Edited Transcript of Zackie Achmat's Speech at the Opening of the People's Health Summit (Session chaired by Linda Mafu who is referred to a number of times in the speech) Peoples Health Summit 2 July 2004 Last year, our government promised us treatment. Today, fewer than 10000 people have been put on treatment by this government. We know that there are enormous difficulties to do it, we know that. But, there is no leadership from national government. Our national Dept of Health Comrade Nono Similela has left the department. The National Department doesn't have a TB director, the National Department does not have a deputy director for AIDS programmes, the National Department does not have a director general because Comrade Ayanda Ntsaluba couldn't work with our National Minister. Today, there is no national leadership from the National Department. Provinces are left on their own to run their antiretroviral program. And that is fine for provinces like the Western Cape. But it is extremely difficult for provinces like the Eastern Cape, Limpopo, Mpumalanga, and the other poorer provinces of the country. So, it's a tragedy, that no one of National Government is here. The premier of the province sends her apologies. She's at an ANC NEC. But she said she'll send Dr. Goqwana to be here the whole weekend. Regrettably he sees fit only to come on Sunday. We hope, that he will come with a message of hope, instead of fighting with us on Sunday. But if he's coming for a fight, he will get one. This Peoples' Health Summit has to give us some of the tools for people living with HIV/AIDS. Our health care workers, our families, our friends, our communities. Those tools are knowledge, unity, and leadership. Knowledge of our own health is critical as some of the comrades who've spoken before me have said. Understanding medicines, through treatment literacy. No one can be a TAC activist, if you're not a treatment literacy activist now. We also must have knowledge of our rights as citizens. But in order to make the antiretroviral program reach millions of people, we're going to need knowledge of our health care services. So knowledge is one of the weapons that we have to take away from this conference. The second one is unity. Unity between health care workers and people living with HIV and unity on the principle that everyone has the right to life and everyone has the right to health care access. If we can achieve that unity in our TAC branches, in the Eastern Cape Provincial Council of Churches and throughout the country,we will build an antiretroviral program. But unity is not enough; leadership is also required. Now we know that nationally, we cannot rely on this Health Care Minister for leadership. So where is that leadership going to come from? It has to come from us, from civil society. It has to come from the individuals here. But our leadership has to be built first and foremost on a pro-poor message. That we address the needs of the poorest first. And that is why we have tonight, people from Lusikisiki here. Because, in the Transkei, in the former homelands, it suffered most under apartheid. Like many of the other rural areas. We must not be scared to be pro-feminist, to be pro a woman's right to chose when to give birth or not to give birth. That is the type of leadership that we need to give. We must not be scared to be pro-human rights in the leadership we exercise. Health care and illness are a mirror that reflects poverty and inequality including poor working conditions, poor housing, lack of access to nutrition, lack of access to water sewage and other social security. All these contribute to why we have ill health in our country. The success of the antiretroviral rollout will only be achieved if we can build a peoples health movement that understands the history of our country and the history our struggle for freedom Our struggle for health is deeply rooted in our struggle to transform South Africa to eliminate inequality and injustice. South Africa was formed under colonialism and apartheid and from our struggle against it. Let us consider some of the old figures which we mustn't forget. In order to live decently, our workers need a decent income. Under apartheid, workers wages was based on colour. The average white person's annual income in 1979 was more than R7,600, an Indian worker R3,200, a coloured worker R2,400, and an African worker R1,180. A white nurse started work at R310 a month and an African nurse at R197 a month. How did our struggle for health begin? Comrades will remember from school, there was a missionary called Kemp. And he visited the old Transkei, and he said 'the country is remarkably healthy'.' And he pointed out that there was no TB and no syphilis. Although people died, sometimes of famine and of illnesses like malaria, mostly people were health with few abnormalities. What then happened in our country? In 1899 our gold mining industry had 12,000 white workers and 100,000 African workers. By 1970, that was 40,000 white workers and 400,000 African workers. Why am I boring you with those statistics? A very simple fact: that with migrant labour came illness. (And I want to add the voice of TAC nationally to the voice of TAC Lusikisiki, to say that that empty clinic of Anglo Gold, that stands empty only sees a few people a day, in Lusikisiki, should become a part of the public health service. Anglo Gold needs to repay our communities.) I have in front of me the record of a report written in 1946 which explains how diseases such as TB, rheumatoid arthritis and sexually transmitted infections spread on the mines and there were taken back to the rural areas. Women were particularly affected by men returning from the mines. The private sector, in particularly the mining industry, has a lot to answer for. (And we have to support the National Union of Mine Workers, to make sure that Anglo American, does not only treat their workers, but their partners too. We also have to ask why are workers dropping out of the antiretroviral program so fast, why is there only one mine worker who is prepared to reveal his status? ) In 1914 the first World War broke out. It started in Europe and spread across the world. And at the end the war, South Africa didn't have a National Health Department. But what came back with the soldiers was a flu epidemic, a viral infection that killed 20,000 white people and 130,000 African people. Out of that epidemic, we got the first National Public Health Department. By the time of the 2nd World War, millions of men were now working not only on the mines, but also in factories that made cars, shoes, clothes and all sorts of products. From 1942 to 1944 a national commission investigated the creation of a National Health Service in South Africa. So when we talk about a Peoples' Health Service, we must know that our struggle goes back many years. In 1944, the National Commission for a National Health Service reported that we must implement a plan where we have 400 publicly funded community health care centres across the country. And it shouldn't only be in the poor areas, it should be in the rich areas as well. And it shouldn't be hospital centred, it should promote health rather than only look after people where they are sick.' They promised 400 but only established 50, and only 5 worked. They demanded that there should be a single health authority. That all the provincial and local departments should be combined under a single