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In African societies, as elsewhere in the world, health and illness are experienced both at the level of the individual body and at the level of the social body. Individual suffering often reveals social structures and tensions, for example when a child’s illness strains family relationships or when a treatable disease proves fatal among the poorer members of a society; healing practices may also create new kinds of community, as when a doctor and patient form a lasting bond or when the pursuit of health care spawns a social movement. The experiences associated with health, illness, and healing always reflect and affect social relationships, whether they forge, preclude, strengthen, or strain them. This chapter addresses health in sub-Saharan Africa as a product and a project of social contexts ranging in scale from the intimacy of the family to the broad power dynamics of the global political economy. AFRICAN HEALTH IN GLOBAL CONTEXT Before turning to questions of well-being and illness in specific cultural contexts, it is important to start by considering the comparative framework of biomedical assessments of the health of the world’s populations. In doing so, it becomes clear that the frequency and severity of debilitating illnesses are closely tied to political and economic power dynamics; in short, patterns of poverty are closely associated with patterns of disease. Africa’s economic position correlates with its disease profile, which includes a high prevalence of communicable diseases, high maternal mortality and infant and child mortality rates, and notable effects of pandemics. Overall health indicators reveal that health is generally poor on the continent—the average life expectancy in Africa in 2009 was fifty-four years, which makes it the world region with the lowest life expectancy rate (WHO 2011b: 54). According to the World Health Organization (WHO), the leading causes of mortality in Africa (based on 2004 figures ) are HIV/AIDS, lower respiratory infections, diarrheal diseases, and malaria, in Tracy J. Luedke Health, Illness, and Healing in African Societies 7 Health, Illness, and Healing in African Societies 141 that order. Communicable diseases are the primary threat to Africans’ health, accounting for 70 percent of the causes of death (WHO 2008a: 54). HIV/AIDS and malaria are significant challenges to well-being on the continent and also illustrate more broadly the ways that patterns of marginalization inform health on a global scale. Sub-Saharan Africa is the region most affected by the global HIV/AIDS pandemic. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), in the year 2009 a total of 1.8 million people died of HIV/ AIDS, 72 percent (1.3 million) of whom were Africans (UNAIDS 2010: 25). AIDS is now the leading cause of death in sub-Saharan Africa. This reflects the fact that in Africa HIV/AIDS is a generalized epidemic that affects the population as a whole (unlike in other regions of the world, where HIV transmission is primarily concentrated among particular subpopulations). There is, however, considerable regional variability in the scale of the disease’s effects. Southern Africa (Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe) is the most heavily affected, accounting for 34 percent of all people living with HIV and 34 percent of all AIDS deaths in 2009, as well as 31 percent of new HIV infections. Four southern African countries have HIV prevalence rates of more than 15 percent (UNAIDS 2010: 23, 28). High rates of HIV/AIDS also increase the incidence of other diseases. For example, tuberculosis, which was previously largely under control, increased in frequency nearly fourfold between 1980 and 2000, as it became a primary opportunistic infection associated with AIDS (WHO 2008b: 52). In Southern Africa, greater than 50 percent of the tuberculosis patients who were tested were found to also be HIV positive (USAID 2011: 3). Although Western epidemiological and public health approaches to HIV/AIDS have often stressed individual behaviors, much recent social scientific work has emphasized the social, political, and economic structures that influence susceptibility , transmission, and treatment. For example, Meredith Turshen has pointed out that structural adjustment policies exacerbated economic insecurity, increased labor migration, and disrupted family life, all of which furthered the spread of HIV/AIDS. The internal power dynamics within African societies also condition patterns of transmission. According to Anne Akeroyd, gender informs vulnerability to the disease and access to care in contexts where women often have less control over their sexual lives, are dependent on men for access to key resources...

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