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Abstract
The Gluckman Commission spent two years during World War II aiming ultimately unsuccessfully at the creation of an inclusive national health system with a number of progressive features, notably its emphasis on health centres and preventive medicine. It has tended to be flagged as evidence of the progressive side of the SAP government which was undone by the untimely 1948 defeat. It is argued there that it can be more profitably recontextualised if one considers the context of administrative reform, a growing demand of those involved in the health system for 20 years previous, the context of planning for an industrialised, developmental state in which the aspect of industrial society probably needs more attention and changes in medical practice internationally. In so doing, the Gluckman Commission is restored to its own time and the transition between the pre-government and the Nationalist Party dominated system after 1948 begins to look rather more complex.
Acknowledgements
I would like to thank Catherine Burns and Francie Lund for their encouragement in my sally into this area of research and Simonne Horwitz for sending me parts of her Oxford doctoral thesis on the history of Baragwanath Hospital to read.
Notes
1National Health Services Commission, Report on the Provision of Organized National Health Service for All Sectors of the People of the Union of South Africa 1942–44. UG 30/1944, 15.
2University of the Witwatersrand, A1207 B1-6, Gluckman Papers, speech 6 February 1945, 465.
3For Gale's career and ideas, see D. Duncan, The Mills of God: The State and African Labour 1918–48, (Johannesburg: Witwatersrand University Press, 1995), 86–87.
4S. Kark and J. Cassel, ‘The Pholela Health Centre: A Progress Report’, South African Medical Journal, 26, 6 (1952), 101–104.
5D. Yach and S. Tollman, ‘Public Health Initiatives in the 1940s and 1950s: Lessons for a Post-Apartheid Era’, American Journal of Public Health, 183 (1993), 1043–1050.
6National Health Services Commission, Report on the Provision of an Organized National Health Service for All Sectors of the People of the Union of South Africa 1942-44. UG 30/1944, 15.
7Although a notable absence was the African National Congress, Drs Moroka and Xuma included.
8National Health Services Commission, 1944, 14; Gluckman Papers.
9National Health Services Commission, 1944, 17.
10 National Health Services Commission, 1944, 102.
11D. Harrison, ‘The National Health Services Commission, 1942–44: Its Origins and Outcome’, South African Medical Journal, 83 (September 1993), 683.
12A. Digby, Diversity and Division: Health Care in South Africa from the 1800s (Bern: Peter Lang, 2006), 198.
13Memorandum by George Gale in Training Auxiliary Native Personnel for Preventive Medical Services 28/5/43, Gluckman Papers.
14Speech: 6 February 1945, 455, Gluckman Papers.
15G. Gale, ‘Health Centre Practice: Promotive Health Services and the Development of the Health Centres Scheme’, South African Medical Journal, 20, 12 (1946), 326–330.
16S. Marks and N. Andersson, ‘Industrialization, Rural Health and the 1944 National Health Services Commission in South Africa’, in S. Feierman and J. Janzen, eds, The Social Basis of Health and Healing in Africa (Berkeley: University of California Press, 1992), 156.
17 Natal Witness, 9 October 1946, from the Gluckman Papers, B4.
18A. Jeeves, ‘Delivering Primary Health Care in Impoverished Urban and Rural Communities: The Institute of Family and Community Health’, in S. Dubow and A. Jeeves, ed., South Africa's 1940: Worlds of Possibilities (Cape Town: Double Storey, 2005), 87–107.
19 Star, 13 November 1953, from the Gluckman Papers, B4.
20S. Dubow, ‘Introduction’, in Dubow and Jeeves, South Africa's 1940, 1–19.
21S. Kark and E. Kark, Promoting Community Health: From Pholela to Jerusalem (Johannesburg: Witwatersrand University Press, 1999).
22D. Posel, ‘The Case for a Welfare State: Poverty and Politics of the Urban African Family in the 1930s and 1940s’, in Dubow and Jeeves, South Africa's 1940s, J. Seekings, ‘Visions, Hopes and Views about the future’, in Dubow and Jeeves, South Africa's 1940s.
23D. Yach and S. Tollman, ‘Public Health Initiatives in the 1940s and 1950s: Lessons for a Post-Apartheid Era’, American Journal of Public Health, 183 (1993), 1043–1050; M. Susser, ‘A Personal History: Social Medicine in a South African Setting’, Journal of Epidemiological and Community Health, 60 (2006), 57.
24A. Jeeves, ‘Health, Surveillance and Community: South Africa's Experiment with Medical Reform in the 1940s and 1950s’, South African Historical Journal, 43 (2000), 244–266; ‘Delivering Primary Health Care in Impoverished Urban and Rural Communities: the Institute of Family and Community Health’, in Dubow and Jeeves, South Africa's 1940s, 87–107; S. Marks and N. Andersson, ‘Industrialization, Rural Health and the 1944 National Health Services Commission in South Africa’, in Feierman and Janzen, The Social Basis of Health and Healing in Africa, 131–162; and Digby, Diversity and Division.
25A. Jeeves, ‘Health, Surveillance and Community: South Africa's Experiment with Medical Reform in the 1940s and 1950s’, South African Historical Journal, 43 (2000), 244–266; ‘Delivering Primary Health Care in Impoverished Urban and Rural Communities: the Institute of Family and Community Health’, in Dubow and Jeeves, South Africa's 1940s, 87–107; S. Marks and N. Andersson, ‘Industrialization, Rural Health and the 1944 National Health Services Commission in South Africa’, in Feierman and Janzen, The Social Basis of Health and Healing in Africa, 131–162; and Digby, Diversity and Division.
26H. Gluckman, Abiding Values (Johannesburg: Caxton, 1970), 423, 427.
27‘A Ghost from the Past: the South African Developmental State of the 1940s’, unpublished paper, European Conference of African Studies, Uppsala, Sweden, 2011.
28It is really in the course of work on the Union of South Africa as a developmental state in progress that the point of an article on the Gluckman Commission occurred to me as I make no claim to be a historian of public health or medicine.
29Leon Gluckman, who eventually left for England, was director of the famous musical King Kong which made the name of Miriam Makeba and highlighted the talent of the writer Todd Matshikiza and the musicians Hugh Masekela and Abdullah Ibrahim amongst others. It brought him for instance into close professional contact with two well-known white Communists, the novelist Harry Bloom and the future Rivonia conspirator, Arthur Goldreich. He died in England in early middle age before his father. I have been told that he shied away from overt political engagement himself, however, as compared to most of the King Kong team.
30H. Gluckman, Life's Rewards (Johannesburg: Caxton, 1978), 229; Response to the Report of the Tomlinson Commission, Gluckman Papers.
31Speech to the Health Officials’ Association, Johannesburg City Hall, 27 November 1944, Gluckman Papers.
32Rough notes for speech, 7 October 1946, Gluckman Papers.
33It is conceivable to interpret this last comment as designed to appease the National Party leadership but see, for instance, his descriptions earlier of Smuts’ legislation vis-à-vis Indians as perfectly fair and defensible (National War Memorial Health Fund to Prime Minister D F Malan et al., May 1951).
34Speech, 27 November 1944, Gluckman Papers, 7, B4.
35‘Came the machine age, and a revolution began in the very basis of production… But the machine, when it came, found society unprepared for the economic and social consequences of its coming. Men and nations are still living, ideologically, in the pre-machine age. And that is the tragedy of modern civilisation’ (Rough notes for speech, Johannesburg Club, 7 October 1946). Look at the titles of his essentially self-published memoirs selected from old speeches and letters late in life: 'abiding values’ and ‘life's rewards’.
36D. Harrison, ‘The National Health Services Commission, 1942–44’.
37Gluckman, Abiding Values, 403; speech of 17 February 1942. See also Gale in the essay The Gluckman Report, An Abiding View in the Gluckman Papers.
38National Health Services Commission, 1944.
39S. Horwitz, ‘“A Phoenix Rising”: A Social History of Baragwanath Hospital, Soweto, South Africa, 1942-1990’ (DPhil thesis, St Antony's College, Oxford, 2006), chs. 2, 1.
40A. Digby, Diversity and Division, 177.
41As cited in D. Wylie, Starving on a Full Stomach: Hunger and the Triumph of Cultural Racism (Charlottesville and London: University of Virginia Press, 2001), 37.
42D. Harrison, ‘The National Health Services Commission, 1942–44’, 682
43As well as the influence of the Chamber of Mines, also dissatisfied and some key figures, like Gale, in the bureaucracy. Harry Gear, his deputy, brought experience of health reform in China and India, into his own contribution to discussion: see Ibid. The Native Affairs Department was also concerned with the poor state of health in rural areas (see Marks and Andersson, ‘Industrialization, Rural Health and the 1944 National Health Services Commission’). The Chamber of Mines was already inveigled to contribute something to rural health experimentation: see Ibid, 248.
44Communist Party of South Africa, ‘The Future: A Planned Health Policy for South Africa’, South African Medical Journal, 17, 19 (1943), 295–298.
46D. Posel, ‘The Case for a Welfare State: Poverty and the Politics of an Urban African Family in the 1930s and 1940s’, in Dubow and Jeeves, South Africa's 1940s, 66.
45Marks and Andersson, ‘Industrialization, Rural Health and the 1944 National Health Services Commission’, 150.
47R. Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (London: Harper Collins, 1997), 644.
48In 1943, that was all Gale thought he could get approval for in Parliament: see Memorandum by George Gale in Training Auxiliary Native Personnel for Preventive Medical Services 28 May 1943, Gluckman Papers.
49A. Jeeves, ‘Health, Surveillance and Community’, 254.
50G. Gale, ‘Government Health Centres in the Union of South Africa’, South African Medical Journal, 23, 3 (1949), 636.
51Social and Economic Planning Council Report 5, Regional and Town Planning, UG 34/1944.
52Native Laws Commission (chair H.A. Fagan) UG 28/1948, 50.
53 Native Laws Commission (chair H.A. Fagan) UG 28/1948, 50.
54J. Seekings, ‘Visions, Hopes and Views about the Future: The Radical Moment of South African Welfare Reform’, in Dubow and Jeeves, South Africa's 1940s, 44–63.
55Social and Economic Planning Council Report 2, Social Security, Social Services and the ∣National Income (chair H.J. van Eck, UG 14/1944). See Seekings, ‘Visions, Hopes and Views about the Future’, for a good discussion of wartime overall welfare reform debates and their outcome.
56UG 14/1944, 19.
57J. Pickstone, ‘Production, Community and Consumption: The Political Economy of Twentieth-Century Medicine’, in R. Cooter and J. Pickstone, eds, Medicine in the Twentieth Century (Amsterdam: Harwood, 2000), 1–19.
58J. Seekings, ‘The Carnegie Commission and the Backlash against Welfare State Building in South Africa 1931–37’, Journal of Southern African Studies, 34, 3 (2008), 515–537.
59Social and Economic Planning Council Report 1. Re-employment, Reconstruction and the Council's Status, UG 9/1943.
60Social and Economic Planning Council Report 5, Regional Town and Planning, UG 34/1944.
61A. Digby, Diversity and Division, 416.
62For a detailed account of another centre in Grassy Park, a Cape Town Coloured neighbourhood, see H. Phillips, ‘The Grassy Park Health Centre: A Peri-urban Pholela?’, in Dubow and Jeeves, South Africa's 1940s, 108–128, .
63Gale, ‘Health Centre Practice’, 326–330.
64Gale, ‘Government Health Centres in the Union of South Africa’, 630–636. See Rand Daily Mail, 11 January 1950. However Gale believed that the Nats had it in for the Health Centres. See Health Centres Service, Ministry of Health, confidential memorandum and correspondence with Henry Gluckman in the Gluckman Papers.
65The Standard Encyclopaedia of Southern Africa (Cape Town: HAUM, 1970) described Bremer in fact as an ‘apostle of preventive medicine’ who tried himself to create a national health service. Bremer's efforts to make subsidised brown bread more nutritious led it to be dubbed Bremer bread.
66A. Digby and H. Phillips, At the Heart of Healing: Groote Schuur Hospital 1938–2008 (Auckland Park: Jacana, 2008), 25.
67Harrison, ‘The National Health Services Commission, 1942–44’, 681; Seekings, ‘Visions, Hopes and Views about the Future’, 44–63.
68Kark and Kark, Promoting Community Health.
70Posel, ‘The Case for a Welfare State’, 81.
69The small, dying and increasingly leftish Labour Party however did support a national health plan strongly in the late 1940s (see Marks and Andersson, ‘Industrialization, Rural Health and the 1944 National Health Services Commission’,150). The Karks were Labour Party supporters (Kark and Kark, Promoting Community Health, 6).
71‘The Ministry's plans for primary health care administered through local health centres were relegated to experimental programmes undertaken by a few local authorities, but non-cooperation of local general practitioners made them inoperable’ (D. Porter, Health, Civilisation and the State: A History of Public Health from Ancient to Modern Times [London: Routledge, 1999], 325). Enthusiasm about the centres had been associated with the British Socialist Medical Association. See Digby and Phillips, At the Heart of Healing, 29. In effect British doctors, hostile to the centres, became the hospital-orientated policemen of the system. See also Jeeves, ‘Health, Surveillance and Community’, 253.
72Digby and Phillips, At the Heart of Healing, 30.
73Digby, Diversity and Division.
74Horwitz, ‘“A Phoenix Rising”’.
75The one other hospital whose history has received real scholarly attention is Groote Schuur in Cape Town. (See Digby and Phillips, At the Heart of Healing). Here again, although it did not engage in much medical research in its earlier history, was a major facility linked to a prestigious medical school. Unlike Baragwanath, Groote Schuur functioned for all races on a segregated basis and is located on the slopes of Table Mountain in what was formerly a white residential area. Its architecture followed plans which took into account the model of the latest racially segregated hospitals in the American South. Cape Town received relatively modest numbers of African migrants until a later period although many Africans made their way to Groote Schuur from the eastern Cape for treatment. In the hospital which preceded the establishment of Groote Schuur in 1938, New Somerset, only Coloured patients were entertained thereafter with Africans excluded, in a sense fitting NP plans for the Western Cape. The pattern in Durban was different again.
76The medical assistant programme was phased out. In the end, only 60 medical assistants were trained including six white women [white men were deemed inappropriate for this job] and some 46 Africans: Gale, ‘Health Centre Practice’.
77Pickstone, ‘Production, Community and Consumption’, in Cooter and Pickstone, Medicine in the Twentieth Century, 1–20.
78G. Rosen, A History of Public Health, expanded edition (Baltimore and London: Johns Hopkins University Press, 1993), 460.
79J.W. Leavitt, ‘“Be Safe, Be Sure”: New York City's Experience with Epidemic Smallpox’, in J.W. Leavitt and R. Numbers, Sickness and Health in America: Readings in the History of Medicine and Public Health (Madison: University of Wisconsin Press, 1997), 3rd ed., 415. For a positive example see G. Brieger, ‘Sanitary Reform in New York City: Stephen Smith and the Passage of the Metropolitan Health Bill’ in the same collection, 437–52.
80Porter, Health, Civilisation and the State.
81P. Weindling, ‘Health and Medicine in Interwar Europe’, in Cooter and Pickstone, Medicine in the Twentieth Century, 31–51.
82Rosen, A History of Public Health, 369.
83National Health Services Commission 1944, 28.
84Kark and Cassel, ‘The Pholela Health Centre’, 101–104.
85Digby, Diversity and Division, 416.
86D. Wylie, Starving on a Full Stomach: Hunger and the Triumph of Cultural Racism (Charlottesville and London: University of Virginia Press, 2001). She also points to the analogy with the parallel colonial obsession with soil erosion and its human causes. For more on soil erosion, see W. Beinart, ‘Soil Erosion, Conservationism and Ideas about Development: A Southern African Exploration 1900–1960’, Journal of Southern African Studies, 11 (1983), 52–83, and K. Showers, Imperial Gullies (Athens, OH: Ohio University Press, 2005).
87Gluckman, Speech to the National War Memorial Health Foundation, 25 April 1946.
88National Health Services Commission, 164.
90Gluckman Papers.
89Remark on Harry Lawrence's Health Amendment Bill, n.d., Gluckman Papers. See also UG 9/1943.
91Gluckman, Abiding Values, 313.
92Speech, 1946, Gluckman Papers.
93Confidential Memorandum: Health Centres Service of the Ministry of Health, 8, Gluckman Papers, presumably written by George Gale.
94National Health Services Commission Report, 108.
95For an extreme Foucauldian treatment of white authorities’ ‘constructions of the African body’, see A. Butchart, The Anatomy of Power: European Constructions of the African Body (London & New York: Zed, 1998). I would describe this as a one-dimensional exposition of this confrontation.
96‘As antibiotics grew in the post-war consciousness, infections diseases looked set to disappear’ (Pickstone, ‘Production, Community and Consumption’, 13).
97Gale, ‘Health Centre Practice’; Kark and Cassel, ‘The Pholela Health Centre’, 101–104.
98Wylie, Starving on a Full Stomach, 181.
99R. Packard, ‘Post-Colonial Medicine’, in Cooter and Pickstone, Medicine in the Twentieth Century, 97–112.
100Digby, Diversity and Division, 41.