Thabo Mbeki
Office of the President
Republic of South Africa
Union Buildings
West Wing
Government Avenue
Pretoria, South Africa
Phone: (012) 319 1500
Fax: (012) 323 8246
E-mail: president@po.gov.za

6 August 2001

Dear Manto:

Some time ago, I came across WHO (World Health Organization) statistics tabulating the numbers and causes of death in South Africa. They are the latest available on the particular web page on which they appear. For all the countries they range between the years 1994 and 1998. Please find enclosed the full text as published by the WHO.

We decided to do some primitive analytical work on these figures, essentially aiming to rank the biggest causes of death in descending order. What follows below is the result of this work.

As you will see, this lists 29 causes of death. The WHO list is substantially longer. But again, as you will see from the table, the causes included accounted for the overwhelming majority of deaths in the country. This amounts to 97.89% of all deaths.

I believe that these figures present us with the challenge to answer a number of social and medical questions. Of course, I assume that they represent a more or less accurate picture of the causes of death in our country. If this is the case, some of the questions we have to answer are:

* What social policies have we put in place to reduce the incidence of death, bearing in mind the importance of the causes of death by rank?

* Do our health policies and therefore the allocation of resources reflect the incidence of death as reflected by these figures? and,

* Are the programs of the state medical research institutes geared to respond to the profile of the incidence of death as reflected by these statistics?

You might want to circulate this letter to all ministers and deputy ministers who serve in the social cluster so that we can get a cluster response as soon as possible.

There is no need for me to emphasize the point that, necessarily, the government has to respond to the objective reality of the health profile of our country and not what we or other people wish it to be or mistakenly assume it to be. It may be, of course, that the issue is more complex than I am stating it.

Needless to say, these figures will provoke a howl of displeasure and a concerted propaganda campaign among those who have convinced themselves that HIV/AIDS is the single biggest cause of death in our country.

These are the people whose prejudices led them to discover the false reality, among other things, that we are running out of space in our cemeteries as a result of unprecedented deaths caused by HIV/AIDS. In this context, I must also make a point that we have to act without delay on the proposal made by the Presidential AIDS Panel that, among other things, an investigation be made of the HIV and AIDS statistics that are regularly peddled as a true representation of what is happening in our country.

Nevertheless, whatever the intensity of the hostile propaganda that might be provoked by the WHO statistics, we cannot allow that government policy and programs should be informed by misperceptions, however widespread and well established they may seem to be. The statistical table resulting from our analysis follows immediately below.

I trust that it will be possible for the social cluster to respond to the questions we have posed, and others that may be relevant, without undue delay.

Yours sincerely,

Thabo Mbeki