“Is cervical cancer a big problem in South Africa?” This is a question I get, in some form or another, from many people back home when I tell them about the project I’m working on in Johannesburg.
The short answer? Yes.
The long answer? Yes, cervical cancer is a major public health issue in South Africa and many other African countries. UNAIDS estimates that women living in Eastern and Southern Africa are 10 times more likely to die of cervical cancer than women living in Europe. Within South Africa, Black women are almost twice as likely to be diagnosed with cervical cancer compared to White women.
Over 90% of cervical cancers are preventable, and the UNC-Wits-Right to Care team is working to increase access to prevention services in South Africa. Routine vaccination against HPV, the cause of most cervical cancers, did not begin in South Africa until 2014. And, although cervical cancer screening is free, only a third of South African women receive screening at the recommended intervals.
In our classes, we learn about criteria used by governments, organizations, and funders to determine public health priorities: the number of people affected, the magnitude of a disparity, the evidence in favor of intervention, the cost (in dollars, years of life lost…) of action or inaction. By any measure, cervical cancer is indeed a public health problem, and these statistics are important–they tell the story of a disease that is almost entirely preventable, yet continues to kill hundreds of thousands of women every year.
At the same time, I have been thinking about how we frame public health problems, and what larger dynamics these measures can obscure. Cervical cancer is a disease of inequities, and confronting the social conditions that give rise to unequal health outcomes (in the words of Link and Phelan, their fundamental cause) must also be part of addressing this problem.
Public health is not immune from reproducing the patterns of inequity that we seek to solve. As a student, I have concentrated on gender and other social inequities as they impact women’s reproductive health. These dynamics are also reflected in gender inequality in the global health workforce and geopolitical inequalities that influence public health priorities. If the goal of global public health is “real partnership, a pooling of experience and knowledge, and a two-way flow between developed and developing countries,” we have a long way to go until this vision becomes a reality.
Recently, leaders at the National Institutes of Health pledged to take steps to end the “manel”– all-male speakers panels–and increase diversity in global health leadership. In his statement, Dr. Collins, Director of the NIH (and UNC School of Medicine grad), writes, “it is not enough to give lip service to equality; leaders must demonstrate their commitment through their actions.”
It is an incredible privilege to be in South Africa doing work that I find important, challenging, and fulfilling. I feel very lucky to be completing my practicum with UNC-Wits-Right to Care and learning from a team that truly demonstrates this commitment to promoting equality–from increasing access to Pap smears to building partnerships and creating opportunities in global health.