A lot is written about service delivery, corruption, racial aggressions, be they micro or macro, civil unrest et cetera. Though these reflections on current affairs are of great importance, it is equally important to advance ideas which may, at first glance, seem abstract and mind numbing. However, when one surfs through the noise and wipes the frost over many of these social ills, you will discover that many, if not all, have theoretical or rather ideological bearing. We can link many of these social phenomena to some abstract and, at first glance, mind numbing idea. To take time to think about these ideas is necessary, if we are to ever understand this world we exist in.

The target of my pen, in this piece, is the idea advanced by the Black First, Land First (BLF), and, in fact, many so called “Blackists” or “Fanonistas” in activist spaces and academia. Let me begin by defining these nicknames. For the purpose of this piece, a “Blackist” or “Fanonista”, and I will use them interchangeably, is someone who reads a lot of Fanon, yes, but more than that, someone who subscribes, boundlessly, to the essentials of Critical Race Theory. Critical Race Theory emerges in the early 1970s, popularised by an African American civil rights lawyer, Derrick Bell. This is not to say that people did not speak nor write about these ideas, however, as a scholarly movement, this is when it can be traced back to. The Oxford Research Encyclopaedia of Education defines it as a discipline which makes, “…race a significant… and central issue in… society. All aspects of society.” Steeped in Black Nationalist thought, it places race at the base of all social phenomena. Contrary to Marxist thinking, which argues that the economy is the base, which over determines politics, the arts, law, culture, religion, education et cetera, Critical Race Theorists believe that it is race which is at the base of all this, the most primary antagonism in society.

However, my pen is not necessarily interested in the grey haired debate between the Marxists and the “Fanonistas”. Rather, my pen is pointing to the philosophical tragedy that is the idea of “Black first”. This idea of “Black first”, though, at times, honourable in its intentions to build solidarity among the oppressed, makes very amateur philosophical bloomers.

The simple logic of this platitude is that one, before they are anything else in the world, is black.  A sentiment which is, at first glance, very attractive, particularly to black activists and revolutionaries. But if there is anything we have learned so far in this piece, is that we have a responsibility to look further and longer than just the first glance. What are the philosophical implications of this logic? What are the implications, even to how we think and theorise about our own struggle as the oppressed? In this piece my pen will go as far as possible, to the ends of the first question, the former. The latter, I will leave to another piece if my ink allows.

To greater understand the ends of the first question, we must look to French philosopher, playwright, novelist and social activist, Jean Paul Sartre. One of Sartre’s greatest interventions to Existentialist thought, which is the study of existence and the human subject, is the maxim that, “Existence precedes essence”. It is important that I break down this maxim before I make any more advances. “Essence” refers to the intrinsic nature or quality of something. Others will say, meaning of something. Ancient philosophy, and religious doctrine, advances this idea that there is a higher meaning and purpose to life. That all things and humans have a predefined meaning, purpose, and ideal set of characteristics. Religion obviously credits this task of predefining and moulding our destiny and purpose to God. To religion our essence, or meaning, is derived from God and his master plan for the universe.

“Existence”, on the other hand, refers to the objective fact or reality of living. To be pedantic, or rather overly precise about it, the objective fact that one has a body that is tangible, we can touch and feel, is, in very exact and basic terms of the word, testament to their existence. To drive this point, take for example a chair. It is an objective fact that the chair exists, we can touch, feel and see it. The essence of the chair can be described as the reasons and meaning behind its creation or manufacturing. The essence, or purpose of the chair is that it was made so people could sit on it. We can therefore differentiate between its essence, and its actual existence. The fact that it is there before us, as an object.

Now that we have made some philosophical inroads, particularly from a definition point of view, we can expose the philosophical tragedy that is; “Black first”. Analytically, the assertion that is made by the “Blackist” cohort is that in this world, in this “anti-black world”, we are, before anything else, black, hence “Black first”. What is rather interesting is that many of the “Fanonistas” will agree that the social category, black, is in fact a social contract. In other words to be black, is to be given a social meaning, or allocation of value. The Webster dictionary defines a social construct as a, “…construction of meaning, notion or connotation …placed on an object…”

What we learn here is that, racism placed a meaning to a particular group in society, as though it were defining an object. Just as the carpenter meditates on the meaning and purpose of the chair before he constructs it, so did racism when it allocated inferior value to a group in society, only for racism, unlike the carpenter, this is a retrospective process. In very simply terms, it is foolish to suggest that white people, before the existence of black people came together and planned the creation of black people, not only the essence but even the objective reality, their arms, legs, eyes, hair, size of their noses et cetera, as though they were a carpenter manufacturing a chair. The value and meaning of all these body parts follow their existence. Their existence comes before their essence. Unless you think of white people as God, if you are religious person.

If you are not, then to assert that one can be black first in the world, a socially constructed class, is to assert that values and meaning predate the existence of the individual. Which is nothing other than religious gossip. We exist first. We can say this with confidence because humans are not like objects created by man. Humans are rational beings, with a mind of their own, are conscious, and can think. To accept that our essence is determined before our fathers’ semen meets our mothers’ seed, is to liken us to mere objects, created by man. A screw driver, for example, is made by humans for a particular set of reasons. In other words the nature or should I say “essence” of a screw driver exists first in the mind of the maker before it exists in the natural world. In this sense the essence of the screw driver precedes its existence. Black is a social construction, a very powerful social construction that has had dire consequences on generations upon generations, undisputed, but it still remains a social construction. One that can be replaced by another, and its replacement may dramatically change social interactions and views, but it will not deform the human body or change the objective fact that is the human body. To accept this fate at the genesis of our very existence, in fact before, is to liken us to a mere screw driver, which derives value from the maker, in our case the white man.

We are black, but we are not black first. We exist first. And then we resist.

Che Guevara asserts that “Some day medicine will have to convert itself into a science that serves to prevent disease and persuades the public towards carrying out its medical duties. Medicine should only intervene in cases of extreme urgency, to perform surgery or something else which lies outside the skills of the people of the new society we are creating”.

The only sustainable remedy to an ailing public health system like ours lies in reorganizing the primary health care pillars. Despite the unfortunate two tier health system consequence of our history, there has been inadequate effort to consolidate on what constitutes a primary health care organisation premised on prevention. 

The National Health Insurance (NHI) alone, although a revolutionary socialist policy proposition is also incapable of resolving our failing public health system. It is also important to reflect on the delay in the passing of the National Health Insurance bill which is a consequence of disagreements on the role of private in particular medical aid schemes as demonstrated by a letter from Ishmail Momoniat to Dr O Shisana the advisory to the presidency on the NHI, in the letter he argues that “making the role of medical schemes complementary , which is in our view premature and will be perceived as a threat to the private sector and current medical aid users and taxpayers and will expose the bill to legal challenges”. This obviously was an argument hell-bent at retaining the status quo which seeks continued commodification of health and protecting business interest at the expense of the general population.

To give context and flesh to the statement that National Health Insurance is but not the ultimate solution, there is a need to highlight the success of National Health Insurance and its inadequacy to address challenges of the health care systems with focus on countries that have implemented it.

It is known that Botswana, Rwanda, Burkina Faso, & Ghana are some of the countries with Universal Health Care coverage yet have low performance outcomes. The similarities to draw from this countries is the poor socio-economic status of the general population. It is also important to note that the most unequal societies in the world have the worst health care systems even in the presence of NHI. The most equal societies have the best health care outcomes and thus the best health care systems. Therefore there exists a relationship between health status of a population and their socio-economic status. This is evident in the pattern of diseases in South Africa, which generally reflects a high prevalence of diseases related to low or poor socio-economic status.

The disease that mostly affect South Africa in particular are HIV/AIDS, Infectious diseases, Malnutrition, Mental illness and Injury/trauma. All of which have a relationship with poverty with exception to injury/trauma. Research by The mental health and poverty project at the department of psychiatry and mental health at the University of Cape Town (UCT), including various research work, confirms the relationship between poverty and mental illness in particular depression. They found that the link between mental health and poverty is a strong one. The relationship between HIV/AIDS, Infectious diseases, malnutrition and poor socio-economic status is well documented.

According to UNAIDS the leading global effort to end AIDS a public health threat by 2030 as part of sustainable development goals. In 2016 alone, SA had 270 000(240 000 – 290 000) new infections, 110 000 (88 000 -140 000) AIDS related deaths and 12000 newly infected children. It is important to note that not much is said about the number of untested and yet possibly positive individuals.

Important to note is that most, if not, all are preventable conditions.

The mantra that says the problem of the health system reflects the problems of our larger society and cannot be separated from those problems is vindicated by the nature of the problems of the South African health system.

The result ultimately is an increased number of the population in need of curative care. Curative care, although important, is unsustainable and should not be the focus in developing a health system capable of responding efficiently and effectively. Curative care has little effect on the growing burden of the ailing public health system.

Undoubtedly the problems of the health systems can only be resolved by a robust preventative orientated health approach. In 1970-1974 Cuba entered polyclinic phase; these are community based clinics that house primary health care specialists. They exist in every Cuban community and are well acquainted with people and social determinate that affect their health which makes it easy for them to better serve their patients health needs. Gastroenteritis, another a common killer of the third world infants was sharply decreased during this phase from 4158 deaths in 1962 to 761 in 1975.

The Cuban system went as far as the personalised community based approach which meant allocating a reasonable population of the community to a multidisciplinary team of health care providers. This team will visit each and every family for screening, education and general check-ups at least every 3 months. It is important reflect on Cuba precisely because like South Africa, it is a developing country with a relatively lower GDP to South Africa. However, Cuba competes with developed countries as it relates to the health care outcomes, it is ranked 39 of 191 countries in terms of health care performance.

Consistent with some of the resolutions by the first National People’s Assembly on EFF’s national health policy, the remedy to South Africa’s public health problems is the strengthening of the preventative care. What constitutes preventative health care should be robust consistent public education particularly to affected areas, screening of the general population and evaluation of patients on treatment. Education should take the form of home visit education by an informed team of health professionals, the use of billboards and media to raise awareness not periodically but consistently to ensure health education becomes a lifestyle. Screening of the population through home based visits to ensure that risk groups are identified timely and given appropriate attention, house permanent screening and prevention centres in malls and taxi ranks and other busy areas. Ensure those already on treatment to take it correctly and for improvements and unattended health concerns.

This should be done by a well responsive local health machinery with proper understanding of the epidemiology of the region. Well-resourced and capacitated 24hour clinics to compliment the rigorous community based/household approach.