me of his goal, once Rhodesia was liberated, of helping the newly
independent country set up a national health program based on Comprehensive
Primary Health Care, in which local community health workers – chosen for their
commitment to the common good – would be agents of change in the promotion of a
more equitable, just, and thereby healthier society. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">No
sooner did Rhodesia – now Zimbabwe – in May 1990, win its independence from the
UK, than David Sanders at once returned to his homeland, where he was recruited
to play a key role in forming the new Ministry of Health. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">In
that early realm of independence, David Sanders invited me to visit Zimbabwe,
both to witness the new, people-centered mobilization that was underway, and to
share some of my experiences of community-based health promotion in Mexico and
elsewhere.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">Part
of David’s motive in bringing me to Zimbabwe was for me to give presentations
and exchange observations with key honchos in the new health ministry, some of
whom were still wedded to the conventional model of Western (i.e., colonial)
medicine, with its hierarchical pecking order and its focus on sickness rather
than health. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">For
a while, David and his cohorts made good progress with the new, more holistic,
community-centered initiative, along the lines heralded in Alma Ata as “Primary
Health Care”. The nation’s top decision makers – still imbued with the
revolutionary spirit of newly won independence-- made space for this more
democratic, people-empowering approach to health care. But sadly, as so often
seems to happen in human history, those who had been heroes in the fight for
liberation, once they rose to power, gradually became oppressors themselves. As
wealth again began to concentrate at the top and the state became more
authoritarian, priorities shifted. The egalitarian, more empowering
community-based approach to health promotion advanced by David and his
colleagues fell out of favor with the controlling class – especially with the
conventional medical establishment. His detractors began to hit below the belt,
lambasting David as a “white colonial” who was trying to impose second-class
services on what he viewed deep-down as second-class people. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">This
was painful for David who was deeply committed to health and fair treatment for
all. In time the barriers to advancing universal primary health care in
Zimbabwe became so great that David decided to move to South Africa. At that
time South Africa was still under apartheid rule, with a huge gap in wealth and
health between the white elite and the black majority. But it was not without
hope for change. There was a strong and growing resistance led by the African
National Congress (ANC) and others. Even the medical establishment itself was
divided. After the mainstream Medical Association of South African (MASA)
defended a doctor who had overseen the torture of Steven Biku, an outspoken
leader of the Black Consciousness Movement, a portion of MASA’s members split
off in protest. They then formed NAMDA (National Medical and Dental
Association), which took a united stand for racial equality. NAMDA also
introduced a network of community-based health care in shantytowns, providing
training and backup for local, relatively unschooled, but socially committed
health promoters. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">As
part of the coordinated effort to promote international awareness and
solidarity in support the South African struggle against apartheid, David
Sanders and his colleague reached out to the global health community. Among
other actions, David arranged for NAMDA to invite me to visit the mushrooming
shantytowns outside Johannesburg and to engage in an educational exchange with
its field organizers. While there, we shared experiences and methods for
implementing CBHC (community-based health care) in marginalized communities,
and encouraging people to analyze the social and physical determinants of
health and to work together to improve their situation.<span> </span><span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">This
exchange – instigated in large part by David – took place (I believe) in 1992.
The growing anti-apartheid tide was then being countered by a ruthless
escalation of repression, curfews, and arrests of activists. Many in the
struggle grew discouraged. But David and other leaders of NAMDA were confident
that the racist regime was planting seeds of its own demise. Its draconian
clampdown on protest only triggered greater resistance. … And sure enough, in
an attempt by the ruling class to quell the rising storm, Prime Minister F.W.
de Klerk agreed to hold South Africa’s first all-race, democratic election. In
May 1994, Nelson Mandela – who had been freed after 27 years in prison – became
South Africa’s first president of the nation’s post-apartheid era. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">Much
of the more recent history of David’s indefatigable role in promoting
health-for-all and social justice – in South Africa and worldwide –<span> </span>is well known to his contemporary friends and
colleagues. Many have given tribute to his on-the-ground research and
service-oriented training of students, which he spearheaded for decades at the
University of the Western Cape. I will therefore focus here only a few more of
my own undertakings with David, with which some of his younger colleagues and
admirers may be less than familiar.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">Everyone
is aware of the seminal role that David has played in the formation and ongoing
pursuits of the People’s Health Movement (PHM). But fewer may be familiar with
his previous key role in the International People’s Health Council (IPHC),
which in many ways was the precursor of the PHM.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">The
International People’s Health Council was launched in<span> </span>Managua, Nicaragua, in December 1991, at the closure of a small
international symposium on “Health Care in Societies in Transition”. The
symposium and the IPHC that grew out of it were conceived and organized by
several of the same pioneers in Primary Health Care who, nine years later, in
2000, would be instrumental in midwifing the first global People’s Health
Assembly (PHA) and the People’s Health Movement that grew out of it. These key
players in launching both the IPHC and the PHM included Zafrullah Chowdhury
(Bangladesh), Mira Shiva (India), David Sanders (South Africa), Maria Zuniga
(Nicaragua), and myself. The idea for the symposium had initially been
conceived several years before, during the Sandinistas’ heyday in Nicaragua,
when revolutionaries, backed by a diverse workforce of <i>brigadistas de salud </i>(community
health brigadiers), had overthrown the tyrannical Somoza government and set up
a people’s republic. In a few short years, the fledgling government – backed by
strong community involvement – had achieved spectacular improvements in health.
Inspired by this success story, our motley group of health activists decided to
hold the transitions seminar in Managua. We saw Nicaragua as a shining example
of a society in transition to achieving better health. Ironically, however, we
delayed too long in getting our symposium off the ground. In 1990, after years
of ceaseless attacks by the US-financed “Contras” and of infiltration by the
CIA, the weary population voted the Sandinistas out of power and voted in a
coalition government that was puppet to US imperial interests. Rapidly the
people-supportive agenda of the Sandinistas was rolled back, the gap between
the rich and poor grew wider, and the population’s health once again began to
deteriorate. Sadly, Nicaragua was not alone in this pattern. Similar reversals
in democratic process and in the health and welfare of the people were then
taking place in many countries, spurred by economic globalization with its
structural adjustment mandates and so-called “free trade” agreements. So our
transitions seminar, initially planned to learn from societies transitioning to
<i>better</i> health, ended up discussing transitions that were endangering and
worsening the health of societies. Our seminar’s challenge was to explore
possibilities for reversing this retrograde process. (All this is written about
in David Sanders and my book, <i>Questioning the Solution – </i>see below.) <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">We
felt our seminar’s analysis of the current social and political determinants of
health, and possible action for coping with them, were important enough they
should be recorded and shared. So Maria and I and others put together a booklet
of the proceedings, which we titled <i>Health Care in Societies in Transition </i>(published
by HealthWrights in English and by CISAS in Spanish). We also thought the
dialogue we had begun should be continued, with more health activists
participating. Hence we launched the IPHC, which grew in size and had
subsequent international meetings. The most notable of these events took place
in Palestine and in South Africa – the latter adroitly organized by David. <span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">After
a few years, PHM – with a much larger cast of players – took over and expanded
the role of the role of the IPHC, whose mission it continued. David was a wise
and dynamic spearhead of both.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">David
Sanders wrote over 50 groundbreaking papers and several books. His first book, <i>The
Struggle for Health: Medicine and the politics of underdevelopment, </i>published
in 1985, was a bombshell. It likely did more than any other publication to
awaken the international health community to the fact that a population’s
health is determined more by the distribution of power and resources than by
health services per se.</span><b><span style="font-size:11pt;font-family:Times"> </span></b><span style="font-family:Times"><span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">Over the years David and I realized we shared similar
perspectives on health and social justice. In the mid-1990s we started writing
a book together, which we eventually titled <i>Questioning the Solution: The
politics of Primary Health Care and child survival. </i>I visited Cape Town and
he visited California to complete it. This book is lengthier than <i>The
Struggle for Health</i> and contains a lot of examples from Latin America (most
extensively Mexico, Nicaragua, and Cuba). As a case-study, the book explores
in-depth the worldwide promotion of ORS (oral rehydration solution) for the treatment
of diarrhea. (For this reason, with tongue in cheek, David and I titled the
volume <i>Questioning the Solution. </i>The idea for the title was David’s.)<i>
</i>Undoubtedly, the vast promotion of mass-produced packets of ORS has
substantially lowered child mortality from diarrhea. Yet, as <i>Questioning the
Solution</i> points out, other solutions – namely homemade cereal-based drinks
– may have saved even more children’s lives – and done so less expensively,
more quickly, and more effectively, with less dependence on a
distantly-produced commercial product that may not always be available. Yet the
economic leverage by Big Pharma on WHO and UNICEF to promote their
commercially-produced ORS packets (which rapidly became a multi-million dollar
business) stacked the deck in their favor. So it was that the less ideal but
more profit-generating option has been universally promoted, sidelining less
costly, more quickly available, and potentially more effective home solutions.
The consequences of this grand-slam marketeering may have cost millions of
children’s lives – and still does.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">David felt very strongly about this exploitation of
children’s health and the myriad other ways in which Big Pharma, Big Sugar, Big
Oil, Big Ag, Big Water, Big Media, and other corporate superpowers put profit
before people – and before sustainable life on the planet.<span></span></span></p>
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<p class="MsoNormal" style="margin:0cm 0cm 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-family:Times">Sadly, our companion David Sanders is no longer with us
in person. But his struggle for “health for all” lives on in the minds and
hands of the countless friends and students and activists whose lives he so
deeply touched. We all owe it to David to indefatigably keep his action, his
vision, and his passion – and his wry sense of humor – alive.</span><span style="font-size:10pt;font-family:Arial"> </span><span style="font-family:Times"><span></span></span></p>
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