The Plagues of Transition

It seems hardly worth noting that dictatorship and war are harmful to health. Over 20 million died of starvation in Mao’s Great Leap Forward; untold millions died under Lenin, Stalin and Hitler; Pol Pot murdered two million Cambodians. Accurate body counts from the cruel regimes presiding over Burma, Afghanistan and the Congo remain unavailable but are certainly huge.

During the past decade or so, greater peace and the fragile beginnings of democracy came to such troubled nations as South Africa, Mozambique, Russia and other countries of the former Soviet Union. Millions gained essential human and civil rights, including the right to criticize their leaders. For many, the main struggle nowadays is finding a decent job and building a decent life.

You’d think health might be improving in the places that recently became more democratic. But all is not well in such countries. In many, political and economic transition brought new plagues every bit as horrible as those associated with repression and war.

During the 1980s, both Mozambique and South Africa, for example, were largely spared the HIV epidemic then devastating East and Central Africa. Mozambique was at war: villages were isolated, and migrant workers, who would eventually bring the virus into the country, were few. South Africa, too, had few cases before 1990, largely because apartheid’s influx controls, limited migration from countries where HIV was prevalent.