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Many Pygmy societies of Central Africa, as well as the San in Southern Africa, suffer more than other people in their countries from health problems. A recent article in the prestigious medical journal The Lancet describes the health challenges of the two indigenous African cultures.

Defining “indigenous” in the context of Africa is often a charged issue. The authors of this article admit that all Africans are obviously indigenous when compared to Europeans who live in Africa, but the term needs to be used in the context of power structures and inequalities as they exist now. Quoting from another source, they define African indigenous societies as peoples who “have specific attachment to their land and territory; they have specific cultures and mode[s] of production that are distinct from the groups that dominate political, economic and social power” (p.1938).

The point is that the Mbuti and the other Pygmies of central Africa, plus the Ju/’hoansi, G/wi and other San peoples of Southern Africa, are all marginalized in the states in which they live. They often suffer from human rights violations, and frequently they are denied economic and social justice. These peoples have sought to strengthen their positions through alignments with international indigenous rights movements. The issues that define them as “indigenous” are really, in the words of the article, “self-definition, cultural difference, and marginalization” (p.1938).

The authors write that there are over 14.2 million indigenous people in Africa. They face daily, overt discrimination. Access to health care is often denied because of the derogatory attitudes of some medical workers toward them. Information about their health issues is hard to obtain because official data is often biased against them.

While the word “Pygmy” is generally a negative term, the authors indicate that the various forest-dwelling hunter-gatherer societies (or former hunter-gathers) use the term to distinguish themselves from the agricultural, Bantu peoples, some of whom are also forest-dwelling but who hold positions of power in local areas. The article discusses numerous problems—and statistics when they are available—relating to the health of the Mbuti and the other Pygmies.

Some of the Pygmies suffer high rates of infant mortality, and the Mbuti in particular are afflicted with a lot of intestinal parasites. Several societies, including the Mbuti, have symptoms of yaws—20 to 90 percent of their children have latent infections from the disease.

Interestingly, however, in an area of the DR Congo which is affected by a dangerous hemorrhagic fever called the Marburg virus, the Mbuti seem to be seronegative for the infection, even though they are more frequently exposed to wild animals—the potential disease vectors—from their forest hunting activities than the other local people. The reasons are not clear.

The Pygmy communities that have moved permanently outside the forest are increasingly susceptible to infections caused by hazards that are rampant in non-forest environments. One example would be the chiggers that infest clearings, which can cause crippling infections in Central Africa. Outside their forests, the Pygmies are also susceptible to HIV/AIDS, parasites, infectious diseases, and poor nutrition. They may also become infected with respiratory illnesses and malaria.

The authors point out that major social changes can be brought about by moving permanently out of the forests. Long-term cultural patterns, such as traditional singing ceremonies that help minimize tensions and resolve conflicts, may be abandoned. These changes may lead to alcoholism and domestic violence.

In contrast, Pygmies who are able to continue living at least part of their lives in their forests “have better health in several respects than nearby farming groups” (p.1941). In their forests they can maintain strong senses of wellbeing, personal ease, mental wellness, and spiritual health. The authors recommend that Central African governments should promote the rights of the Pygmy peoples to not only continue to live in their traditional forests if they wish, but to also have equitable access to health care along with everyone else in their countries.

The article is equally hard-hitting in discussing the health of the San people of Southern Africa. While it does not mention the G/wi or the Ju/’hoansi by name in the text, it does cover the enforced removal by the Botswana government of the G/wi from their traditional lands in the Central Kalahari Game Reserve. Relegating the San peoples to the bottom level of society, the Botswana government “provides a stark example both of prejudice and the exercise of majority power, and of the consequences to the social structure and health of the dispossessed” (p.1944).

The authors discuss the rapid spread of HIV/AIDS among the San, though unfortunately they don’t mention the reports in March 2005 and August 2006 of Richard B. Lee’s research. Lee has concluded that traditional Ju/’hoansi gender equality helps the women of that society stave off the disease since they can insist on protection when they have sex with men. This article in The Lancet only attributes the lower HIV rate for the San living in one town to the remoteness of the community.

The article does draw on the research of Renée Sylvain, who has analyzed the landless San of the Omaheke region of Namibia. Alcoholism, a growing problem in that area, has led to an increase in gender violence, especially among younger people.

The authors cite a well-know quote by Botswana President Festus Mogae about the San groups: “How can you have a stone-age creature continuing to exist in the time of computers? If the Bushmen want to survive, they must change, otherwise, like the dodo they will perish.” The hostility of his government toward the San societies has been covered by several news stories in this website.

These two case studies—the Central African Pygmies and the Southern African San—show, according to the authors, that indigenous societies need to be “recognized and empowered to negotiate on equal terms with majority populations” (p.1944). The article presents effective arguments for better treatment of indigenous peoples, including the peaceful societies, in many nation-states around the world.

Ohenjo, Myang’ori, et al. 2006. “Health of Indigenous People in Africa.” The Lancet 367 (June 10): 1937-1946