Public health activist mourned around the world

TALI FEINBERG

Sanders, aged 74, died on 30 August from what is believed to have been a heart attack while on holiday in Wales. “He hailed from Zimbabwe, and was a world expert in social medicine and healthcare delivery to third-world countries,” said Dave Bloom, whose family also lived in Zimbabwe. “His parents were Louis and Anne Sanders. Louis was a general practitioner in Salisbury [now Harare].”

Sanders was a doctor of the people, and a leftist early on in his views on health and politics. Anthony Costello of The Social Edge podcast says the professor spent time in the United Kingdom as a political émigré from what was then Rhodesia. He trained in paediatrics, and became a founder member of the Medical Association Against Private Practice.

At the London School of Hygiene & Tropical Medicine, he became an advocate for the 1978 Alma-Ata Declaration on primary healthcare which identified primary healthcare as key to attaining the goal of health for all around the globe. He was also influenced by the writings of Marxist doctor Vicente Navarro.

Returning to Zimbabwe for 12 years from 1980 to 1992, he was an activist for the Zimbabwe African People’s Union (ZAPU) and the Zimbabwe African National Union – Patriotic Front (ZANU PF), took a post as health adviser for Oxfam, and then as lecturer at Harare Medical School. Over time, he became disillusioned with the regime of Robert Mugabe.

Since 1992, through his pioneering work at the University of the Western Cape (UWC) in Cape Town, and in the People’s Health Movement (PHM), he was a leading critic of structural adjustment, neoliberal economics, and the social and economic inequality which underpins poor health. His research and books highlighted social and political injustice as the root cause of maternal and child ill health.

“One lesser known fact about David is that he was a passionate and expert fly fisherman. For many years, he went fly-fishing in the UK with jazz singer, author and raconteur George Melly,” said Costello.

John Abeles, Sanders’ close friend, said that Sanders was a talented raconteur, joker, and mimic. On the Zimbabwe Jewish community Facebook group, people described him as “a legend in his own time”, “a mentor at medical school”, “a fierce and relentless advocate for public healthcare in Zimbabwe, South Africa, and throughout the developing world”, and “an unforgettable figure in public-health circles in Zimbabwe in the early post-independence period”.

The South African government paid tribute to him in a message from Health Minister Dr Zweli Mkhize, who said, “[He was] a champion of economic and social justice, and a pioneer of public health, notably the importance of primary healthcare. He emphasised the importance of involving communities, being accountable to communities, and the role of community health workers in promoting health and preventing disease. As we mourn David’s passing, we also celebrate his life and passion for the health of the poor throughout the world.”

On a tribute website set up by the PHM, Dr Mary Bassett of the Harvard TH Chan School of Public Health wrote, “I’m from the United States, and grew up in New York City, but for many years, Zimbabwe was home. I met David in 1985 when I had just finished my medical training, and had decided that I should work in Africa. I was invited for an interview in Harare. That weekend, David showed up at the gate. He said, ‘I thought you might like to see some places that you aren’t likely to be shown.’ He took me to Mbare, the single men’s hostels, the market, and so on.”

“‘Retirement’ seemed not to have slowed David down. I often felt that we took him too often from his family. We don’t get people like David Sanders very often.”

Professor Uta Lehmann, the school’s director, who worked with Sanders for 26 years, admitted that working with him wasn’t always easy. “It could be exasperating that he arrived late for every single meeting, insisted on not ever getting rid of any piece of paper, so that he would disappear behind the piles on his desk, or arrive with 75 slides for what was supposed to be a 15-minute presentation,” Lehmann says. “But, like everyone else, I listened spellbound when he unpacked the upstream determinants of health.”

Dr Mark Heywood agreed that Sanders could be obsessive about the inequalities that caused people to get sick. “He was like a stuck record at times, but he never had any shame in repeating himself,” he said. “He was totally committed to poor people and to health, and he lived his values.”

Sanders’ public health work was part of a much larger commitment to the politics of social justice, said Rekang Jankie of the Alternative Information and Development Centre (AIDC). “David saw health not as a medical condition, but as a measure and reflection of the entire society in which people live.”

According to the School of Public Health, where he was emeritus professor, Sanders worked extensively with governments, the World Health Organization, and the United Nations Children’s Fund (UNICEF). He was the Heath Clark Visiting Lecturer at the London School of Hygiene & Tropical Medicine in 2005, and an honorary professor at that institution from 2005 to 2007. He was also visiting professor at the Charité – Universitätsmedizin in Berlin, as well as at the Centre for International Health, University of Bergen, in Norway.

Sanders was an honorary professor in the department of paediatrics and child health, faculty of health sciences at the University of Cape Town (UCT), and professor in the school of medicine, faculty of health sciences, Flinders University, in South Australia. He was founder and co-chair of the global steering council of the PHM.

In 2012, he was awarded an honorary doctorate by UCT in recognition of his contribution to the development of policies and programmes in primary healthcare.

Dr Louis Reynolds of the PHM said that Sanders loved fishing, football, walking, children, music, good movies and books, parties, and being sociable. “Otherwise, he never seemed not to be at work, no matter where he was and what was going on around him. Even small children loved him instantly. He recognised immediately what made each one of them tick, and nurtured it in their games, the tricks they played, and their conversations with him.

“Few people who had meaningful encounters with David came out unchanged. They saw themselves, the world, and their place in it in a new light. They understood that they have power, and that they could use that power to change things, especially if they encouraged and mobilised others to join them.”